Sex Differences in Patient-Reported Outcomes Following Surgical Hip Preservation Interventions: A Systematic Review and Meta-Analysis

Abstract

Background: Female patients undergoing hip preservation surgery often have inferior patient-reported outcome scores (PROs), raising concerns about the clinical benefit of hip preservation surgery in women. Comparison of preoperative and postoperative PROs, and change in PROs, for female versus (vs.) male hip preservation patients was completed via systematic review.

Methods: In accordance with PRISMA guidelines, the MEDLINE, Cochrane Central, and Em-base databases were searched. Level I-IV studies of patients undergoing surgical intervention for femoroacetabular impingement (FAI) and/or developmental dysplasia of the hip (DDH) with at least two years of postoperative follow-up were included. Sex-stratified PRO scores or outcome information had to be included.

Results: We identified 32 hip preservation studies evaluating sex-related PRO differences, and/or providing sex-specific PRO data. The quantitative analysis of 24 studies (1843 patients) was stratified by DDH status. The modified Harris Hip Score (mHHS), Hip Outcome Score-Activities of Daily Living subscale (HOS-ADL), and Hip Outcome Score-Sport-Specific subscale (HOS-SSS) were assessed. Patients undergoing surgery for FAI only were 52.1% female (n= 806/1546). As predicted, women had lower preoperative PRO scores, however, they had significantly greater improvements in HOS-ADL (20.14±4.41 vs. 26.00±0.35, p<0.05) and HOS-SSS (33.21± 0.71 vs. 38.33± 0.46, p<0.05) compared to males. Similar results were found in the DDH cohort of 330 patients (72.1% female): females had lower preoperative PRO scores, but significantly greater improvement of mHHS (22.68±0.45 vs. 10.60±1.46, p<0.01).

Conclusion: The present review suggests that men undergoing surgery for FAI and/or DDH tend to have higher preoperative and postoperative PRO scores. However, it appears that women often have greater preoperative to postoperative improvement in PRO scores. This finding is strongest in surgical treatment of DDH. Level of Evidence: III.

Keywords: clinical assessment/grading scales; femoroacetabular impingement syndrome; hip arthroscopy; hip labral tears; medical aspects of sports; patient-reported outcome scores; patient-reported outcomes; sex-based physiologic differences.

Figure 1A to 1B.

FAI Male vs. Female Pre- and Postoperative PROs; Male vs. Female ΔPRO. HOS: Hip Outcome Score, ADL: Activities of Daily Living, SSS: Sports-Specific Subscale, mHHS: modified Harris Hip Score, Pre-Op: preoperative, Post-Op: postoperative, Δ PRO: absolute change from preoperative to postoperative PRO.

Figure 2A to 2B.

DDH Male vs. Female Pre- and Postoperative, ΔmHHS. HOS: Hip Outcome Score, ADL: Activities of Daily Living, SSS: Sports-Specific Subscale, mHHS: modified Harris Hip Score, Pre-Op: preoperative, Post-Op: postoperative, ΔPRO: absolute change from preoperative to postoperative PRO.