Workup of Patient with Hip Spine Syndrome: The Impact of Pathological Spinopelvic Mobility

The term hip spine syndrome (HSS) was first described by Offierski and Macnab in 1983. The authors noted that the incidence of degenerative changes of the hip and spine increases with age and frequently occurs concurrently [1]. They differentiated between a “simple,” “complex,” and “secondary” HSS [1]. The term simple HSS was used for symptoms being attributable either to hip or lumbar spine pathology. The term “complex HSS” was used for symptoms being potentially attributable to both—the hip and lumbar spine pathology, but after further diagnostics the complaints were attributable to either hip or spine. The term “secondary HSS” was used for symptoms where the pathology of the hip and lumbar spine was inter-related. For example, fixed flexion deformity of the hip due to osteoarthritis (OA) may affect the pelvis, which tilts forward, leading to a compensatory hyperlordosis of the lumbar spine. This may lead to increased OA of the facet joints of the lumber spine causing low back pain, nerve root entrapment, or lumbar spinal stenosis [1]. Vice versa, lumbar spine pathology like scoliosis may affect pelvic tilt and obliquity, potentially leading to accelerated degeneration of a mildly dysplastic hip [1]. In 2007, Ben-Galim et al. aimed to test Offierski’s and Macnab’s hypothesis of the HSS. They reported in a clinical, prospective study that lower back pain and lumbar spine function had improved 2 years after total hip arthroplasty (THA) in 25 patients, which was confirmed by further studies later on [2, 3]. Therefore, they concluded that the HSS is a valid clinical entity, and in patients with hip OA and lumbar back pain without severe spinal deformity or neurologic deficit, the hip should be treated first [3].