With Proper Surgical Indications, Sex-Based Differences in Pathology Do Not Impact Hip Arthroscopy Outcomes or Complications: A Systematic Review.

Abstract

Purpose: To identify sex-based differences in pathology, outcomes, and complications after hip arthroscopy for femoroacetabular impingement (FAI), and to compare patient-reported outcomes (PRO) scores between male and female patients.

Methods: The PubMed and MEDLINE databases were searched in September 2024, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Included studies had data stratified by sex, minimum 2-year PRO scores for hip arthroscopy in the setting of FAI and labral pathology, and a 2014 or later publication date. Patient demographic information, preoperative radiographic measurements, and surgical procedure information was also recorded. PROs were recorded when discussed. Information on the minimum clinically important difference, patient acceptable symptomatic state, and substantial clinical benefit was recorded when available.

Results: In total, 21 studies were included in the systematic review. The systematic review found that there are sex-based differences in preoperative characteristics, such as male patients having a significantly greater incidence of acetabular injury, larger alpha angle, complex labral tearing, and greater grade LT villar classification, leading to differences in surgical indication, and female patients being indicated for capsular repair or plication at a greater frequency. There was a significant heterogeneity between male and female patients for preoperative modified Harris Hip Score (mHHS) (male: 55.7-83; female: 49-64.45; I² = 0.78), Non-Arthritic Hip Score (NAHS) (male: 62.54-78.1; female: 47.2-66; I² = 0.77), Hip Outcome Score-Sport-Specific Subscale (HOS-SSS) (male: 46.72-52.3; female: 22.8-45.7; I² = 0.96), as well as postoperative HOS-SSS (male: 72.2-91; female: 62.6-82.4; I² = 0.66). Despite these differences, both male and female patients experienced similar magnitudes of improvement for mHHS (male: 13-20.14; female: 20.6-30.2; I² = 0.00), NAHS (male: 18-19.93; female: 18.75-33.5; I² = 0.00), and HOS-SSS (male: 27.7-31.4; female: 26.75-39.8; I² = 0.42), as well as postoperative scores for mHHS (male: 82.445-96; female: 79.2-89.6; I² = 0.00) and NAHS (male: 82.445-94.5; female: 81.2-89.2; I² = 0.00). No differences were consistently identified in regard to survival rates and complications.

Conclusions: Male and female patients present with different preoperative characteristics that affect surgical treatment. With proper surgical indication, both male and female patients achieve significant postoperative improvement after hip arthroscopy and demonstrate comparable survival rates.

Level of evidence: Level IV, systematic review of Level II-IV studies.