Richard N Villar MBBS, MA, MS, FRCS
Villar Bajwa Practice, Spire Cambridge Lea Hospital, Cambridge, UK.
There are many examples of differences in the presentation and treatment of disease between men and women. These have been described in conditions such as osteoarthritis, spinal stenosis and even anterior cruciate ligament reconstruction. In addition, in some circumstances the response to surgery between the genders may be different. There is, however, no study to specifically compare the outcome of hip arthroscopic surgery for femoroacetabular impingement (FAI) between men and women.
Our hypothesis was that there would be no difference in the outcome of hip arthroscopic surgery for FAI between men and women.
We investigated 262 consecutive patients who underwent hip arthroscopic surgery for all varieties of FAI (cam, pincer, mixed) by a single surgeon. Of these, 43 (16.4%) were lost to follow-up, leaving 219 available for analysis. All patients were assessed pre-operatively and post-operatively at one and two years. Our outcome measures were the modified Harris hip score (mHHS) and Non-arthritic hip score (NAHS). We also measured the patients’ pre-operative alpha angle using the lateral view of a plain radiograph of the hip.
There were 111 men and 108 women included in the study. The mean age for men was 38.8 years (16 to 68) while that for women was 38.0 years (15 to 70).
The mean follow-up was 2.4 years (2 to 4.2).
The parameters of age, time to presentation, length of follow-up and the Tönnis grade for both groups were compared and found not to be significant (Table I).
We found men to have higher (better) mean scores than women pre-operatively (mHHS; men = 68.5, women = 62.0, p = 0.04 and NAHS; men = 69.2, women = 63.6, p = 0.04). That is, women were worse off than men before surgery.
However, post-operatively, irrespective of the degree of chondral damage found at surgery both men and women reached similar post-operative scores by one year (mHHS; men = 82.6, women = 79.8, p = 0.09 and NAHS; men = 81.8, women = 79.4, p = 0.20) (Table II).
Outcome scores (mHHS and NAHS) for both men and women continued to improve at two years, although there was no statistical difference between the two genders. The mean pre-operative alpha angle was significantly higher for men than women (58.3° vs 45.8°, p = 0.03).
Men and women both benefit from arthroscopic surgery for FAI. However, women start pre-operatively from a worse position than men but improve to a greater degree. By one year after surgery both genders are doing equivalently well and continue to improve at least until the two-year point.