Orthopedics has traditionally approached sex differences as a matter of anatomical scale—bone size, muscle mass, and ligamentous laxity. However, emerging evidence suggests that sex and gender are not peripheral modifiers but central biological and socio-clinical determinants shaping musculoskeletal health, injury patterns, treatment response, and long-term outcomes. It is now imperative to reframe orthopedics through a sex- and gender-informed precision lens.