The Cost of Access: Citation Disparities and Financial Burdens in Companion Open Access Orthopedic Journals

Introduction: Companion open access (cOA) journals have become prevalent in orthopedic surgery, yet citation impact, financial burden, and demographic patterns associated with cOA publishing remain poorly characterized. This study aimed to quantify APC costs and revenue, compare citation rates between traditional and cOA journals, and examine whether gender, geographic origin, or career stage influence cOA publication likelihood.Methods: A retrospective bibliometric analysis of articles published between 2015 and 2024 in 34 orthopedic journals (17 traditional-companion pairs) was conducted using the Scopus API. Author gender was inferred via name-based algorithm; geographic origin was classified by World Bank income categories. Citations were analyzed using Mann-Whitney U tests, t-tests, and negative binomial regression. Logistic regression identified independent predictors of cOA publication. APC data were obtained from OpenAPC and publisher websites.Results: Of 63,994 articles analyzed, 47,960 (74.9%) were in traditional journals and 16,034 (25.1%) in cOA journals. Traditional articles received significantly more citations (mean 23.95 vs. 10.73; p<0.001), persisting after multivariable adjustment. LMIC authors were more likely to publish in cOA venues (aOR 1.273, p=0.0003), while gender showed no independent association (aOR 0.971, p=0.492). Mean APC was $918.40, with total estimated revenue of $15.6 million over the study period.Conclusion: cOA orthopedic journals generated over $15.6 million in APCs while producing articles with substantially fewer citations than traditional journals. LMIC authors were disproportionately represented in cOA venues. This raises concerns about the value and equity of the current cOA model and highlight the need for greater transparency in editorial transfer criteria and fee structures.