EP1.3 Evaluating the Effects of Sex, Age, and Acetabular Coverage on Axial Distraction Stability in Hip Arthroscopy Patients: An In Vivo Study Distraction Profile Male vs. Females

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ID: 331136
2026
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Abstract
Abstract Background Effective hip arthroscopy requires adequate joint distraction, yet factors influencing distractibility remain incompletely defined. Prior studies suggest associations with sex, age, and acetabular coverage, though findings are inconsistent. Despite the clinical relevance of increased distraction as a potential marker of hip instability, distraction patterns across patient subgroups have not been comprehensively characterized. Purpose/Hypothesis To evaluate distraction profiles in patients undergoing primary hip arthroscopy for femoroacetabular impingement syndrome (FAIS) and assess the influence of sex, age, and acetabular morphology (lateral center-edge angle [LCEA]). We hypothesized that younger females and those with dysplastic hips would demonstrate greater distractibility. Methods A retrospective review was performed of patients ≥18 years undergoing primary hip arthroscopy for FAIS from 2019–2024. Preoperative radiographs were used to measure alpha angle, Tönnis angle, and LCEA. Intraoperative distraction was assessed from 0–100 lbF using a standardized traction protocol. Patients were stratified by sex, age group (18–25, 26–35, ≥36 years), and acetabular coverage (LCEA <20°, 20–25°, >25–40°, >40°). Multivariable linear regression evaluated independent predictors of distraction at each traction load, including sex, age, BMI, and acetabular coverage. Statistical significance was set at p < 0.05. Results A total of 678 patients were included (218 males [32.1%], 460 females [67.9%]). Age was similar between groups, though males had slightly higher BMI (26.1 vs 25.6, p=0.004). Males demonstrated larger alpha angles on AP (65.8° vs 54.4°) and frog-leg views (63.8° vs 56.8°; p < 0.001), and higher Tönnis angles (6.2° vs 5.2°, p=0.048), with no difference in LCEA (p=0.891). Distraction increased with traction force in both sexes. No differences were observed at 25 lbF (p=0.844); however, females demonstrated greater distraction at 50, 75, and 100 lbF (all p < 0.001). Age stratification showed no differences in distraction at any force (all p > 0.05). Dysplasia analysis revealed sex-specific patterns. In males, greater distraction was observed in borderline vs pincer hips at 50 lbF (p < 0.001), dysplastic vs normal hips at 75 lbF (p=0.026), and dysplastic vs pincer hips at 100 lbF (p=0.003). In females, differences emerged only at 100 lbF, where dysplastic hips demonstrated greater distraction than normal hips (p=0.006). Multivariable regression identified reduced acetabular coverage as an independent predictor of increased distraction across all loads (all p < 0.05). Female sex independently predicted greater distraction at 50 and 75 lbF (both p < 0.001), with a similar trend at 100 lbF (p=0.052). Age and BMI were not significant predictors. Conclusion Reduced acetabular coverage and female sex independently influence hip distraction profiles, with greater distractibility observed at higher traction forces. These findings underscore the importance of sex- and morphology-specific considerations in intraoperative assessment and capsular management.
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Authors Ashley L Matter, Elisabeth Reinisch, Allan K. Metz, Joseph T. Featherall, Leah Henry, Steve Aoki
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Journal Journal of hip preservation surgery
Year 2026
DOI
10.1093/jhps/hnag043.187
URL
https://doi.org/10.1093/jhps/hnag043.187
Keywords Keywords not found

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