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Gender Research Gap in Orthopaedics and Trauma Surgery: Gender-specific Disparities in Submission of Abstracts to the German Congress of Orthopaedic and Trauma Surgery from 2015 to 2024 Open PDF
(Georg Thieme Verlag KG, 2025-04-30)
Vogel, Carolina
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Bertsch, Vera
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Rollmann, Mika F.
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Histing, Tina
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Braun, Benedikt J.
Gender-specific differences also affect the subject of orthopaedics and trauma surgery (O&T). While the proportion of women studying medicine is steadily increasing, the proportion of female surgeons in O&T is only 18.6%. This underrepresentation affects not only clinics but also research and is reflected in participation in scientific annual meetings such as the German Congress for Orthopaedics and Trauma Surgery (DKOU).This retrospective study examined the gender differences in abstract submissions to the DKOU from 2015 to 2024. The anonymised data were subjected to examination regarding gender, role in submission and academic title.The overall participation of women in the 82,813 abstracts was 20%. The proportion of women among submitters was 23.3%, among presenters 24.5% and among co-authors 18.2%. In the analysis of the female cohort alone, women were more likely to be submitters and presenters than in the male cohort (p < 0.001). The proportion of female participation in abstract submissions increased by an average of 0.5% per year over the study period. However, women were significantly underrepresented at higher academic degrees, such as habilitations (7.4%), professorships (7.6%) and university professorships (5.2%).The results show that the proportion of women submitting abstracts to the DKOU largely corresponds to the percentage in the field of orthopaedics and trauma surgery (18.6% in 2022), reflecting the overall gender disparity in this specialty. If this trend analysis were applied to the general development of gender parity in orthopaedics and trauma surgery, gender-equitable staffing of medical positions could not be achieved before the year 2087. To accelerate this development, targeted measures to promote women in orthopaedics and trauma surgery are necessary. This includes dismantling structural barriers and implementing specific support programs for female surgeons pursuing academic careers.
Sex and Gender Considerations in Orthopaedic Research Open PDF
(Ovid Technologies (Wolters Kluwer Health), 2024-10-08)
Bechtold, Joan E.
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Bauer, Thomas W.
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Clayton, Janine
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Foucher, Kharma C.
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Graves, Leland
JBJS convened a symposium to discuss the reporting of sex and gender in research studies as an imperative to improve research methods and results to benefit all patients. Barriers to improved reporting include a lack of societal and cultural acceptance of its need; a lack of education regarding appropriate terminology and appropriate statistical methods and efficient study designs; a need for increased research funding to support larger group sizes; unknown concordance of cell and animal models with humans to reflect biologic variables such as sex; and a lack of understanding of key considerations of gender, race, and other social determinants of health and how these factors intersect. Attention to developing and disseminating best-practice statistical methods and to educating investigators (at all career levels), reviewers, funders, editors, and staff in their proper implementation will aid reporting. Concomitantly, well-designed studies with sufficient rigor and adequate resources are essential to enable meaningful and reproducible research. Existing recommendations, such as the Sex and Gender Equity in Research (SAGER) guidelines, provide valuable guidance that can be applied across the research ecosystem. Academic institutions and private foundations are likely groups to assist in scientific and institutional review board guidance and study recruitment and pilot funding to generate meaningful power estimates, and to serve as sources for additional funding and presentation of workshops, educational events, and seminars. All of this needs to be conducted on an ongoing basis to ensure that sex and gender are considered in scientific analyses, where relevant.
What Are the Rates and Trends of Women Authors in Three High-impact Orthopaedic Journals from 2006-2017? Open PDF
(2020)
Hiller, Kathryn P.
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Boulos, Alexandre
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Tran, Megan M.
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Cruz, Aristides I.
BACKGROUND: The gender gap among authors publishing research in journals is narrowing in general medicine and various medical and surgical subspecialties. However, little is known regarding the gender gap among authors publishing research in orthopaedic journals. QUESTIONS/PURPOSES: (1) What is the proportion of women first and last authors of original research articles in three high-impact orthopaedic journals from 2006 to 2017? (2) What is the proportion women first authors of original research by orthopaedic subspecialty from 2006 to 2017? METHODS: A sample of original research publications from the even numbered months of issues of Clinical Orthopaedics and Related Research® (CORR®), the Journal of Bone and Joint Surgery, American volume (JBJS), and the American Journal of Sports Medicine (AJSM) were examined from 2006 to 2017. These journals were selected because of their clinical relevance, target audience, and relatively high impact factors. Over the studied period, a single author extracted and reviewed pertinent data, including the gender of the first and last authors and the primary subspecialty of the research article. The senior author refereed disputes regarding the primary subspecialty of each included article. The proportion of women first and last authors in each journal was compared between 2006 to 2017 using chi-square analysis. The proportion of women first authors according to orthopaedic subspecialty in which an article primarily focused its study was also compared between 2006 to 2017 using chi-square analysis. RESULTS: Data were collected from 6292 articles, 13% (800) of which were first-authored by women and 10% (604) of which were last-authored by women. From 2006 to 2017, the overall percentage of women first authors in the examined journals increased (from 11% in 2006 to 17% in 2017; odds ratio 1.6563 [95 % CI 1.4945 to 1.8356]; p < 0.001). Overall across the period studied, the percentage of women first authors in JBJS was 14% while 12% of first authors in CORR and AJSM were women. Regarding subspecialty, the percentage of women first authorship ranged from 9% in the shoulder subspecialty to 21% in pediatric orthopaedics across all three journals. CONCLUSIONS: There has been an increase in the percentage of women first authors in articles published in three high-impact orthopaedic journals from 2006 to 2017. This observed increase is encouraging in terms of promoting gender diversity in orthopaedics and may be reflective of a modest increase in the number of women entering the orthopaedic workforce. CLINICAL RELEVANCE: Between 2006 and 2017, the overall number of women first authors in CORR, JBJS, and AJSM modestly increased. This may suggest a nascent narrowing of the gender gap in orthopaedics. Although this is a welcome finding in terms of promoting and encouraging gender diversity in this man-dominated field, the overall percentage of women authorship remains modest, at best. Future investigations should examine whether the modest increase in women first authorship over time found in this study translates into an increased percentage of senior/last authorship in the future, as this may have implications for women orthopaedic workforce retention.
Trends in Gender Disparities in Authorship of Arthroplasty Research Open PDF
(2020)
Xu, Raylin F.
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Varady, Nathan H.
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Chen, Antonia F.
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.
How Well Represented Are Women Orthopaedic Surgeons and Residents on Major Orthopaedic Editorial Boards and Publications? Open PDF
(2020)
Rynecki, Nicole D.
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Krell, Ethan S.
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Potter, James S.
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Ranpura, Akash
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Beebe, Kathleen S.
BACKGROUND: Recent studies indicate that women are substantially underrepresented as orthopaedic surgeons and residents compared with other specialties in medicine and medical school. The reasons for this are multifactorial and not completely understood, but previous studies suggest that women may be attracted to fields in which they have female role models. Given that women interested in academia and research may use female editorship and authorship as a proxy for female representation in orthopaedic surgery, we wanted to examine the proportion of women represented in orthopaedic journals and determine if it reflects the distribution of women in orthopaedic surgery as a field. We further wanted to understand if this representation has changed over time in the setting of a slowly shifting gender landscape within orthopaedic surgery. QUESTIONS/PURPOSES: (1) How are women orthopaedic surgeons and residents represented in orthopaedic journals compared with men? (2) Have these proportions changed in the past two decades in light of relatively new efforts to recruit women to the field of orthopaedic surgery? METHODS: The gender composition of editorial boards and first and last authors were obtained from the 1997, 2007, and 2017 volumes of the following journals: The Journal of Bone & Joint Surgery (JBJS), the Journal of the American Academy of Orthopaedic Surgeons (JAAOS), and Clinical Orthopaedics and Related Research® (CORR®). Gender neutral names were searched to obtain a picture to ensure proper tallies. RESULTS: The total combined amount of women first and last authors increased from 88 of 1450 (6%) in 1997 to 152 of 1912 (8%) in 2007 to 723 of 5391 (13%) in 2017. Similarly, three of 113 (3%) editorial board members were women in 1997, three of 105 (3%) were women in 2007 and 10 of 107 (9%) editors were women in 2017. Of note, 0 out of 9 editors-in-chief were women. CONCLUSIONS: Based on the current percentage of women orthopaedic surgeons and residents, women are represented equally or in greater numbers as editors and authors in JAAOS, JBJS, and CORR. This may be in part due to women orthopaedic surgeons entering academic medicine at a greater rate than males. CLINICAL RELEVANCE: Orthopaedic surgeons serving as mentors to prospective female applicants can cite female representation on editorial boards and as authors as an example of gender parity in the field. Additionally, active orthopaedic surgeons who are women interested in these leadership positions should be encouraged that these opportunities exist, regardless of gender.
Academic musculoskeletal radiology: influences for gender disparity Open PDF
(2018)
Qamar, S.R.
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Khurshid, K.
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Jalal, S.
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Bancroft, L.
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Munk, P.L.
Introduction: Research productivity is one of the few quintessential gauges that North American academic radiology departments implement to determine career progression. The rationale of this study is to quantify the relationship of gender, research productivity, and academic advancements in the musculoskeletal (MSK) radiology to account for emerging trends in workforce diversity. Methods: Radiology residency programs enlisted in the Fellowship and Residency Electronic Interactive Database (FREIDA), Canadian Resident Matching Service (CaRMS) and International Skeletal Society (ISS) were searched for academic faculty to generate the database for gender and academic profiles of MSK radiologists. Bibliometric data was collected using Elsevier’s SCOPUS archives, and analyzed using Stata version 14.2. Results: Among 274 MSK radiologists in North America, 190 (69.34%) were men and 84 (30.66%) were women, indicating a statistically significant difference (χ2 = 6.34; p value = 0.042). The available number of female assistant professors (n = 50) was more than half of the male assistant professors (n = 88), this ratio however, plummeted at higher academic ranks, with only one-fourth of women (n = 11) professors compared to men (n = 45). The male MSK radiologist had 1.31 times the odds of having a higher h-index, keeping all other variables constant. Conclusions: The trend of gender disparity exists in MSK radiology with significant underrepresentation of women in top tiers of academic hierarchy. Even with comparable h-indices, at the lower academic ranks, a lesser number of women are promoted relative to their male colleagues. Further studies are needed to investigate the degree of influence research productivity has, in determining academic advancement of MSK radiologists. © 2017, ISS.
Potential Sex Bias Exists in Orthopaedic Basic Science and Translational Research Open PDF
(2018)
Bryant, Jessica
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Yi, Paul
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Miller, Liane
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Peek, Kacy
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Lee, Daniel
BACKGROUND: Potential sex bias has been shown in general surgery basic science and translational research, with unequal representation of male and female specimens. Because basic science research forms the foundation for clinical studies on which patient care is based, it is important that this research equally consider both sexes. The purpose of this study was to determine if potential sex bias exists in the basic science and translational orthopaedic literature. METHODS: A systematic review was conducted of all articles published in 2014 in The Journal of Bone & Joint Surgery, Clinical Orthopaedics and Related Research, The Bone & Joint Journal, and the Journal of Orthopaedic Research (JOR). All original research articles utilizing animals, cells, or cadavers were included. The data abstracted included study type, sex of specimen studied, and presence of sex-based reporting of data. A second review was performed of all basic science articles published in JOR in 1994, 2004, and 2014 to compare sex bias trends across 3 decades. Distributions of variables were compared using the Fisher exact test, with significance defined as p < 0.05. RESULTS: Of 1,693 articles reviewed, 250 (15%) were included: 122 animal-based studies (49%), 71 cell-based studies (28%), and 57 human cadaver-based studies (23%). Overall, authors in 88 studies (35%) did not report the sex of animals, cells, or cadavers used. Of 162 studies in which the authors did report sex, 69 (43%) utilized male only, 40 (25%) utilized female only, and 53 (33%) utilized both sexes. Of those studies that used both sexes, authors in only 7 studies (13%) reported sex-based results. A subanalysis of JOR articles across 3 decades revealed a significant increase in studies specifying sex (p = 0.01) from 2004 to 2014. CONCLUSIONS: Potential sex bias exists in orthopaedic surgery basic science and translational research, with an overrepresentation of male specimens. CLINICAL RELEVANCE: Inequality in sex representation must be addressed as basic science and translational research creates the foundation for subsequent clinical research, which ultimately informs clinical care.
Despite Growing Number of Women Surgeons, Authorship Gender Disparity in Orthopaedic Literature Persists Over 30 Years Open PDF
(2020)
Brown, Meghan A.
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Erdman, Mary Kate
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Munger, Alana M.
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Miller, Anna N.
BACKGROUND: The most recent demographic data reveal that only 6.5% of practicing orthopaedic surgeons are women, and as far as we know, only two women have held chair positions in academic orthopaedic programs in the United States. Furthermore, orthopaedic surgery is the least gender-diverse speciality recognized by the Accreditation Council for Graduate Medical Education. The factors that contribute to the lack of gender diversity in orthopaedics remain ill-defined. A lag in publication productivity may be a barrier to career advancement for women orthopaedic surgeons, but this has not been well studied. QUESTIONS/PURPOSES: (1) What is the proportion of orthopaedic studies published in six major orthopaedic journals by women first or senior authors from 1987 to 2017? (2) Did men and women orthopaedic surgeons publish in equal proportions during the study period (measured in 5-year intervals)? (3) Are there differences in the characteristics (such as study type or subject focus) of orthopaedic publications authored by women and those authored by men? (4) Has the increased proportion of practicing women orthopaedic surgeons been matched by an equal increase in authorship by women orthopaedic surgeons during the study timeframe? METHODS: A cross-sectional analysis was designed to characterize trends in authorship of orthopaedic studies by women over time. All publications from the first issue of each of six major orthopaedic journals were evaluated at seven time points (1987, 1992, 1997, 2002, 2007, 2012, and 2017). Characteristics of each first and senior author (including gender, academic degree, and specialty), and study category of each publication were collected. Articles for which this information was not available were excluded (35 of 1073, or 3.3% of published studies, no difference in proportion of excluded studies between journals). The proportions of women and men authors were compared at the seven time points and for six study categories (basic science, case report/technique article, clinical medicine, economics/practice management, editorial content [including true editorials, letters to the editor, commentaries, and book reviews] and review/meta-analysis) using a Fisher's exact test or chi-squared analysis. We compared the rates of change of women authorship, practicing women orthopaedic surgeons, and women orthopaedic residents during the study period using an ANOVA and Tukey's honestly significant difference (HSD) post-hoc test with Cohen's D measure of effect size. RESULTS: From 1987 to 2017, only 1.7% (15 of 880) of senior authors and 4.4% (46 of 1038) of first authors of orthopaedic publications were women orthopaedic surgeons. Based on population proportions (that is, percent of practicing women orthopaedic surgeons compared with men), the proportion of women senior authors was less than would be expected at each time point after 1987 compared with men. There were no differences between the types of studies authored by women or men. Finally, during the study period, the rate of growth of women senior authorship was less than the rates of growth of both practicing women orthopaedic surgeons (d = 5.3, 95% CI, 4.8-5.6; p = 0.023) and women first authorship (d = -4.3, 95% CI -4.6 to -3.6, p = 0.030; estimated mean 3.3, p = 0.013). CONCLUSIONS: Women orthopaedic surgeons published a small proportion of academic orthopaedic research from 1987 to 2017, and women senior authors consistently published less than would be expected based on their population proportion compared with men orthopaedic surgeons. Furthermore, the growth of practicing women orthopaedic surgeons has not been matched by growth in senior authorship by women over the same timeframe. CLINICAL RELEVANCE: This discrepancy warrants further exploration because a low rate of publication may negatively impact the career advancement of women orthopaedic surgeons and contribute to the overall lack of gender diversity in orthopaedics. We suggest that journals and publishers review their editorial processes to ensure blinding of author names during peer review and editorial decision-making, and to disclose those review processes to authors. We also suggest that institutions encourage women trainees and junior faculty to participate in mentorship programs and specialty societies that promote academic productivity.

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