Background and purpose: Hip-spine syndrome refers to the coexistence of hip and spinal pathologies, complicating diagnosis and surgical decision-making. This study investigated how German hip and spine surgeons prioritize surgical sequence in hip-spine syndrome and compared these patterns with those previously reported among U.S. surgeons.
Methods: A cross-sectional survey containing five standardized case scenarios of concurrent hip osteoarthritis and typical degenerative spinal disorders was distributed to members of the German Society for Joint Replacement and the German Spine Society. Respondents included orthopaedic hip surgeons, orthopaedic spine surgeons (OSS), and neurosurgical spine surgeons (NSS). Quantitative data were analyzed using descriptive statistics and chi-square tests, and qualitative comments were examined using text-mining and thematic synthesis. Findings were compared on a point-by-point basis with the published results of the original U.S. study.
Results: In general, German surgeons recommended spine-first treatment when neurological deficits such as myelopathy or neurogenic claudication were present, and hip-first treatment in cases without neurological deficits. Preferences differed significantly among specialties, especially between NSS and OSS. Compared with U.S. respondents, German surgeons were more likely to prioritize spine-first procedures in scenarios involving neurogenic claudication. Decision-making was primarily driven by symptom severity, spine-pelvis-hip biomechanics, and perceived procedural risk, rather than by surgeons’ years of experience.
Conclusion: The preferred order of surgery for patients with hip-spine syndrome varies with neurological status, surgeon specialty, and geographic context. These results underscore the importance of interdisciplinary communication and individualized, patient-centered strategies when formal treatment guidelines are lacking.
Trial registration: Not applicable.
Supplementary Information: The online version contains supplementary material available at 10.1186/s12891-026-09533-2.
Keywords: Decision-making; Hip osteoarthritis; Hip-spine syndrome; Spine disease; Surgical sequence; Treatment strategies.