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Thirty-five patients were reviewed with what is called hip-spine syndrome. Concurrent disease at both the hip and spine is not infrequent in the older population. In most cases, the finding and diagnosis were straight forward, and were classified as a simple hip-spine syndrome. Cases in which the spine symptoms are aggravated by deformity of the hip were called a secondary hip-spine syndrome. Symptomatic disease at both the hip and spine can present as a complex hip-spine syndrome. Symptoms from both sites gives a confusing clinical picture and may require ancillary investigations to diagnose the major source of disability. Failure to recognize concurrent disease at both the hip and spine may lead to misdiagnosis and possibly erroneous treatment.