Hip-spine syndrome in adult spinal deformity patients

With the increasing prevalence of hip-spine syndrome, it is crucial to appreciate the biomechanical interplay between hip and spine degeneration or deformity and the consequential compensatory changes. Adult spinal deformity (ASD) patients are uniquely affected as a concomitant hip osteoarthritis (HOA) may impact their baseline and postoperative sagittal alignment. Similarly, severe HOA patients undergoing total hip replacement with concomitant spinal deformity may require personalized surgical planning for the placement of their acetabular component. If surgical intervention is required in ASD patients, the authors’ preferred sequence is to perform spinal realignment first. If major realignment is not planned, we recommend treating the most symptomatic pathology. Further investigation is required to evaluate the impact of hip pathology on radiographic and patient-reported outcomes following ASD surgery and vice versa.