PURPOSE OF REVIEW: Hip arthroscopy is an effective surgical procedure to treat intra-articular hip pathology including femoroacetabular impingement (FAI) and labral tears. This review aims to synthesize current evidence on sex-based differences in the pathology, presentation, surgical management, and outcomes of femoroacetabular impingement (FAI) and hip arthroscopy. RECENT FINDINGS: Emerging evidence indicates distinct morphological and clinical patterns of FAI between sexes. Cam-type morphology is more prevalent in males, whereas females more frequently present with pincer morphology and generalized joint hypermobility. Sex-specific differences in acetabular and femoral version, pelvic anatomy, and ligamentous laxity may contribute to variable symptomatology and diagnostic challenges. Postoperative outcomes following hip arthroscopy also appear to vary, with some studies reporting inferior outcome scores in females while others report no differences based on patient sex. Sex-based anatomical and biomechanical differences in FAI are clinically significant and may impact diagnosis, treatment strategy, and surgical outcomes. Recognizing and addressing these distinctions can optimize outcomes for both male and female patients. Continued research is needed to refine our understanding sex-specific etiology, pathology, and management approaches to ultimately improve long-term hip preservation.