Background: Despite widespread acceptance of the importance of diversity in leadership, systemic challenges in leadership attainment in orthopaedic surgery still exist for several groups. We hypothesize that women, underrepresented in medicine groups, and Asians have decreased odds of achieving program director and chairperson positions compared with peers., Methods: Demographic data were collected from the Association of American Medical Colleges for faculty, program directors, and chairpersons in orthopaedic surgery. Odds ratios were calculated treating race, ethnicity, or sex as the predictor variables and attainment of a leadership position as the outcome, comparing the composition of program directors in 2020 and chairpersons in 2019 with faculty in 2019., Results: Significantly decreased odds were found for women at 0.37 (0.264 to 0.51 [ P < 0.0001]) and the Other category at 0.16 (0.065 to 0.3864 [ P = 0.0001]) while significantly increased odds were found for White and Black/African American faculty at 1.32 (1.02 to 1.71 [ P = 0.0314]) and 1.95 (1.17 to 3.26 [ P = 0.011]), respectively, in holding program director positions. Significantly decreased odds of attaining chairpersonship were found for women at 0.17 (0.07 to 0.41 [ P = 0.0075]) and Asian faculty at 0.33 (0.14 to 0.75 [ P = 0.0062]) while White faculty demonstrated significantly increased odds at 2.43 (1.41 to 4.19 [ P = 0.0013])., Conclusions: Women showed markedly decreased odds of leadership attainment while Black/African American faculty had increased likelihood of becoming program directors but were not markedly more likely to become chairs. Asian faculty were less likely to become program directors and markedly less likely to become chairs. While decreased odds for women were expected based on current literature, decreased odds of Asians becoming chairs and an increased likelihood of Black/African American orthopaedic surgeons becoming program directors but not attaining the role of chairs at the same rate were novel findings, revealing concerning trends for these groups., (Copyright © 2024 by the American Academy of Orthopaedic Surgeons.)