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Total hip and total knee arthroplasty are 2 of the most common surgeries in the US, with approximately 1.25 million total joint procedures performed in 2019. [1] Multiple studies have projected significant increases in the number of primary and revision total joint arthroplasties through 2030. [2-5]

Now, new research goes further into the future to offer projections not only of even greater growth in total joint arthroplasty procedures by 2050, but also of a concerning decrease in the number of orthopaedic surgeons available to perform those surgeries.

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It’s a sobering look at the next few decades of total joint arthroplasty in the US, and if the projections prove to be accurate, orthopaedic surgeons’ future caseloads could potentially double what they are today.

Study Overview

The population-based study, from researchers at Cleveland Clinic and the University of Massachusetts Memorial Medical Center, utilized data from the National Inpatient Sample (NIS) to determine the number of TJAs performed between 2000 and 2018. Data from the Physician Specialty Data Reports from the Association of American Medical Colleges were used to identify the number of orthopaedic surgeons who were actively practicing during that period.

The researchers also examined the pipeline for new orthopaedic surgeons: PGY-1 orthopaedic residency positions and adult reconstruction fellowship positions, based on data from the according to the National Resident Matching Program and the American Association of Hip and Knee Surgeons, respectively.

They then performed data analysis to arrive at a procedure-to-surgeon ratio (PSR) for each year. The PSR is the number of annual TJA cases performed per total active orthopaedic surgeons. These ratios were calculated by dividing the number of actual (or projected) TJAs by the number of actual (or projected) orthopaedic surgeons.

Study Findings

At the 2023 annual meeting of the American Academy of Orthopaedic Surgeons, the researchers reported their projections:

• The annual volume of primary TJAs will grow 70% to more than 2.25 million procedures by 2050.
• A higher growth in demand is expected for THAs than for TKAs: 1,219,852 THAs vs. 1,037,474 TKAs by 2050.

• The number of active orthopaedic surgeons is projected to decrease 14% by 2050, from 18,834 surgeons in 2020 to 16,189 in 2050, with attrition through retirement and surgeons leaving the profession for other reasons such as burnout. [6,7]
• The number of residents is projected to grow 39% by 2050 from 844 residents in 2020 to 1,173 in 2050, and joint reconstruction fellowship positions are forecasted to grow by 149% from 189 fellows in 2020 to 460 in 2050. These projections, unfortunately, are still predictive of a workforce that will be unable to keep pace with the growing number of TJA procedures.
• In 2017 – the standard point of comparison used in the study – the average primary TJA caseload per active orthopaedic surgeon was 65.2 procedures; the projected TJA caseload for 2050 is 139.4. The number of TJAs performed per surgeon, therefore, will double by 2050 to meet the projected demand.
• Increasing the number of orthopaedic surgeons by 10% every 5 years could ensure the caseload per surgeon remains similar to the 2010 to 2017 numbers.

Source

Deren ME, Rullan PJ, Zhou G, Emara A, Klika AK, Koroukian S, Barsoum WK, Piuzzi NS. How to determine the orthopaedic surgeon workforce in the United States: an analysis based on projected volume in primary total joint arthroplasty from 2020 to 2050. Presented at the 2023 annual meeting of the American Academy of Orthopaedic Surgeons, March 2023, Las Vegas, Nevada.

References

1. Agency for Healthcare Research and Quality. HCUP Fast Stats Data Tools | AHRQ Data Tools. Accessed March 15, 2023. https://datatools.ahrq.gov/hcup-fast-stats
2. Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007 Apr;89(4):780-5.doi: 10.2106/JBJS.F.00222.
3. Kurtz SM, Ong KL, Lau E, Bozic KJ. Impact of the economic downturn on total joint replacement demand in the United States: updated projections to 2021. J Bone Joint Surg Am. 2014 Apr 16;96(8):624-30.doi: 10.2106/JBJS.M.00285.
4. Sloan M, Premkumar A, Sheth NP. Projected volume of primary total joint arthroplasty in the U.S., 2014 to 2030. J Bone Joint Surg Am. 2018 Sep 5;100(17):1455-1460.doi: 10.2106/JBJS.17.01617.
5. Schwartz AM, Farley KX, Guild GN, Bradbury TL Jr. Projections and epidemiology of revision hip and knee arthroplasty in the United States to 2030. J Arthroplasty. 2020 Jun;35(6S):S79-S85.doi: 10.1016/j.arth.2020.02.030. Epub 2020 Feb 19.
6. Ames SE, Cowan JB, Kenter K, Emery S, Halsey D. Burnout in orthopaedic surgeons: a challenge for leaders, learners, and colleagues. J Bone Jt Surg. 2017;99(14):e78. doi:10.2106/JBJS.16.01215.
7. Smith JM, Boe EA, Will R. Physician wellness in orthopedic surgery. Orthop Clin North Am. 2021;52(1):41-52. doi:10.1016/j.ocl.2020.08.004.