Sex-Based Differences in Outcomes, Clinical Benefit, and Survivorship in Patients With Borderline Hip Dysplasia Undergoing Hip Arthroscopy at a Minimum 5-Year Follow-up: A Propensity-Matched Comparison Study
Author(s):Maldonado DR, Walsh EG, Schab AR, Domb BG.
DOI Link: 10.1177/03635465251410548
Background
Borderline hip dysplasia (BHD) presents unique challenges in hip arthroscopy, and sex-based differences in midterm outcomes remain poorly defined. Understanding differences in clinical benefit and survivorship may improve patient selection and counseling.
Methods
This retrospective cohort study evaluated patients with BHD (LCEA 18°–25°) undergoing primary hip arthroscopy between 2008 and 2018. Patients were propensity-matched 1:1 by age, BMI, and Tönnis grade. Outcomes included patient-reported outcome measures (mHHS, NAHS, VAS), clinical benefit thresholds (MCID, PASS, MOI), patient satisfaction, and survivorship defined as conversion to total hip arthroplasty. Minimum follow-up was 5 years.
Key Findings
Both sexes demonstrated significant and comparable improvements in all PROMs at ≥5 years.
Survivorship was similar between men (94.7%) and women (89.5%) (P = .229).
Women demonstrated significantly higher rates of clinical benefit achievement, including:
- MCID: mHHS (86.8% vs 69.7%), NAHS (88.2% vs 61.8%), VAS (84.2% vs 64.5%)
- PASS (mHHS): 90.8% vs 78.9%
- MOI (NAHS): 77.6% vs 55.3%
Conclusion
In patients with borderline hip dysplasia undergoing hip arthroscopy, both sexes demonstrate durable improvements and similar survivorship at 5 years. However, women achieve higher rates of clinically meaningful benefit across multiple outcome thresholds.
What Does This Mean for Providers?
Hip arthroscopy in carefully selected patients with BHD yields durable outcomes regardless of sex. However, sex-based differences in patient-reported clinical benefit suggest women may be more likely to perceive meaningful improvement. These findings may assist in refining preoperative counseling and setting realistic expectations, while reinforcing that survivorship remains comparable between sexes.