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

OBJECTIVE: 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. DESIGN: Systematic review with meta-analysis LITERATURE SEARCH: CINAHL, Cochrane Central Register of Controlled Trials, Embase, Medline, SPORTDiscus and Web of Science from inception to February 2024. SELECTION CRITERIA: Studies were included if they assessed return-to-sport after hip arthroscopy and analysed the influence of sex/gender on return-to-sport outcomes, or reported sex/gender stratified return-to-sport rates. DATA SYNTHESIS: We used pooled odds ratios through a random-effects model and conducted meta-regressions to compare return-to-sport outcomes between females/women/girls and males/men/boys. RESULTS: 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/higher level between 1 to 3 years post-operatively (0.53, 95%CI 0.34 to 0.81, P=0.004), and at any level of sport at >3 years post-operatively (0.46, 95%CI 0.25 to 0.86, P=0.014). Sports participation decreased over time, with ~5.5% to 10% lower rates observed in females/women/girls compared to males/men/boys. The reporting of determinants was minimal, precluding further exploration of their effects. CONCLUSION: 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.