We present the case of an 80-year-old Malaysian gentleman who sustained a displaced intracapsular neck of femur (NOF) fracture and underwent a modified SPAIRE (Sparing Piriformis and Internus, Repair Externus) approach for total hip replacement (THR). The standard approach used in our hospital for THR in NOF fractures is the modified Hardinge approach to the hip. We used this modified SPAIRE approach as this patient lives in a 'Mahjong' center and always sits cross-legged on the floor. Therefore, he is at increased risk of an anterior dislocation. This approach is a modification of the standard SPAIRE approach popularized by the Exeter Hip Unit, United Kingdom. In this report, we describe the modification of the SPAIRE approach that has not been described before and the outcome for this patient.