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Clinical Practice Guideline: Surgical Sequencing and Management of Hip-Spine and Knee-Spine Syndromes

Editorial | Volume 11 | Issue 1 | JCORTH Jan-Jun 2026 | Page 1-4 | Arvind J. Vatkar [1], Sachin Kale [2], Sumedha Shinde [3], Ashok Shyam [4]. DOI: https://doi.org/10.13107/jcorth.2026.v11.i01.820
Authors: Arvind J. Vatkar [1], Sachin Kale [2], Sumedha Shinde [3], Ashok Shyam [4]
[1] Department of Orthopaedics, MGM Medical College, Navi Mumbai, Maharashtra, India.
[2] Department of Orthopaedics, Dr. D.Y. Patil School of Medicine, Navi Mumbai, Maharashtra, India.
[3] Department of Immuno Haematology and Blood Transfusion, Dr. D.Y. Patil School of Medicine, Navi Mumbai, Maharashtra, India.
[4] Department of Orthopaedics, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, Maharashtra, India.
Address of Correspondence:
Dr. Sachin Kale, Department of Orthopaedics, Dr. D.Y. Patil School of Medicine, Navi Mumbai, Maharashtra, India. E-mail: sachinkale@gmail.com
Article Received : 2026-04-04,
Article Accepted : 2026-04-15

Abstract

Abstract: Hip-spine and knee-spine syndromes are complex, multisegmental degenerative conditions where spinal, pelvic, hip, and knee pathologies interact biomechanically. Effective management requires a holistic approach, not isolated joint treatment. Key compensatory changes, including loss of lumbar lordosis, sagittal imbalance, and lower-limb contractures (pelvic retroversion, hip extension, knee flexion), impact posture, pain, and function. Spinopelvic parameters, like pelvic incidence, are crucial for alignment, surgical planning, and outcomes in total joint arthroplasty. Clinical assessment must distinguish true joint pathology from referred spinal pain to prevent misdiagnosis and inappropriate surgical sequencing. Current evidence favors a global, alignment-focused strategy, involving careful preoperative imaging, recognition of deformities, and multidisciplinary planning to optimize the timing of arthroplasty and spine surgery. Restoring lower-limb mechanics often relieves low back pain and improves overall balance, mobility, and quality of life.

Keywords: Hip-spine syndrome, Knee-spine syndrome, Spinopelvic alignment, Surgical sequencing, Arthroplasty-first approach

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© 2026 Journal of Clinical Orthopaedics
How to Cite This Article: Vatkar AJ, Kale S, Shinde S, Shyam A. Clinical Practice Guideline: Surgical Sequencing and Management of Hip-Spine and Knee-Spine Syndromes. Journal of Clinical Orthopaedics 2026 May, 11(05): 1-4.