Private Equity in Orthopaedics: An Analysis of Practice Acquisitions, 2016 to 2023.

Introduction: Private equity (PE) has had an increasing influence in health care, including procedural subspecialties such as orthopaedic surgery. No studies yet have characterized the orthopaedic practices that are acquired by PE firms. Methods: This cross-sectional study analyzed PE acquisitions of orthopaedic practices in the United States between January 1, 2016, and December 31, 2023. A combination of PitchBook and manual web searches was used to identify PE acquisitions. The Medicare Data on Provider Practice and Specialty were used to identify Tax Identification Numbers of practices and the unique providers of each practice at time of affiliation. Results: Eighty-nine orthopaedic practices were identified from 2016 to 2023, accounting for 4.8% of orthopaedists by 2023. More than three-quarters of acquisitions took place from 2021 to 2023 (77.5%). Nearly half of acquisitions were in the South (47.2%). At time of acquisition, 36.6% of providers in the practices were surgeons, 10.0% were nonsurgical physicians, and 53.4% were ancillary providers, such as advanced practice providers and therapists. The most represented subspecialties included sports (24.8%) and arthroplasty (18.2%), and the least represented were pediatrics (0.7%) and tumor (0.3%). Conclusion: PE involvement in orthopaedics skyrocketed in 2021. Practices targeted by PE firms typically included a multidisciplinary mix of providers, more than half of whom were nonphysician adjuncts, with a geographic predilection for the South. Orthopaedic subspecialties with historically higher reimbursements and outpatient volumes were overrepresented in PE-acquired practices. Future work should examine the resulting influence of PE in orthopaedics, including provider turnover, practice patterns, and clinical outcomes. Level of Evidence: Level III. See Instructions for Authors for a complete description of levels of evidence.