Two patients walk into an orthopedic office with the same complaint: persistent hip pain that flares with activity. One is a man, one is a woman, and statistically, the underlying cause is likely to look different in each of them. Several of the most common hip conditions seen in orthopedic practice show clear, measurable differences between the sexes, and understanding why matters for getting an accurate diagnosis.
A Wider Pelvis Changes How the Hip Is Built
Female and male pelvises are shaped differently, and that difference extends directly into the architecture of the hip joint. Women typically have a wider pelvis with a greater angle of the pubic arch and a larger pelvic inlet, along with measurably higher acetabular anteversion, the rotational angle of the hip socket. These are not minor variations. They change how the femoral head sits within the socket and how forces transmit through the joint during everyday movement and exercise.
Hip Dysplasia Shows Up Far More Often in Women
Developmental hip dysplasia, a condition where the socket does not fully cover the ball of the joint, occurs up to four times more often in women than in men.1 Anatomical differences in pelvic shape combine with women's tendency toward greater ligamentous laxity to create conditions where the joint is more prone to shallow coverage in the first place. Left unaddressed, this incomplete coverage increases the long-term risk of early cartilage breakdown and osteoarthritis.
Impingement Looks Different Depending on Sex
Femoroacetabular impingement, a structural mismatch that causes abnormal contact between the ball and socket, affects men and women at similar overall rates, but the type of impingement differs sharply. Men are far more likely to develop cam-type impingement, where the femoral head itself is misshapen, while women more frequently develop pincer-type impingement, where the socket overcovers the femoral head, often alongside generalized joint hypermobility. One large radiographic study found cam-type deformities in roughly 21 percent of male hips with impingement compared to under 5 percent of female hips, while pincer-type deformities appeared in about 24 percent of female hips versus under 5 percent of male hips.2 That distinction shapes everything from physical exam findings to surgical planning.
Hormones Add Another Layer After Midlife
Beyond structural anatomy, hormonal shifts across a woman's life add another variable to hip health. Estrogen appears to have a protective effect on cartilage, and its decline during menopause is associated with a rise in osteoarthritis risk. Symptomatic hip osteoarthritis, meaning hip arthritis that actually causes pain and limits function, is more common in women, even though structural changes visible on imaging are sometimes more frequent in men. Pregnancy adds a separate hormonal factor, since relaxin and related hormones loosen ligaments to prepare the pelvis for childbirth, an effect that can also influence hip joint stability.
Why an Accurate Diagnosis Depends on Recognizing These Differences
None of this means men and women need fundamentally different categories of care, but it does mean that a clinician evaluating hip pain should weigh sex-based patterns alongside imaging and physical exam findings. A woman with hip pain and joint laxity is statistically more likely to be dealing with dysplasia or pincer-type impingement than the cam-type deformity more common in men, and treatment planning, from physical therapy approach to surgical technique, often follows from that distinction. Research into hip arthroscopy outcomes continues to explore whether these anatomical differences also affect recovery and long-term results between sexes.3
Getting the Right Answer Starts With the Right Questions
Hip pain is rarely one-size-fits-all, and the biological differences between male and female hips are a meaningful part of why two people with the same symptom can need very different treatment paths. If your hip pain has not responded to generic advice, an evaluation that accounts for these anatomical and hormonal factors can make the difference between guessing and actually knowing what is going on.
If something about your hip pain has not added up, a thorough evaluation that looks at your specific anatomy is often the clearest path to an answer.
Frequently Asked Questions
- Why are women more likely to get hip dysplasia than men?
Women are more prone to hip dysplasia due to a combination of pelvic shape, including a wider pelvis and higher acetabular anteversion, and a general tendency toward greater ligament laxity compared to men. - Is femoroacetabular impingement different in men versus women?
Yes. Men more often develop cam-type impingement, involving an abnormally shaped femoral head, while women more often develop pincer-type impingement, where the socket overcovers the joint, frequently alongside joint hypermobility. - Does menopause affect hip pain or arthritis risk?
Yes. Declining estrogen during menopause is linked to a higher risk of osteoarthritis, since estrogen appears to have a protective effect on cartilage health. - Can pregnancy affect hip joint stability?
Yes. Hormones like relaxin increase during pregnancy to loosen ligaments in preparation for childbirth, and this temporary laxity can affect hip joint stability. - Why do men and women sometimes need different treatment for similar hip symptoms?
Because the underlying structural cause often differs by sex, with women more likely to have dysplasia or pincer-type impingement and men more likely to have cam-type impingement, treatment approaches are often tailored to that specific anatomy.
Reference Links:
- Morphology of the dysplastic hip and the relationship with sex and acetabular version - PubMed
- Sex differences in the prevalence of radiographic findings of structural hip deformities in patients with symptomatic femoroacetabular impingement - PubMed Central
- Sex-Based Differences Femoroacetabular Impingement and Hip Arthroscopy - PubMed Central
AUTHOR: Megan Flynn, M.D. – Orthopedic Sports Medicine Surgeon
Megan Flynn, M.D. is a fellowship-trained orthopedic surgeon specializing in sports medicine, regenerative medicine, and performance-focused musculoskeletal care. She serves as Director of Performance & Women’s Health and is dedicated to helping athletes and active individuals recover from injury, restore mobility, and return safely to peak performance through advanced surgical and non-surgical treatment strategies.
Credentials & Recognition
Dr. Flynn completed her undergraduate education at the University of Notre Dame before earning her medical degree from Georgetown University, where she received honors for leadership and teaching and was elected class vice president. She began her surgical training at Columbia University and completed her orthopedic surgery residency at the Cleveland Clinic.
To further refine her expertise, Dr. Flynn completed a prestigious sports medicine fellowship at the American Sports Medicine Institute, gaining advanced experience in the treatment of complex athletic injuries and performance optimization.
Clinical Expertise
Dr. Flynn specializes in the care of athletes at every level, from elite professionals to active individuals and weekend competitors. Her clinical focus includes soft tissue injuries and advanced treatment of the knee, shoulder, and elbow, using both minimally invasive surgical techniques and regenerative medicine therapies.
Known for her compassionate bedside manner, comprehensive approach to recovery, and commitment to patient well-being, Dr. Flynn is equally passionate about mentoring and training the next generation of physicians in the evolving field of sports medicine. Her goal is to deliver personalized, performance-driven care that restores confidence, function, and long-term joint health.
Medical Disclaimer: This information is for educational purposes only and does not constitute medical advice. For diagnosis and treatment recommendations, please consult with Dr. Flynn or another qualified orthopedic specialist at the American Hip Institute.
AUTHOR: Dr. Benjamin G. Domb, M.D., ABOS, ABIME – Orthopedic Hip Surgeon & Sports Medicine Specialist
Benjamin G. Domb, M.D., ABOS, ABIME is a nationally recognized orthopedic surgeon specializing in sports medicine, hip arthroscopy, and minimally invasive hip preservation. He serves as Medical Director of the American Hip Institute and Chair and Fellowship Director of the American Hip Institute Research Foundation, where he leads innovation in joint preservation and advanced hip care.
Credentials & Recognition
Dr. Domb graduated with honors from Princeton University and earned his medical degree from the Johns Hopkins School of Medicine, one of the nation’s top-ranked medical programs. He has been recognized among the Top Doctors in the United States by major national publications and physician-review organizations, reflecting his reputation as one of the most experienced hip surgeons worldwide.
He is the Founder and Fellowship Chair of the American Hip Institute Research Foundation, a nonprofit organization dedicated to advancing research, education, and innovation in hip preservation surgery. Dr. Domb has authored more than 500 scientific publications, developed numerous surgical techniques, and trained dozens of orthopedic surgeons practicing across the globe.
Clinical Expertise
Dr. Domb focuses on minimally invasive hip arthroscopy, complex hip preservation, and sports-related hip injuries. He has treated professional and Olympic athletes from major leagues, including the NFL, NBA, and NHL, and previously served as Head Team Physician for the Chicago Sky. Patients from across the country travel to Chicago for his expertise in advanced hip surgery, where he applies the same high standard of individualized care used for elite athletes to every patient he treats.
Medical Disclaimer: This information is provided for educational purposes only and does not constitute medical advice. For diagnosis and treatment recommendations, please consult with Dr. Domb or another qualified orthopedic specialist at the American Hip Institute.
