Sex-Based Differences in Prevalence, Outcomes, and Complications of Hip Arthroscopy for Femoroacetabular Impingement: A Systematic Review and Meta-analysis

Abstract

Background: Trends between the sexes have been reported regarding prevalence, patient-reported outcomes (PROs), and complications of hip arthroscopy (HA) for femoroacetabular impingement syndrome (FAIS), yet current results lack consensus. Purpose: To evaluate sex-based differences after HA for FAIS in (1) prevalence of cam and pincer morphology in FAIS and (2) PROs, pain scores, and postoperative complication rates. Study Design: Systematic review; Level of evidence, 4. Methods: The EMBASE, PubMed, and Ovid (MEDLINE) databases were searched from establishment to February 28, 2022, according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Included studies had sex-based data on prevalence, outcomes, and complications of HA for FAIS. Reviews and commentaries were excluded. Data were combined, and between-sex differences were analyzed. Meta-analyses using random-effects models were performed when possible. Pooled risk ratios (RRs) and standardized mean differences were calculated. Results: A total of 74 studies were included (213,059 patients; 132,973 female hips [62.4%] and 80,086 male hips [37.6%]). The mean age was 30.7 ± 7.7 years among male patients and 31.1 ± 7.8 years among female patients. Male patients experienced mixed-type impingement significantly more often (39.4% vs 27.2% for female patients; RR = 0.69 [95% confidence interval [CI], 0.58-0.81]; P < .001), whereas female patients experienced pincer-type impingement more often (50.6% vs 30.8% for male patients; RR = 2.35 [95% CI, 1.14-4.86]; P = .02). Male patients had higher likelihoods of undergoing femoroplasty (89.8% vs 77.4% for female patients; RR = 0.90 [95% CI, 0.83-0.97]; P = .006), acetabuloplasty (67.1% vs 59.3% for female patients; RR = 0.87 [95% CI, 0.79-0.97]; P = .01), or combined femoroplasty/acetabuloplasty (29.2% vs 14.5% for female patients; RR = 0.63 [95% CI, 0.44-0.90]; P = .01). Although female patients showed greater improvements in Hip Outcome Score–Sport-Specific subscale ( P = .005), modified Harris Hip Score ( P = .006), and visual analog scale pain ( P < .001), both sexes surpassed the minimal clinically important difference at 1, 2, and 5 years postoperatively. Female patients had higher complication rates ( P = .003), although no sex-based differences were found in total hip arthroplasty conversion rates ( P = .21). Conclusion: Male patients undergoing HA for FAIS had a higher prevalence of mixed-type FAIS while female patients had more pincer-type FAIS. Female patients gained greater improvements in PROs, although both sexes exceeded the minimal clinically important difference, suggesting that both male and female patients can benefit from HA.