Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio.
Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio.
J Bone Joint Surg Am. 2023 Jul 5;105(13):1038-1045. doi: 10.2106/JBJS.22.00874. Epub 2023 Mar 10.
Orthopaedic practices in the U.S. face a growing demand for total joint arthroplasties (TJAs), while the orthopaedic workforce size has been stagnant for decades. This study aimed to estimate annual TJA demand and orthopaedic surgeon workforce supply from 2020 to 2050, and to develop an arthroplasty surgeon growth indicator (ASGI), based on the arthroplasty-to-surgeon ratio (ASR), to gauge nationwide supply and demand trends.
National Inpatient Sample and Association of American Medical Colleges data were reviewed for individuals who underwent primary TJA and for active orthopaedic surgeons (2010 to 2020), respectively. The projected annual TJA volume and number of orthopaedic surgeons were modeled using negative binominal and linear regression, respectively. The ASR is the number of actual (or projected) annual total hip (THA) and/or knee (TKA) arthroplasties divided by the number of actual (or projected) orthopaedic surgeons. ASGI values were calculated using the 2017 ASR values as the reference, with the resulting 2017 ASGI defined as 100.
The ASR calculation for 2017 showed an annual caseload per orthopaedic surgeon (n = 19,001) of 24.1 THAs, 41.1 TKAs, and 65.2 TJAs. By 2050, the TJA volume was projected to be 1,219,852 THAs (95% confidence interval [CI]: 464,808 to 3,201,804) and 1,037,474 TKAs (95% CI: 575,589 to 1,870,037). The number of orthopaedic surgeons was projected to decrease by 14% from 2020 to 2050 (18,834 [95% CI: 18,573 to 19,095] to 16,189 [95% CI: 14,724 to 17,655]). This would yield ASRs of 75.4 THAs (95% CI: 31.6 to 181.4), 64.1 TKAs (95% CI: 39.1 to 105.9), and 139.4 TJAs (95% CI: 70.7 to 287.3) by 2050. The TJA ASGI would double from 100 in 2017 to 213.9 (95% CI: 108.4 to 440.7) in 2050.
Based on historical trends in TJA volumes and active orthopaedic surgeons, the average TJA caseload per orthopaedic surgeon may need to double by 2050 to meet projected U.S. demand. Further studies are needed to determine how the workforce can best meet this demand without compromising the quality of care in a value-driven health-care model. However, increasing the number of trained orthopaedic surgeons by 10% every 5 years may be a potential solution.
美国的骨科医疗机构面临着全关节置换术（TJA）需求不断增长的局面，而骨科劳动力规模已经停滞了几十年。本研究旨在从 2020 年到 2050 年，根据关节置换术与外科医生的比例（ASR），估计 TJA 的年度需求和骨科外科医生的劳动力供应，并开发一个关节置换术外科医生增长指标（ASGI），以衡量全国范围内的供需趋势。
对接受初次 TJA 的患者和在职骨科医生的全国住院患者样本和美国医学院协会的数据进行了回顾（分别为 2010 年至 2020 年）。使用负二项式和线性回归分别对预计的 TJA 年度量和骨科外科医生数量进行建模。ASR 是实际（或预计）每年全髋关节置换术（THA）和/或膝关节置换术（TKA）的数量除以实际（或预计）骨科外科医生的数量。ASGI 值使用 2017 年的 ASR 值进行计算，以 2017 年的 ASGI 值为参考，2017 年的 ASGI 值定义为 100。
2017 年 ASR 计算显示，每位骨科外科医生的年度病例数（n=19,001）为 24.1 例 THA、41.1 例 TKA 和 65.2 例 TJA。到 2050 年，预计 TJA 量将达到 1,219,852 例 THA（95%置信区间[CI]：464,808 至 3,201,804）和 1,037,474 例 TKA（95%CI：575,589 至 1,870,037）。预计到 2050 年，骨科外科医生的数量将减少 14%（从 2020 年的 18,834 人（95%CI：18,573 人至 19,095 人）到 2050 年的 16,189 人（95%CI：14,724 人至 17,655 人））。这将导致到 2050 年，ASR 为 75.4 例 THA（95%CI：31.6 至 181.4）、64.1 例 TKA（95%CI：39.1 至 105.9）和 139.4 例 TJA（95%CI：70.7 至 287.3）。到 2050 年，TJA 的 ASGI 将从 2017 年的 100 增加到 213.9（95%CI：108.4 至 440.7）。
根据 TJA 量和在职骨科外科医生的历史趋势，到 2050 年，每位骨科外科医生的平均 TJA 病例量可能需要翻一番，以满足美国的预计需求。需要进一步研究如何在以价值为导向的医疗保健模式下，在不影响护理质量的情况下，使劳动力能够最好地满足这一需求。然而，每 5 年增加 10%的受过培训的骨科外科医生可能是一个潜在的解决方案。
