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

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 males and females.

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 patient reported outcome (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 (MCID), Patient Acceptable Symptomatic State (PASS) and Substantial Clinical Benefit (SCB) was recorded when available.

Results: A total of 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 significantly higher incidence of acetabular injury, larger alpha angle, complex labral tearing, and higher grade LT villar classification; leading to differences in surgical indication; such as female patients being indicated for capsular repair or plication at a higher frequency. There was a significant heterogeneity between males and females for preoperative mHHS (Male: 55.7-83; Female: 49-64.45; I²=0.78), NAHS (Male: 62.54-78.1; Female: 47.2-66; I²=0.77), HOS-SSS (Male: 46.72-52.3; Female: 22.8-45.7; I²=0.96), as well as post-operative HOS-SSS (Male: 72.2-91; Female: 62.6-82.4; I²=0.66). Despite these differences, both males and females 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.

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

Level of evidence: Level IV, Systematic Review of Level II-IV Studies.