Editorial Commentary: Hip Arthroscopy Outcomes May Have a Gender Bias.

It is a great challenge to analyze whether sex difference affects outcome of hip arthroscopy, because the indications, risk factors, and comorbidities are difficult to determine and may be heterogeneous between and within studies. For instance, mental health disorders, namely depression, are associated with worse outcomes following hip arthroscopy, and these disorders tend to be more prevalent in a female population. There are also known bony morphologic differences between men and women. Women tend to have a higher rate of borderline hip dysplasia defined by lateral center-edge angle between 18 and 25°. This is notable because long-term (10 year) survivorship of patients with this morphology undergoing hip arthroscopy is notably lower (79-82.2%) compared with patients undergoing hip arthroscopy without BHD (>90%). These gender differences, although notable within specific cohorts, are more difficult to tease out in large systematic reviews with all comers. In addition, many studies do not have longer-term follow-up required to assess conversion to THA. Perhaps hip arthroscopy outcomes are instead directly linked to independent bony morphologic, psychologic, and soft tissue-based risk factors that may have a gender bias.