Summary Differentiating Hip Pathology From Lumbar Spine Pathology is a common acquired condition caused by overlapping symptoms between the hip and lumbar spine that may mimic one another that leads to substantial disability and potential misdiagnosis. The condition typically presents in adults and the elderly and presents with low back pain (LBP) associated with buttock, groin, thigh, and knee pain. Diagnosis is made with a combination of clinical history, thorough physical examination including provocative tests, plain radiographs, and often advanced imaging or diagnostic injections to delineate the primary pathology. Treatment is usually nonoperative initial management involving physical therapy or diagnostic/therapeutic injections. Operative treatment (such as total hip arthroplasty or spinal decompression/realignment) is indicated when the primary source of pain is identified and conservative measures fail, or when severe lumbar stenosis is present alongside hip pathology. Epidemiology Incidence incidence prevalence US new cases Demographics age sex Location body location physiologic location Risk factors basic advanced Etiology Pathophysiology mechanism of injury (trauma) basic advanced pathoanatomy this is the molecular or cell biology of disease cell biology this is the anatomic cascade of disease microbiology list of causative organisms. Genetics inheritance pattern autosomal dominant, autosomal recessive, X-linked etc. mutations chromosome gene protein encoded for Associated conditions medical condition A orthopaedic condition A Anatomy Osteology describe anatomic bone Arthrology articulation Muscles muscle action insertion origin Tendons tendon name origin insertion function Ligaments ligament attachments Blood Supply basic advanced Nervous System and Nerves basic advanced Biomechanics basic advanced Classification Basic Commonly Used Classification System Type I Description Type II Description Type III Description Advanced Classification System Advanced Type I Description I d Type II Description II d Type III Description III d Presentation History basic advanced Symptoms common symptoms location duration severity aggravating / alleviating factors rare symptoms Physical exam inspection deformity swelling palpation range motion flexion extension rotation vascular neuro instability provocative tests Imaging Radiographs recommended views xrays that should alwasy be obtained on evaluation optional views secondary views that might give additional information findings normal anatomy basic abnormal findings advanced abnormal findings measurements basic measurements (tibial clear space) advanced measurements (pelvic incidence) criteria dictating treatment basic criteria advanced criteria sensitivity & specificity CT indications advanced views a findings basic findings advanced findings sensitivity and specificity MRI indications a views a findings basic findings advanced findings sensitivity and specificity Ultrasound indications preferred views finding basic findings advanced findings sensitivity/specific Bone scan indications when do you order sensitivity and specificity Studies Labs serum urine surface (nasal swab, sputum) Invasive studies Histology gross anatomy histology low power high power immunostaining Electrophysiologic studies basic findings advanced findings Differential Differential A key findings that differentiate topic from differential A found with topic key finding A found with differential A key finding A Differential B key findings that differentiate topic from differential B found with topic key finding A found with differential key finding A key finding C Diagnosis Made Treatment Nonoperative observation +/- physical therapy indications techniques outcomes Operative operative treatment of hip pathology alone indications antibiotics techniques operative treatment of spine pathology alone indications timing techniques outcomes operative treatment of hip and spine pathology indications timing techniques outcomes Techniques Hip Arthroscopy indication approach basic technique advanced technique Hip Arthroplasty indications approach technique techniques - advanced basic complications advanced complications Lumbar Decompression Alone indications approach techniques complications Lumbar Fusion indications approaches techniques complications Lumbosacral Fusion indications approach technique complications Thoracolumbar Fusions indication approach techniques complications Complications Hip Arthroplasty Dislocation incidence risk factors diagnosis treatment Prognosis Natural history of disease / Prognosis without treatment Prognostic variable favorable negative Survival with treatment