Utilisation of total hip arthroplasty in the United States by settlement type: is there equity of access?

INTRODUCTION: Total hip arthroplasty (THA) volumes continue to increase. However, little information exists regarding the number of orthopaedic surgeons and THAs performed by settlement type. This study aimed to quantify orthopaedic surgeons performing THAs across different settlement types in the United States and correlate the volume of THA per surgeon in each settlement type. METHODS: The Medicare Provider Utilization and Payment Data: Physician and Other Practitioners Dataset was queried to quantify all orthopaedic surgeons performing primary or revision THA from 2013 to 2020. Patients were classified into 4 settlement types (urban/metropolitan, micropolitan large town, small town, and rural) using Rural-urban commuting area (RUCA) codes. 2-sided Mann-Kendall tests were used to correlate surgeons' THA volumes by settlement type. RESULTS: The number of surgeons billing for primary or revision THAs ranged from 4096 to 4694 over the study period. On average, 88.1% of THAs occurred in urban/metropolitan areas, 9.6% in micropolitan areas, 1.8% in small towns, and 0.4% in rural areas. The number of orthopaedic surgeons billing for THAs significantly increased in urban/metropolitan areas over the study period. Additionally, an increasing number of THAs were performed in each settlement over the study period. CONCLUSIONS: While an increasing number of THAs were performed annually in each settlement type, there remains a mismatch between the proportion of the population residing in rural areas (20% of the United States population) and the number of surgeons performing THAs in these areas. Further research is required to understand THA surgeon distribution in the context of the projected growth of THA demand.