EP8.4 Female Patients Report Worse Preoperative Symptoms with Smaller Cam Lesions

Abstract Introduction Acetabular labral tears frequently cause hip pain and are commonly a result of femoroacetabular impingement (FAI). However, little is known about the sex-based differences in preoperative symptoms. The purpose of this study was to compare male and female baseline characteristics and patient-reported outcome measures (PROMs). Methods This was a retrospective analysis of prospectively collected data from patients diagnosed with a symptomatic labral tear between 2015-2023. Patients were excluded if they had previous ipsilateral hip surgery or were under 18 years old. A fellowship-trained orthopaedic surgeon measured the lateral center edge angle (LCEA) and alpha angle (AA) for all patients. Due to the variability of where cam lesions can be located, AA was measured on both standing anteroposterior and 45° Dunn Lateral radiographs, and the largest value was used for analysis. Osteotomy type was determined intraoperatively by the senior surgeon based on dynamic impingement assessed during manipulation under anesthesia. Logistic regression was performed to identify radiographic predictors of femoral osteotomy, with results reported as odds ratios (OR) with 95% confidence intervals (CI). The PROMs collected were modified Harris Hip Score (mHHS), Hip Outcome Score - Activities of Daily Living (HOS-ADL), HOS-Sports Scale (HOS-SS), Non-arthritic hip score (NAHS), and international Hip Outcome Tool (iHOT). Results A total of 280 patients were included in the final analysis (158 males, 122 females). At baseline, male patients had significantly worse tonnis grades (P<0.001) and chondrolabral junction breakdown (P<0.001). Additionally, female patients had significantly lower AA (male, 77.2±13.9; female, 59.7±13.8; P<0.001). When stratifying patients further by radiographic evidence of a cam lesion and whether a femoral osteotomy was performed, AA did not differ within the same sex; however, AA differed significantly between sexes when a femoral osteotomy was performed (male, 77.5±13.3; female, 59.3±13.7; P<0.001, Figure 1). Furthermore, sex independently predicted significantly worse outcomes, while adjusting for age, body mass index, and pincer lesions for mHHS (β,-4.85, P=0.024), HOS-ADL (β,-7.09, P=0.014), NAHS (β,-5.24, P=0.045), and iHOT (β,-8.88, P=0.001). Conclusion Among patients with symptomatic labral tears, females presented with worse preoperative PROM scores despite smaller cam lesions. Additionally, standard radiographic measurements used to define cam morphology did not correlate with intraoperative indications for femoral osteotomy. These findings suggest that females may experience greater symptom burden with less radiographic evidence of FAI, highlighting the need for sex-specific thresholds in the diagnosis and surgical planning of FAI.