What is hip–spine syndrome?

Hip–spine syndrome was first described in 1983 as degenerative disease of both the hip and the lumbar spine in the same person. Doctors describe four patterns:

Simple: one area is clearly the main pain source
Complex: both areas contribute
Secondary: each problem worsens the other
Misdiagnosed: the wrong area was treated

How common is it?

It is common. About one-third of patients over 50 having spine surgery also have hip arthritis changes. In a 2024 study led by Dr. Diebo of 520 adults having deformity surgery, 34% had severe arthritis in both hips.

Is my pain coming from my hip or my back?

Some clues point one way or the other, but they overlap:

More likely hip	More likely spine
Deep groin pain	Burning or shooting pain down the leg
Pain or stiffness putting on socks and shoes	Pain eased by sitting or leaning forward
Pain with hip rotation on exam	Numbness or tingling in a nerve pattern
Clicking or catching	Positive straight-leg-raise test

When the answer is unclear, an image-guided numbing injection into the hip or near a spinal nerve can show which area is driving the pain.

How do the hip and spine affect each other?

The pelvis links the spine and the hips. When the lower back loses its curve, people tilt the pelvis backward to stand upright, and that requires the hips to extend. Stiff, arthritic hips limit that movement. In 2019, Dr. Diebo's team proposed an X-ray classification that sorts patients into three types based on spinal alignment and hip arthritis grade: "Hip," "Spine," and "Hip–Spine." Pelvic tilt helps tell the types apart.

Which surgery comes first, hip or spine?

There is no single rule. The order is debated. A 2026 review of more than 160,000 patients found no overall difference in complications between doing the hip or the spine first. However, a prior spinal fusion, especially a long one or one extending to the pelvis, raises the risk of hip replacement dislocation. One review found that risk to be about 2.5 times higher, highest in the first three months. In one study, dislocation occurred in 7.8% of patients with lumbar fusion to the pelvis, compared with 2.2% of those without spinal fusion. One study found that only about 7% of patients who had the hip replaced first later needed spine surgery. Because of this, many surgeons favor replacing the hip first when the hip is the main pain source.

Hip surgeons can lower dislocation risk with certain approaches and implants, such as dual-mobility cups. The best plan comes from hip and spine surgeons reviewing your full-length standing X-rays together.

What results should I expect?

In Dr. Diebo's 2024 study, patients with both severe hip arthritis and spinal deformity started with worse function. They still had lower scores one year after spine surgery, even with good spinal correction. Treating both problems may be needed for the best result.

When to see a specialist. If hip and back pain overlap, or a hip or spine operation didn't relieve your pain, request an appointment.

Sources

Diebo, Bassel G., et al. "Radiographic Categorization of the Hip-Spine Syndrome in the Setting of Hip Osteoarthritis and Sagittal Spinal Malalignment." Journal of the American Academy of Orthopaedic Surgeons, vol. 27, no. 17, 2019, pp. e785–e793. PMID 31442211.
Diebo, Bassel G., et al. "Hip Osteoarthritis in Patients Undergoing Surgery for Severe Adult Spinal Deformity: Prevalence and Impact on Spine Surgery Outcomes." Journal of Bone and Joint Surgery (Am), 2024. PMID 38958659.
Soler, F., et al. "Impact of Prior Spinal Fusion Surgery on Complications and Functional Outcomes Following Total Hip Arthroplasty." European Spine Journal, 2024. †
Yang, D. S., et al. "Risk of Dislocation and Revision Following Primary Total Hip Arthroplasty in Patients With Prior Lumbar Fusion With Spinopelvic Fixation." Journal of Arthroplasty, 2023. †

← All patient guides