Purpose
To assess differences in post-operative outcomes between males and females following hip arthroscopy.
Methods
A systematic review was performed following the PRISMA guidelines. Medline, Embase, Cochrane and PubMed databases were searched. Keywords included “hip,” “arthroscopy,” “outcome,” “gender difference,” “sex difference,” “gender,” and “patient reported outcome.” Studies were included that reported sex specific analysis of outcomes following primary hip arthroscopy. Methodological Index for Non-Randomized Studies (MINORS) criteria was applied to each study. Data collected included patient reported outcome measures (PROMs), complications, rates of revision arthroscopy (RA) and conversion to total hip arthroplasty (THA). Forest plots were generated for the most frequently reported PROMs, RA and THA rates.
Results
48 studies met the inclusion criteria, with 58544 (54% female) hips included. The average follow-up time was 39.8 months (range 90 days to 20 years). Of the 48 included studies, 21 were Level 4, 19 were Level 3, and 8 were Level 2 evidence. The most common indications for hip arthroscopy were femoroacetabular impingement and labral tears. 21 studies reported postoperative PROMs, with no clear trend towards sex differences. Males appear to reach the Minimal Clinically Important Difference (MCID) for the Modified Harris Hip Score (mHHS) and the Hip Outcome Score- Sport Specific Subscale (HOS-SSS) at lower rates than females. Twelve studies reported on revision arthroscopy rates, with four showing a significantly higher rate of revision arthroscopy in females and one showing a higher rate in males. A forest plot of all studies reporting absolute numbers of revision hip arthroscopies between sexes showed a trend towards males being at lower odds of revision arthroscopy than females (OR 0.16- 2.56). Eighteen studies reported on conversion to total hip arthroplasty, with an overall conversion rate of 9.64%. There were no clear sex differences in conversion to total hip arthroplasty. Thirteen studies found no sex differences in conversion rates, four studies found females were more likely to undergo total hip arthroplasty than males and one study found males to be more likely. Overall complication rates were low and there were no sex-based differences.
Conclusion
There was no difference between sexes for post-operative PROM scores. There is a trend towards males being less likely to reach the MCID for the mHHS and HOS-SSS than females but there was no clear trend for PASS rates. Females appear more likely to require revision arthroscopy. There was no difference between sexes in conversion to total hip arthroplasty.