Variable Practice Patterns and Variation Among Orthopaedic Surgeons Specializing in Pediatric Sports Medicine

Abstract

Introduction:Pediatric sports medicine is a growing subspecialty within orthopedic surgery. However, there is very limited literature on the practice of pediatric sports medicine in North America.Purpose:To evaluate and describe the current practice patterns of orthopedic surgeons specializing in pediatric sports medicine via survey of PRiSM (Pediatric Research in Sports Medicine Society) members.Methods:An online survey was distributed to orthopaedic surgeons specializing in pediatric sports medicine through PRiSM in April 2021. The survey was designed to (1) characterize respondent demographics (practice focus on pediatric vs. adult, fellowship training, years in practice, location), (2) characterize the breakdown of different joint specialization, and (3) determine the most common procedures across different joints that the respondent specializes in. Specialization was defined as composing ≥ 25% of a respondent’s practice. Commonly operated joints were defined as composing ≥5% of their practice.Results:Responses from 55 orthopedic surgeons were collected and analyzed. The majority of respondents considered pediatric sports medicine as the primary focus of their practice (89.1%, n=49/55). The number of fellowships completed was almost evenly split between either a single fellowship (52.7%, 29/55) or two or more (47.3%, 26/55). The most common combination of fellowships was pediatric orthopaedics and adult sports medicine (32.7%, 18/55). The majority of survey respondents have been in practice for <10 years (69.0%, 38/55), were affiliated with an academic center (61.8%, 34/55), and utilized non-operative providers as a part of their practice (66.6%, 36/54). On average, 77.5% of patients treated were skeletally immature. Overall, 54.5% of respondents reported specializing in one joint and 41.8% specialized in two. Surgeons commonly operated on a mean of 3 joints. The knee was the most commonly specialized joint (composing a mean of 52.1% of an overall practice), followed by the shoulder (15.2%), hip (13.9%), ankle (7.5%), elbow (7.1%), and wrist (4.2%) (Table 1). Interestingly, 87.3% (48/55) commonly operate on the shoulder but only 21.8% (12/55) were specialists. Conversely, the hip had a similar amount of specialization (23.6%, 13/55) but 56.3% (31/55) reported that they rarely operated on the hip.Conclusions:Pediatric sports medicine practices in orthopaedic surgery are quite variable. The majority of surgeons are <10 years into practice, affiliated with academic centers and have typically completed either 1 or 2 fellowships after residency. The majority of patients are skeletally immature. Most surgeons specialize in one or two joints, most commonly the knee, followed by hip and then shoulder.Table 1.Distribution of joints that make up individuals’ practice (n=55).Figure 1:Number of joints commonly operated on. Joint options were the knee, shoulder, hip, andkle, elbow and wrist. Commonly operated on was defined as composing >5% of total practice.