This narrative review by Devin et al. addresses the diagnostic and management challenge of hip-spine syndrome — the coexistence of hip osteoarthritis and degenerative lumbar spinal stenosis — and provides a systematic framework for identifying the predominant pain generator and sequencing surgical treatment.
When an older patient has both hip and back/leg pain, use the systematic hip-spine syndrome framework: groin pain and limited internal rotation point to hip as the primary generator; neurogenic claudication relieved by forward flexion points to spine.
Use selective fluoroscopic injections to confirm before committing to surgery — and if both are present, sequence matters: correct hip flexion contracture before lumbar fusion, and decompress severe stenosis before THA.
This narrative review by Devin et al. addresses the diagnostic and management challenge of hip-spine syndrome — the coexistence of hip osteoarthritis and degenerative lumbar spinal stenosis — and provides a systematic framework for identifying the predominant pain generator and sequencing surgical treatment.
When an older patient has both hip and back/leg pain, use the systematic hip-spine syndrome framework: groin pain and limited internal rotation point to hip as the primary generator; neurogenic claudication relieved by forward flexion points to spine.
Use selective fluoroscopic injections to confirm before committing to surgery — and if both are present, sequence matters: correct hip flexion contracture before lumbar fusion, and decompress severe stenosis before THA.