Sex-Based Differences in Hip Arthroscopic Findings, Management, and Outcomes: A Systematic Review

Hip arthroscopy is an effective treatment for femoroacetabular impingement and labral tears, with improvements in patient-reported outcomes (PROs). Whether anatomic and management differences between sexes translate into divergent outcomes remains uncertain.

To systematically review sex-based differences in radiographic findings, intraoperative pathology, surgical management, and postoperative outcomes after hip arthroscopy.

Systematic review; Level of evidence, 4.

A literature search of the PubMed, CENTRAL, and Scopus databases was performed on February 27, 2025, in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Articles were included if they reported sex-specific preoperative and postoperative PROs in individuals undergoing hip arthroscopy for femoroacetabular impingement or labral pathology, were published in the English language, and had a minimum 2-year follow-up. Data on patient demographics, radiographic parameters, intraoperative findings, surgical management, and outcomes were extracted. The methodological quality of each study was independently evaluated using the methodological index for non-randomized studies.

Six studies including 3914 hips (2260 female, 1654 male) met inclusion criteria. Four studies were level 3 and 2 were level 4 evidence, all with moderate methodological quality. All studies demonstrated significant postoperative improvements in PROs (p < .05). Of 4 studies reporting alpha angles, all of them found significantly greater values in male patients (p < .05). Of 6 studies, 1 identified significantly higher Non-Arthritic Hip Score and modified Harris Hip Score totals in men within the 30- to 44-year age subgroup (p = .008; p = .015), and 1 reported significantly higher Hip Sports Activity Scale scores in men (p = .01). One study found that a greater proportion of female patients achieved Patient Acceptable Symptom State thresholds for the 12-item International Hip Outcome Tool (p = .0008). No sex-based differences were observed in minimal clinically important difference achievement, revision arthroscopy, or conversion to total hip arthroplasty (p > .05).

Male and female patients demonstrated comparable improvements in PROs, achievement of clinically meaningful thresholds, revision rates, and rates of conversion to total hip arthroplasty after hip arthroscopy. Although men exhibited larger alpha angles and more advanced chondral damage, and women more frequently underwent capsular repair, these sex-based differences did not translate into clinically significant disparities in postoperative outcomes.