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Review
. 2021 Nov 16;9(11):23259671211053034.
doi: 10.1177/23259671211053034. eCollection 2021 Nov.

Are We Able to Determine Differences in Outcomes Between Male and Female Servicemembers Undergoing Hip Arthroscopy? A Systematic Review

Daniel I Rhon  1   2 , Tina A Greenlee  1 , Jonathan F Dickens  2   3   4 , Alexis A Wright  5
Affiliations
Review

Are We Able to Determine Differences in Outcomes Between Male and Female Servicemembers Undergoing Hip Arthroscopy? A Systematic Review

Daniel I Rhon et al. Orthop J Sports Med. .

Abstract

Background: Female servicemembers sustain higher rates of lower extremity injuries as compared with their male counterparts. This can include intra-articular pathology in the hip. Female patients are considered to have worse outcomes after hip arthroscopy for femoroacetabular impingement and for hip labral repair.

Purpose: To (1) compare published rates of hip arthroscopy between male and female military servicemembers and (2) determine if there are any sex-based differences in outcomes after hip arthroscopy in the military.

Study design: Systematic review; Level of evidence, 3.

Methods: We reviewed the literature published from January 1, 2000, through December 31, 2020, to identify studies in which hip arthroscopy was performed in military personnel. Clinical trials and cohort studies were included. The proportion of women within each cohort was identified, and results of any between-sex analyses were reported.

Results: Identified were 11 studies that met established criteria. Studies included 2481 patients, 970 (39.1%) of whom were women. Surgery occurred between January 1998 and March 2018. Despite women accounting for approximately 15% of the active-duty military force, they represented 39.1% (range, 25.7%-57.6%) of patients undergoing hip arthroscopy. In most cases, there were no differences in self-reported outcomes (pain, disability, and physical function), return to duty, or medical disability status based on sex.

Conclusion: Women account for approximately 15% of the military, but they made up 40% of patients undergoing hip arthroscopy. Outcomes were not different between the sexes; however, definitive conclusions were limited by the heterogeneity of outcomes, missing data, lack of sex-specific subgroup analyses, and zero studies with sex differences as the primary outcome. A proper understanding of sex-specific outcomes after hip arthroscopy will require a paradigm shift in the design and reporting of trials in the military health system.

Keywords: femoroacetabular impingement; hip arthroscopy; military medicine; military servicemembers; sex disparity.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: Funding was received from an internal grant from the US Defense Health Agency (W911QY-15-1-0016 to D.I.R.). This work was also supported in part by the Uniformed Services University, Department of Physical Medicine and Rehabilitation, Musculoskeletal Injury Rehabilitation Research for Operational Readiness (HU00011920011). J.F.D. has received education payments from Supreme Orthopaedic Systems and nonconsulting fees from Arthrex. D.I.R. has received royalties from Medbridge and is the owner of Clinically Relevant Technologies. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. #References 5, 8, 14, 15, 17, 33, 43, 46, 49, 54

Figures

Figure 1.
Figure 1.
Flow diagram of study inclusion.
Figure 2.
Figure 2.
Annual proportion of surgical cases compared by sex. Annual count of cases (unique individuals) between June 30, 2004, and July 1, 2013. Hatched bars indicate annual estimates for partial years based on caseload available during that year (2004 and 2013). Data based on N = 1254 from 1 study.
See this image and copyright information in PMC

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References

    1. Anderson MK, Grier T, Dada EO, Canham-Chervak M, Jones BH. The role of gender and physical performance on injuries: an army study. Am J Prev Med. 2017;52(5):e131–e138. - PubMed
    1. Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):19–32.
    1. Armed Forces Health Surveillance Center. Health of women after wartime deployments: correlates of risk for selected medical conditions among females after initial and repeat deployments to Afghanistan and Iraq, active component, US Armed Forces. MSMR. 2012;19(7):2–10. - PubMed
    1. Bell NS, Mangione TW, Hemenway D, Amoroso PJ, Jones BH. High injury rates among female army trainees: a function of gender? Am J Prev Med. 2000;18(3 suppl):141–146. - PubMed
    1. Bennett AN, Nixon J, Roberts A, Barker-Davies R, Villar R, Houghton JM. Prospective 12-month functional and vocational outcomes of hip arthroscopy for femoroacetabular impingement as part of an evidence-based hip pain rehabilitation pathway in an active military population. BMJ Open Sport Exerc Med. 2016;2(1):e000144. - PMC - PubMed

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