Trends in Gender Disparities in Authorship of Arthroplasty Research

Background: Despite efforts to address gender disparities in medicine, female representation in orthopaedics lags behind that of other fields, and little work has evaluated gender disparities within the subspecialty of arthroplasty surgery. The objective of this study was to analyze female authorship trends in arthroplasty research from 2002 to 2019. Methods: Articles published from 2002 to 2019 in 12 clinical orthopaedic and arthroplasty journals were extracted from PubMed. Articles that provided the full name of the first author and contained the terms "arthroplasty," "hip replacement," "knee replacement," or "joint replacement" in the title and/or as keywords were analyzed. The gender of the author was determined with the validated Genderize algorithm, and publication trends were analyzed over time. Descriptive and comparative statistics were computed, and logistic regression was used to evaluate gender trends. Results: From 2002 to 2019, 14,692 articles met the inclusion criteria, and the gender of 63,628 authors was identified. There were 23,626 unique authors; 4,003 (16.9%) were women and 19,623 (83.1%) were men. Female involvement in arthroplasty publications increased from 11.1% in 2002 to 12.6% in 2019 (p < 0.001), and the percentage of female first authors increased from 5.0% in 2002 to 11.3% in 2019 (p < 0.001). Critically, however, the proportion of women as senior authors significantly declined from 8.5% in 2002 to 6.2% in 2019 (p < 0.001). From our analysis of U.S. publications with physician senior authors, the proportion of female senior authors remained relatively stable from 1.7% in 2002 to 2.4% in 2019 without a significantly increasing trend (p = 0.88). Overall, on average, women published a mean (and 95% confidence interval) of 1.9 +/- 0.1 publications, while men published 2.9 +/- 0.1 publications (p < 0.001). The proportion of female senior authors in arthroplasty publications (6.6%) was lower than that of other orthopaedic subspecialties such as sports medicine (9.2%), spine (13.6%), and foot and ankle (13.1%). Conclusions: While overall female representation and first authorship in arthroplasty literature have increased over time, the paucity of women in senior author roles remains troubling. Future studies should examine why the proportion of women publishing in arthroplasty remains lower than that in most other orthopaedic subspecialties.