Sex-Based Differences in the Arthroscopic Treatment of Femoroacetabular Impingement Syndrome: 10-Year Outcomes With a Nested Propensity-Matched Comparison
Author(s): Domb BG, Kufta AY, Kingham YE, Sabetian PW, Harris WT, Perez-Padilla PA
DOI: 10.1177/03635465241302806
Background
Sex-related anatomic and biomechanical differences may influence the outcomes of arthroscopic surgery for femoroacetabular impingement syndrome (FAIS), but robust long-term comparisons have been limited.
Methods
A cohort of 375 hips (249 female, 126 male) was studied with a minimum 10-year follow-up. A nested, propensity-matched subanalysis (1:1 by age and BMI) compared male and female outcomes, focusing on PROs, satisfaction, and surgical characteristics.
Key Findings
- Both sexes demonstrated durable improvement in PROs over 10 years.
- Females reported significantly higher satisfaction and improvement in mHHS, NAHS, HOS-SSS, and VAS pain scores.
- Males had more severe intraoperative cartilage damage and were more likely to undergo femoroplasty.
- Females were more likely to have capsular repair and iliopsoas lengthening.
- High hip survivorship was seen in both groups (i.e., low conversion to THA).
Conclusion
While both sexes benefit from hip arthroscopy for FAIS, women reported greater long-term subjective improvements, even though they more frequently underwent secondary procedures.
What Does This Mean for Providers?
These findings suggest that patient sex should be considered when evaluating and counseling patients for hip arthroscopy. Providers should be aware of anatomical and pathologic differences that may affect surgical planning and outcomes. Women may experience greater subjective benefit, but often require more complex procedures (e.g., capsular management, iliopsoas work). Surgeons should tailor operative techniques and preoperative discussions accordingly to optimize satisfaction and long-term joint preservation in both male and female patients.