One Bony Morphology, Two Pathologic Entities: Sex-Based Differences in Patients With Borderline Hip Dysplasia Undergoing Hip Arthroscopy
Authors: Saks BR, Fox JD, Owens JS, Maldonado DR, Jimenez AE, Ankem HK, Lall AC, Domb BG
DOI: 10.1177/03635465211043510
Background
Borderline hip dysplasia (BHD) presents a diagnostic and therapeutic challenge, with increasing recognition of sex-based differences in clinical presentation and intraoperative pathology. This study explores whether male and female patients with similar bony morphology represent distinct clinical subgroups.
Methods
Patients with BHD undergoing hip arthroscopy were analyzed by sex for differences in clinical presentation, intraoperative findings, procedures performed, and postoperative outcomes.
Key Findings
- Males: More complex labral tears, greater acetabular cartilage damage, and more frequent femoroplasties.
- Females: Higher prevalence of painful internal snapping and more frequent capsular plication, suggestive of underlying hip instability.
- Both sexes demonstrated significant postoperative improvement in patient-reported outcomes.
Conclusions
Despite similar radiographic morphology, male and female patients with BHD present with distinct intra-articular pathology and surgical needs, indicating that sex-specific treatment approaches may be warranted.
What Does This Mean for Providers?
- Recognize that BHD is not a uniform pathology—sex-specific patterns in presentation and intraoperative findings may guide preoperative counseling and surgical planning.
- In males, anticipate more cartilage damage and mechanical impingement; in females, assess for instability and consider capsular management.
- Tailored surgical strategies can optimize outcomes despite similar osseous morphology.