The Hip-Spine Challenge

• Published in: Journal of bone and joint surgery. American volume 2021-10, Vol.103 (19), p.1852-1860
• Main Authors: Chavarria, Joseph C., Douleh, Diana G., York, Philip J.
• Format: Article
• Language: English
• Subjects: Acetabulum - diagnostic imaging; Acetabulum - physiopathology; Acetabulum - surgery; Hip Joint - diagnostic imaging; Hip Joint - physiopathology; Hip Joint - surgery; Humans; Joint Diseases - complications; Joint Diseases - diagnosis; Joint Diseases - physiopathology; Joint Diseases - therapy; Pelvic Bones - diagnostic imaging; Pelvic Bones - physiopathology; Pelvic Bones - surgery; Range of Motion, Articular; Spinal Diseases - complications; Spinal Diseases - diagnosis; Spinal Diseases - physiopathology; Spinal Diseases - therapy
• ISSN: 0021-9355; 1535-1386
• DOI: 10.2106/JBJS.20.01728

The proper diagnosis and treatment of patients with concurrent hip and spine pathological processes can be challenging because of the substantial overlap in symptomatology. There is no consensus on which pathological condition should be addressed first. Factors such as advanced spinal degeneration, deformity, and prior fusion alter the biomechanics of the spinopelvic unit. Attention should be paid to recognizing these issues during the work-up for a total hip arthroplasty as they can result in an increased risk of dislocation. In patients with concurrent spine and hip degeneration, the surgeon must pay close attention to appropriate implant positioning and have consideration for implants with enhanced stability to minimize the risk of dislocation. A proper understanding of sagittal balance and restoration of this balance is integral to improving patient outcomes following spinal surgery. The advent of new imaging modalities, increased awareness of spinopelvic mobility, as well as a better understanding of sagittal alignment will hopefully improve our treatment of patients with hip-spine syndrome.