The evaluation and treatment of back or hip pain is challenging due to the multifactorial interplay between several etiologies that culminate in the symptoms experienced by affected patients. Hip-Spine Syndrome (HSS) encompasses this interplay and is characterized by overlapping pathologies of the hip joint and lumbar spine that result in complex, interrelated pain presentations and compensatory biomechanics.1

HSS was first described by Offierski and MacNab (1983) as a “mechanical interaction between the hip and spine” and interest in this topic has grown substantially, particularly over the past 5 years.2 HSS affects a wide age group, ranging from athletic to aging populations, and misdiagnosis can lead to suboptimal outcomes after hip arthroscopy or lumbar interventions that only address one component of the syndrome.3

A comprehensive review of HSS was previously published in SpineLine in 2021, highlighting the diagnostic pitfalls, broad differential diagnosis, and importance of a structured clinical evaluation to avoid misdiagnosis and unnecessary intervention. That work remains highly relevant for spine providers, particularly given the frequency with which patients with overlapping hip and lumbar pathology present to spine-focused practices.

Since that publication, however, there has been rapid growth in the literature clarifying spinopelvic biomechanics, radiographic parameters, diagnostic injection utility, and surgical sequencing considerations across hip and spine disciplines. A recent bibliometric analysis identified total hip arthroplasty, spinopelvic biomechanics, and disease classification as the dominant emerging research themes, while also highlighting the absence of universally accepted diagnostic and treatment standards.4 The present review is intended as a concise update that synthesizes these more recent advances, with particular emphasis on spinopelvic alignment, functional biomechanics, and interdisciplinary management strategies that are directly applicable to spine providers.