Future Demand for Total Joint Arthroplasty Drives Renewed Interest in Arthroplasty Fellowship

  • Matthew SloanEmail author
  • Ajay Premkumar
  • Neil P. Sheth
Original Article



Total joint arthroplasty (TJA) procedure volume has increased continuously in the USA, but prior reports have suggested that orthopedic surgeon supply may not meet future demand due to retirement and waning interest in arthroplasty fellowships.


We sought to evaluate trends in growth in the number of orthopedic surgeons, orthopedic residents, and arthroplasty fellowships, in order to predict changes in future TJA procedure volume per surgeon.


We retrospectively reviewed data from 1995 to 2017 from the American Academy of Orthopaedic Surgeons, the National Residency Matching Program, American Osteopathic Association Residency Match, the San Francisco Match, and the National Inpatient Sample. Annual volume growth in the rate of TJA procedures and in orthopedic surgeons, residents, and fellows was determined.


TJA procedure volume increased 129%, orthopedic surgeon volume increased 15.6%, and orthopedic resident volume increased 29.4%. The percentage of filled arthroplasty fellowship positions increased from 81.9 to 96.4%, and the number of arthroplasty fellowship positions increased 33.5%. Mean surgeon age increased from 50.9 to 56.5 years. By 2030, we estimate 90.1 TJA procedures per surgeon will be performed annually, a 57% increase from 2014. Over the same time period, we project mean orthopedic surgeon age to reach 62.4 years, if current growth rate persists.


During the study period, orthopedic surgeon, resident, and arthroplasty fellow volume have increased, although at a slower rate than TJA procedure growth. Renewed interest in arthroplasty fellowships has been demonstrated by an increase in the number and near complete filling of all available positions.


total joint arthroplasty orthopedic surgeon orthopedic resident arthroplasty fellow epidemiology projection 


Compliance with Ethical Standards

Conflict of Interest

Matthew Sloan, MD, MS, and Ajay Premkumar, MD, MPH, declare that they have no conflicts of interest. Neil P. Sheth, MD, reports being a paid consultant to Zimmer, Smith & Nephew, and Medacta and receiving royalties from Elsevier, outside the submitted work.

Human/Animal Rights


Informed Consent


Required Author Forms

Disclosure forms provided by the authors are available with the online version of this article.


  1. 1.
    American Academy of Orthopaedic Surgeons (AAOS). Orthopaedic practice in the US. Rosemont: AAOS; 2002–2016.Google Scholar
  2. 2.
    Bozic KJ, Kurtz SM, Lau E, Ong K, Vail TP, Berry DJ. The epidemiology of revision total hip arthroplasty in the United States. J Bone Joint Surg Am. 2009;91(1):128–133.CrossRefGoogle Scholar
  3. 3.
    Bozic KJ, Kurtz SM, Lau E, Ong K, Chiu V, Vail TP, et al. The epidemiology of revision total knee arthroplasty in the United States. Clin Orthop Relat Res. 2010;468(1):45–51.CrossRefGoogle Scholar
  4. 4.
    Fehring TK, Odum SM, Troyer JL, Iorio R, Kurtz SM, Lau EC. Joint replacement access in 2016: a supply side crisis. J Arthroplasty. 2010;25(8):1175–1181.CrossRefGoogle Scholar
  5. 5.
    Healthcare Cost and Utilization Project (HCUP). HCUP Nationwide and National Inpatient Sample (NIS). Rockville: Agency for Healthcare Research and Quality; 2000–2014.Google Scholar
  6. 6.
    Inacio MCS, Paxton EW, Graves SE, Namba RS, Nemes S. Projected increase in total knee arthroplasty in the United States—an alternative projection model. Osteoarthritis Cartilage. 2017;25(11):1797–1803.CrossRefGoogle Scholar
  7. 7.
    Iorio R, Robb WJ, Healy WL, Berry et al. Orthopaedic surgeon workforce and volume assessment for total hip and knee replacement in the United States: preparing for an epidemic. J Bone Joint Surg Am. 2008;90(7):1598–1605.CrossRefGoogle Scholar
  8. 8.
    Jain NB, Higgins LD, Ozumba D, et al. Trends in epidemiology of knee arthroplasty in the United States, 1990–2000. Arthritis Rheum. 2005;52(12):3928–3933.CrossRefGoogle Scholar
  9. 9.
    Kim S. Changes in surgical loads and economic burden of hip and knee replacements in the US: 1997-2004. Arthritis Rheum. 2008;59(4):481–488.CrossRefGoogle Scholar
  10. 10.
    Kurtz S, Mowat F, Ong K, Chan N, Lau E, Halpern M. Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. J Bone Joint Surg Am. 2005;87(7):1487–1497.Google Scholar
  11. 11.
    Kurtz SM, Ong KL, Schmier J, et al. Future clinical and economic impact of revision total hip and knee arthroplasty. J Bone Joint Surg Am. 2007;89(Suppl 3):144–151.Google Scholar
  12. 12.
    Kurtz SM, Lau E, Ong K, Zhao K, Kelly M, Bozic KJ. Future young patient demand for primary and revision joint replacement: national projections from 2010 to 2030. Clin Orthop Relat Res. 2009;467(10):2606–2612.CrossRefPubMedCentralGoogle Scholar
  13. 13.
    Kurtz SM, Ong KL, Schmier J, Zhao K, Mowat F, Lau E. Primary and revision arthroplasty surgery caseloads in the United States from 1990 to 2004. J Arthroplasty. 2009;24(2):195–203.CrossRefGoogle Scholar
  14. 14.
    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;96(8):624–630.CrossRefGoogle Scholar
  15. 15.
    Losina E, Thornhill TS, Rome BN, Wright J, Katz JN. The dramatic increase in total knee replacement utilization rates in the United States cannot be fully explained by growth in population size and the obesity epidemic. J Bone Joint Surg Am. 2012;94(3):201–207.CrossRefPubMedCentralGoogle Scholar
  16. 16.
    Maradit Kremers H, Larson DR, Crowson CS, et al. Prevalence of total hip and knee replacement in the United States. J Bone Joint Surg Am. 2015;97(17):1386–1397.CrossRefPubMedCentralGoogle Scholar
  17. 17.
    Markit IH. 2017 update: the complexities of physician supply and demand: projections from 2015 to 2030. Washington, DC: Association of American Medical Colleges; 2017. Available from Accessed 6 Mar 2019
  18. 18.
    Singh JA. Epidemiology of knee and hip arthroplasty: a systematic review. Open Orthop J. 2011;5:80–85.CrossRefPubMedCentralGoogle Scholar
  19. 19.
    Sloan M, Premkumar A, Sheth N. Projected volume of primary total joint arthroplasty in the US, 2014 to 2030. J Bone Joint Surg Am. 2018;100(17):1455–1460.CrossRefGoogle Scholar

Copyright information

© Hospital for Special Surgery 2019

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryUniversity of PennsylvaniaPhiladelphiaUSA
  2. 2.Department of Orthopaedic SurgeryHospital for Special SurgeryNew YorkUSA
  3. 3.Department of Orthopaedic SurgeryPennsylvania HospitalPhiladelphiaUSA

Personalised recommendations