Abstract The rapid migration of total joint arthroplasty from hospitals to ambulatory surgery centers (ASCs) represents one of the most consequential structural changes in contemporary orthopaedics in the United States. In parallel, surgeon equity ownership in ASCs has expanded, aligning clinical decision-making with financial participation. Although surgeon ownership is legal, common, and often associated with efficiency and innovation, it introduces complex questions regarding transparency, case selection, and public trust. As higher-risk patients remain hospital-based while lower-risk patients migrate to ASCs, outcome comparisons may become distorted, and incentives may be less visible. Current disclosure practices and benchmarking frameworks have not evolved to reflect these structural shifts. This article argues that surgeon ownership in the ASC era necessitates updated safeguards, including standardized ownership disclosure, risk-adjusted site-of-service reporting, independent case review mechanisms, and transparent equity life-cycle planning. Proactive governance, rather than reactionary regulation, is essential to preserve professionalism and patient trust as ambulatory arthroplasty continues to expand.
Siddiqi et al. (Fri,) studied this question.
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