The aim of the study was to develop an algorithm for choosing a rational tactics for surgical treatment of patients with coxo-vertebral syndrome. Material and methods. The study included 175 patients with coxo-vertebral syndrome who underwent total hip arthroplasty from 2009 to 2016. The results of surgical treatment were studied at an average time of 9 months. (from 8 to 10 months) after surgery in 134 patients. Their average age was 54.4 ± 12.7 years. The patients were divided into the main group (74 patients) and the comparison group (60 patients). In the comparison group, standard approaches to hip arthroplasty were used, implying restoration of the anatomical center of rotation and the length of the lower limb. The study group used the developed algorithm for choosing the optimal surgical tactics. Clinical and functional data were assessed using the Harris and Oswestry scales. Radiographic assessment was performed on radiographs of the spine-pelvic complex in a standing position, functional radiographs, CT and MRI. The significance of differences in the groups was assessed using the Mann-Whitney U-test and the McNemar test. Results. The use of the developed surgical approaches made it possible to increase the proportion of patients with good clinical and functional results (the main group - 82.4%, the comparison group - 26.7%) and to achieve higher indicators of the functioning of the hip joint and the quality of life of patients in the postoperative period. Excellent results on the Harris scale in the main group were obtained in 53.2% of patients, in the comparison group - in 9.7%. The proportion of patients with complaints of pain in the lumbar region, lameness and the need to use a cane, preserved after hip arthroplasty, was lower in the study group than in the comparison group.