Are Women Less Likely to Return to Sport Compared to Men Following Hip Arthroscopy. A Systematic Review and Meta-analysis.

Abstract

<b>OBJECTIVE:</b> To compare return-to-sport outcomes between females/women/girls and males/men/boys undergoing hip arthroscopy and explore social and structural determinants of health that may influence return to sport. <b>DESIGN:</b> Systematic review with meta-analysis. <b>LITERATURE SEARCH:</b> CINAHL, Cochrane Central Register of Controlled Trials, Embase, Medline, SPORTDiscus, and Web of Science from inception to February 2024. <b>STUDY SELECTION CRITERIA:</b> Studies were included if they assessed return to sport after hip arthroscopy and analyzed the influence of sex/gender on return-to-sport outcomes, or reported sex- or gender-stratified return-to-sport rates. <b>DATA SYNTHESIS:</b> We used a random effects model to calculate pooled odds ratios and conducted meta-regressions to compare return-to-sport outcomes between females/women/girls and males/men/boys. <b>RESULTS:</b> Forty-five studies were included, with all pooled results deemed as very low-certainty evidence. Compared to males/men/boys, females/women/girls had inferior return to sport at the same or higher level between 1 and 3 years postoperatively (pooled OR = 0.53; 95% CI: 0.34, 0.81; <i>P</i> = .004), and at any level of sport at >3 years postoperatively (pooled OR = 0.46; 95% CI: 0.25, 0.86; <i>P</i> = .014). Sports participation decreased over time, with ~5.5% to 10% lower proportions observed in females/women/girls compared to males/men/boys. The reporting of determinants of returning to sport was minimal, precluding further exploration of their effects. <b>CONCLUSION</b>: Females/women/girls had lower odds of return to sport, especially during longer follow-up periods, than males/men/boys. The lack of reporting of social and structural determinants of health influencing return-to-sport outcomes makes the reasons for this disparity unclear. <i>J Orthop Sports Phys Ther 2025;55(3):1-13. Epub 10 February 2025. doi:10.2519/jospt.2025.12813</i>.