Female-Specific Clinical Risk Factors Associated With Hip Osteoarthritis: A Systematic Review

OBJECTIVE: To identify female-specific clinical risk factors that were associated with hip osteoarthritis (OA), identifiable through clinical assessment and relevant to rehabilitation professionals.

DESIGN: Systematic review with descriptive synthesis.

LITERATURE SEARCH: Six databases were searched from inception through March 2026 using predefined terms related to hip OA and clinical risk factors.

STUDY SELECTION CRITERIA: Observational studies reporting associations between clinical risk factors and hip OA in females were included. Outcomes included radiographic OA, physician-diagnosed OA, registry-based OA diagnoses, and total hip replacement (THR).

DATA SYNTHESIS: Heterogeneity in study design, exposure definitions, outcome definitions, and analytical approaches precluded meta-analysis. Findings were synthesized descriptively following the Synthesis Without Meta-analysis (SWiM) guideline. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.

RESULTS: Fifteen observational studies met the inclusion criteria, including 9 prospective cohort studies. Moderate-certainty evidence supported associations between elevated body mass index, weight gain across the life course, occupational and mechanical exposures, and increased hip OA risk in females. Low-certainty evidence supported associations between reproductive and hormonal factors and prior hip injury, and hip OA risk. Evidence relating to physical activity, lifestyle, and dietary exposures was inconsistent or limited.

CONCLUSION: Females had distinct clinical risk profiles for hip OA. Moderate-certainty evidence supported associations between hip OA risk and body composition, weight gain across adulthood, and occupational mechanical exposures. Low-certainty evidence supported associations between hip OA risk and reproductive factors, hormonal factors and prior hip injury.