INTRODUCTION: The academic impact of open access publications compared with conventional publications in orthopaedic surgery is not well described. The primary objective of this study was to compare the number of academic citations and social media posts between recent conventional and open access publications in orthopaedic surgery. Secondary objectives of this study were (1) to determine the correlation between academic citations and social media posts and (2) to study the trend of academic citations and social media posts over time. METHODS: An internet-based study was performed on 3,720 articles from five high-impact orthopaedic journals and their associated open access journals from March 2017 to February 2019, including 2,929 conventional and 791 open access journal publications. Academic citations were quantified using Google Scholar and Web of Science, and social media mentions using Twitter. The Mann-Whitney U test was used for comparisons of nonparametric data, and the Spearman rank correlation coefficient was calculated for correlations. RESULTS: The average number of academic citations per article was 10.1 on Google Scholar and 6.0 on Web of Science. The average number of Twitter posts per article was 1.6. Conventional publications had markedly more citations than open access publications on Google Scholar and Web of Science. Open access publications had markedly more Twitter posts, but the effect size was small and unimportant. Academic citations were weakly correlated with social media posts. On average, orthopaedic publications accrue 7.4 citations per year on Google Scholar and 4.6 citations per year on Web of Science. DISCUSSION: Our findings support a citation advantage to conventional publication. Publications in open access journals are cited less frequently and less rapidly compared with those in conventional journals. The use of social media for orthopaedic research is effectively equivalent between conventional and open access journals and continues to grow. LEVEL OF EVIDENCE: N/A.