A Systematic Review to Assess Gender Diversity in Authorship Within the Orthopaedic Surgery Literature.

Background: Gender diversity trends in orthopaedic research are dynamic. While an increase of women in orthopaedics has been observed, gender imbalances continue to exist, especially in academic leadership and research roles. The purpose of our study was to assess the representation of women in authorship roles over a 20-year period. Methods: We conducted a systematic review of clinical research studies published in The Journal of Bone and Joint Surgery and The Bone and Joint Journal between 1996-2000 and 2016-2020. First, corresponding and last author gender was determined using a combination of automated name analysis and manual searches. We performed chi-squared tests to assess differences in the proportion of women in each authorship position across time periods, journals, and orthopaedic subspecialties. Results: Women represented 12.4% of first authors, 8.1% of last authors and 10.5% of corresponding authors. The proportion of women in first and corresponding author positions increased over time (p < 0.001 and p < 0.001 respectively) while there was no difference for last author position (p = 0.572). No differences were found when comparing last authors across the subspecialties (p = 0.149 respectively); however, there was a difference for first and corresponding authors (p = 0.019 and p = 0.024 respectively), with the highest proportion of women reported in general orthopaedics (19.0% and 17.7% respectively) and lowest in sports medicine (8.1%) and lower extremity (6.6%). Conclusion: This study found improvements in the representation of women in first and corresponding author roles, however significant gaps remain, particularly in leadership positions represented by last author position. Continued monitoring and intervention are essential to promote long-term, meaningful change in the field.