Characteristics of Industry Payments to Orthopaedic Surgeons, 2017 to 2023

Background: Industry relations with orthopaedic surgeons may help drive innovation but may also influence surgeons. These relations and payments to physicians have come under public scrutiny, leading to the creation of the Open Payments Database to provide a degree of financial transparency. From this database, it has been shown that orthopaedic surgeons receive the most industry payments among medical specialties. The purpose of this study was to characterize payments to orthopaedic surgeons. Methods: We analyzed industry payments made to orthopaedic surgeons from 2017 to 2023 using the Open Payments Database. Payments were categorized by type, manufacturer, and associated product. Descriptive statistics were used to evaluate payment concentration among physicians, manufacturers, and product types. Results: A total of 2,168,886 payments amounting to $4,544,769,649 were made to 35,658 unique orthopaedic surgeons. Payments declined by 17.3% from 2019 to 2020, coinciding with the COVID-19 pandemic, and have not reached 2019 values since. Payments were highly concentrated, with the top 1% of recipients receiving 77.4% of payment value. The highest-value categories were royalties and licenses (63.0% of total value), followed by consulting fees (13.6%). The most common payment category was food and beverage (66.3% of transactions), although this only accounted for 1.9% of total payment value. The top 15 companies were responsible for 81.3% of total payments. Conclusions: The relationship between industry and orthopaedic surgeons remained strong between 2017 and 2023 with the largest value of payments related to royalties and licenses. The Open Payments Database provides transparency regarding the nature of the relationship between industry and physicians, but additional research regarding the impact of these payments is required. Level of Evidence: Level IV , retrospective cohort analysis. See Instructions for Authors for a complete description of levels of evidence.