Symptomatic Femoroacetabular Impingement: Are There Gender-Specific Disease Characteristics?

OBJECTIVES: The purpose of this study was to compare the clinical, radiographic and intraoperative characteristics of symptomatic FAI in males and females, to determine gender-specific differences in FAI presentation. METHODS: We retrospectively identified consecutive cohorts of 50 male and 50 female patients treated for symptomatic FAI by a single surgeon. Established clinical and radiographic methods were used for disease characterization. Statistical analysis was performed to identify significant differences in clinical, radiographic, and intraoperative findings between males and females. RESULTS: Statistical differences in age, BMI, and pain chronicity by gender were not detected. Modified Harris hip scores and UCLA activity scores were significantly lower in females (54.4 vs. 63.7, p 0.005 and 6.8 vs. 8.1, p 0.014, respectively). Females were significantly more likely to have a component of lateral hip pain (38% vs. 20%, p 0.047), in addition to anterior/groin pain. Females had significantly more internal rotation range of motion in flexion than males (16.4° vs. 6.9°, p<0.001), with 58.0% and 86.0% having less than 20°, respectively (p 0.002). Males were significantly more likely than females to have elevated alpha angle (>50 in 94% vs. 70%, p 0.002) and decreased head-neck offset (<0.17 in 96% vs. 78%, p 0.007). Elevated alpha angles on the AP pelvis radiographs were more common in males with FAI compared to females (72% vs. 28%, p<0.001). A crossover sign greater than 10 mm from the acetabular sourcil was significantly more likely in males than in females (64.3% vs. 23.5%, p 0.001). Acetabular articular cartilage cleavage or defects were significantly more common in males (56% vs 24%, p 0.001). The distribution of labral lesions was not significantly different (82% vs 80% detachment). CONCLUSION: Significant differences in disease characteristics exist between males and females with FAI. Female patients have greater disability at presentation and are less active than males with FAI at presentation, despite less advanced acetabular cartilage pathology. Female patients generally had milder cam-type deformities and less acetabular retroversion than males.