Nonarthritic Hip Pathology Patterns According to Sex, Femoroacetabular Impingement Morphology, and Generalized Ligamentous Laxity
Authors: Ortiz-Declet V, Maldonado DR, Annin S, Yuen LC, Kyin C, Kopscik MR, Lall AC, Domb BG
DOI: 10.1177/03635465211056086
Background
Sex-based differences are well documented in hip pathology. Males frequently present with cam-type femoroacetabular impingement (FAI) and associated severe acetabular cartilage damage. Females are more often affected by hip instability, frequently associated with generalized ligamentous laxity (GLL). Understanding these differences is essential for diagnosis, surgical planning, and tailored treatment.
Methods
This study analyzed patients undergoing primary hip arthroscopy for FAIS and labral pathology between 2008 and 2017. Patients were stratified by sex, with further subgroup analysis by alpha angle in males and presence of GLL in females. Radiographic parameters and intraoperative cartilage findings were correlated.
Key Findings
- Males demonstrated larger alpha angles and more severe acetabular cartilage damage, consistent with cam morphology-driven pathology.
- Females had higher prevalence of GLL (38.6% vs. 13.6%) and lower lateral center-edge angles, suggestive of instability.
- The data reinforce distinct pathoanatomic and biomechanical profiles by sex.
Conclusions
Sex-specific hip pathology patterns—cam morphology with cartilage damage in males, and ligamentous laxity with instability in females—should guide clinical evaluation and personalized management strategies.
What Does This Mean for Providers?
- Recognize that male patients with larger alpha angles are at increased risk for more extensive cartilage damage, which may necessitate aggressive chondral preservation strategies.
- Consider assessment for generalized ligamentous laxity in female patients presenting with hip symptoms, as instability may influence surgical technique and postoperative rehabilitation.
- Tailor surgical and nonoperative interventions to address sex-specific biomechanical and morphological differences for optimized outcomes.