Arthroscopic Hip Surgery in the Elite Athlete: Comparison of Female and Male Elite Athletes

OBJECTIVES: 1) To compare ability to return to prior competitive sports activity after arthroscopic hip surgery by gender, with an emphasis on the rate of return to the same level of competition. 2) To compare gender differences in type of sports activities, diagnosis and treatment in athletes requiring hip arthroscopy. METHODS: Prospectively obtained data on all high-level elite athletes (professional, NCAA collegiate and/or Olympic) treated between 2007 and 2014 were retrospectively reviewed. The clinical and surgical records of 547 hips in 484 consecutive patients who underwent primary hip arthroscopy by the senior author for non-arthritic hip pain during the study period were included. Elite athletes who had a Hip Sports Activity Score (HSAS) of over 6 were identified. Patients completed a pre-operative questionnaire that included medical and sports activity history and level of competition, hip-specific outcome scores (Modified Harris Hip Score [MHHS] and International Hip Outcome Tool-33 [iHOT-33]) at baseline and most recent follow-up. Surgical findings and time to return to competitive sports activity were documented. RESULTS: A total of 98 elite athletes with a mean follow up period of 18.8 months (±12.7) were identified. There were 49 females and 49 males. 27 athletes had bilateral hip arthroscopy, 5 of which had 1 operation elsewhere. All patients were available for follow up. Of the 80 patients desiring to return to their original competitive activity, 38 were female (42 hips) (Female Athlete group [FA]) and 42 were male (54 hips) (Male Athlete group [MA]) their mean ages were 21.5(±3.9) and 20.5(±1.9), duration of pain prior to surgery was 12.1 (±10.3) months and 15.1 (±1.9) months, respectively. 84.2% of FA and 83.3% of MA were able to return to the same level of competition at a mean of 8.3 (±3) and 8.8 (±2.9) months, respectively. Statistically significant improvements between pre- and post-operative mean MHHS and iHOT-33 scores were seen in both groups (p <.0001; p <.0001). FA had significantly higher proportions of hips that were diagnosed with Pincer type FAI (p =.0004), and Instability (p <.0001). Conversely, the MA had significantly higher proportions of hips that were diagnosed with Combined type FAI (p <.0001), had more extensive acetabular cartilage rim damage (p =.0002), and in particularly had more hips that required microfracture treatment (p =.001). When comparing cam lesions (includes Cam and Combined type FAI) the alpha angle was statistically greater in MA (mean 74°±6.7) compared to FA (mean 65.4°±6.8) (p <.0001). The category of sports the FA participated in were more flexibility (11%) and endurance (24%) type sports. MA participated more in cutting (33%), contact (14%) and asymmetric (31%) type sports. Patients who were able to return to same level of competitive activity had a significantly shorter duration of pre-operation symptoms compared to those who could not (p < 0.05). Microfracture treatment did not affect the ability to return to sports. CONCLUSION: A similar high percentage of both female and male elite athletes were able to return to competitive sports activity after arthroscopic treatment of FAI and/or hip instability. Distinct differences in diagnosis, treatment and participating type of sports activities were seen when comparing female and male athletes. Duration of symptoms negatively correlated with outcomes. Extensive cartilage damage and Microfracture did not affect outcome / return to sports.