Knee surgery: Trends and the 50 most cited articles

Abstract

Knee Surgery is one of the most commonly performed orthopedic procedures, and a rapidly evolving area of research. A bibliographic analysis was conducted to explore the characteristics of the top 50 most cited articles in knee surgery. The Web of Science Core Collection Database was used to search for Knee AND Surgery, further refined for orthopedic surgery, yielding 1,660 articles. After inclusion and exclusion criteria were applied, the top 50 cited articles were statistically and thematically analyzed. Year of publication ranged from 1982 to 2014. The highest volume of research came from USA, with the Journal of Bone and Joint Surgery having the highest number of papers in the top 50. The most common theme of research was Knee Arthroplasty Outcomes. Our study elucidates trends and popular areas of research in the field of knee surgery, and provides researchers with an overview of areas to focus, where there is scope for high-impact original research.

Full text

[page 192] [Orthopedic Reviews 2019; 11:8322]
Knee surgery: Trends and the
50 most cited articles
David Zargaran,1Alexander Zargaran,2
Sean Lobo,3Zameer Shah1
1St. Thomas’ Hospital, London;
2Guy’s and St Thomas’ NHS Foundation
Trust, London; 3King’s College, London,
UK
Abstract
Knee Surgery is one of the most com-
monly performed orthopedic procedures,
and a rapidly evolving area of research. A
bibliographic analysis was conducted to
explore the characteristics of the top 50
most cited articles in knee surgery. The Web
of Science Core Collection Database was
used to search for Knee AND Surgery, fur-
ther refined for orthopedic surgery, yielding
1,660 articles. After inclusion and exclusion
criteria were applied, the top 50 cited arti-
cles were statistically and thematically ana-
lyzed. Year of publication ranged from 1982
to 2014. The highest volume of research
came from USA, with the Journal of Bone
and Joint Surgery having the highest num-
ber of papers in the top 50. The most com-
mon theme of research was Knee
Arthroplasty Outcomes. Our study eluci-
dates trends and popular areas of research in
the field of knee surgery, and provides
researchers with an overview of areas to
focus, where there is scope for high-impact
original research.
Introduction
The turn of the 21st Century heralded
the beginning of the fourth industrial revo-
lution. The impact of this has already had a
profound effect on healthcare, from its pro-
vision, to the exponential basis upon which
scientific research has grown and devel-
oped. The increase in accessibility has sig-
nificant ethical and moral implications,
which have previously not required analysis
and consideration. Study of critical apprais-
al explores a series of heuristics and biases
used to appraise scientific articles including
the ‘Publication Bias’. This describes the
relationship of a study being published in a
scientific journal being frequently associat-
ed with a statistically significant result.1The
implications of this have determined the
quantity of both the articles published, and
the number of times an article is cited by
others. The analysis of citations provides an
insight into both the influence and reach of
a research article, and such an evaluation
can demonstrate the key topics of interest
within a specialty. Increased awareness of
the impact of the information available to
the scientific community has led to several
new analyses of the most cited articles in a
variety of different fields.2-4 Specific to
orthopedic surgery, to our knowledge, the
authors believe this is the first evaluation of
the top 50 articles published pertaining to
knee surgery exclusively.
Materials and Methods
In June 2019, the Web of Science Core
Collection Database (Clarivate Analytics)
was searched. The initial search terms were
‘Knee’ with the Boolean string ‘AND’ and
the term ‘Surgery’. This search was then
further refined using the ‘Web of Science
Category’ Tag of ‘Orthopedics’. Results
were then ranked by number of citations,
before being evaluated for appropriateness
and relevance. Inclusion criteria required
explicit relevance to surgical intervention.
Articles were reviewed by title and abstract
by two of the authors, and in the event of a
disagreement, a third author would adjudi-
cate. Each article was assessed for author-
ship, author institution, country of origin,
year of publication and name of journal.
Each title and abstract were then tagged by
subject area to assess which topics received
the most discussion.
Results
A total of 1,660 articles were identified,
with the top 50 articles related to surgical
intervention included in the results (Table
1).5-54 A total of 11 articles were excluded,
having not met with the inclusion criteria.
The total number of citations ranged from
1,407 to 274, with the most cited article
titled: Evaluation of knee ligament surgery
results with special emphasis on use of a
scoring scale, published in 1982. However,
the most recurring theme within the top 50
most cited knee surgery articles pertained to
the outcomes of knee arthroplasty (Figure
1). The articles were then assessed for date
of publication, with the highest frequency
of citations of the top 50 papers occurring in
2007 (n=15) (Figure 2).
Evaluating the papers based on country
of origin demonstrated that the United
States of America had n=22 of the 50 most
cited articles in knee surgery (Figure 3).
Furthermore, the Journal of Bone and Joint
Surgery had n=16 out of the top 50 most
cited articles in knee surgery (Table 2).
Figure 4 illustrates the top 50 most cited
articles in knee surgery by journal.
Discussion
Research forms the basis upon which
advances in medicine and surgery are pro-
posed, evaluated, and disseminated.
However, within surgery, research has often
attracted criticism for both the difficulties in
reproducibility, lack of methodological
robustness, and logistical difficulties in
organizing randomized controlled trials
(RCTs). More attempts have been made to
improve both the quality and the quantity of
research, and this is evidenced by the devel-
opment of frameworks such as CONSORT
and IDEAL to help standardize the
approach to research within surgery.55 As a
result, the increased quantity of surgical
research specifically within orthopedics has
led to a proliferation of publications within
the field, with 27 of the 50 most cited arti-
Orthopedic Reviews 2019; volume 11:8322
Correspondence: David Zargaran, St Thomas’
Hospital, Westminster Bridge Rd, Lambeth,
London SE1 7EH, UK.
Tel.: +44.02071887188.
E-mail: david.zargaran@imperial.ac.uk
Key words: Knee surgery, orthopedic surgery,
citation density, impact factor, bibliographic
analysis.
Contributions: DZ, AZ and ZS made substan-
tial contributions to the conception and design
of the work, acquisition, analysis and interpre-
tation of data for the work. DZ, AZ and SL
drafted and revised work critically for impor-
tant intellectual content. DZ, AZ, SL and ZS
gave final approval of the version to be pub-
lished and agree to be accountable for all
aspects of the work in ensuring that questions
related to the accuracy or integrity of any part
of the work are appropriately investigated and
resolved.
Conflict of interest: The authors declare no
potential conflict of interest.
Funding: None.
Received for publication: 23 September 2019.
Accepted for publication: 28 October 2019.
This work is licensed under a Creative
Commons Attribution NonCommercial 4.0
License (CC BY-NC 4.0).
©Copyright: the Author(s), 2019
Licensee PAGEPress, Italy
Orthopedic Reviews 2019;11:8322
doi:10.4081/or.2019.8322
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[Orthopedic Reviews 2019; 11:8322] [page 193]
cles published within the last 10 years of the
database.
Further work could evaluate, with
greater granularity, the themes within knee
surgery over time to provide a dynamic
overview of research themes. Given the
advances in knee surgery, it may reflect the
contemporaneity of these techniques, that
these themes fall considerably behind the
leading theme of ‘Knee Arthoplasty’, and a
dynamic overview could elucidate such
trends.
In line with the work of other authors,
48 of the 50 most cited articles were pub-
lished in American based journals despite
only 22 of the articles being written by
authors at American-based institutions
(Table 2).56 This could reflect the influence
that journals based in the United States have
with regards to the publication and growth
of impactful papers in orthopedic surgery.
Out of the nine journals represented by
the top 50 most cited papers, seven of them
had impact factors above the 2016 mean of
1.9.57 Given that impact factor is derived
from the number of citations received, this
suggests that the selection of papers is in
keeping with articles that are considered
both relevant and important within orthope-
dic surgery, and may have been accepted
with a view to directly improving their
respective journal’s overall standing.
Conclusions
This paper provides an insight into key
and impactful trends within knee surgery,
and at the time of writing, is the only paper
to exclusively explore the 50 most cited
articles in knee surgery. Whilst this form of
analysis provides a unique insight into
trends and key themes in knee surgery, there
are further variables that should be explored
to gain a fuller and richer appreciation of
the role of journals influencing advances
within the field. The trends not only identify
popular areas within the specialty, but also
the relative paucity of cited publications
within the field, and this information can be
leveraged to direct future research efforts.
Furthermore, the overview of research
Review
Table 1. The top 50 articles related to surgical intervention, with the relative number of
citations.
Rank Paper (ref) Citations Rank Paper (ref) Citations
#1 Lysholm 1982 (5) 1407 #26 Lingard 2004 (30) 352
#2 Lohmander 2007 (6) 996 #27 Marder 1991 (31) 348
#3 Ethgen, 2004 (7) 885 #28 Peterson 2010 (32) 345
#4 Daniel 1994 (8) 807 #29 Pinczewski 2007 (33) 342
#5 Knutsen 2004 (9) 805 #30 Gudas 2005 (34) 336
#6 Sharkey 2002 (10) 716 #31 Yasuda 2006 (35) 334
#7 Steadman 2003 (11) 708 #32 Obrien 1991 (36) 333
#8 Bourne 2010 (12) 656 #33 Corry 1999 (37) 322
#9 Bierbaum 1999 (13) 587 #34 Fehring 2001 (38) 321
#10 Steadman 2001 (14) 573 #35 Brander 2003 (39) 319
#11 Hangody 2003 (15) 571 #36 Kurtz 2014 (40) 314
#12 Jeffery 1991 (16) 567 #37 Chauhan 2004 (41) 313
#13 Knutsen 2007 (17) 552 #38 Hangody 1998 (42) 312
#14 Pulido 2008 (18) 539 #39 Diduch 1997 (43) 306
#15 Kurtz 2009 (19) 508 #40 Scott 2010 (44) 303
#16 Hjelle 2002 (20) 455 #41 Ranawat 1993 (45) 297
#17 Noble 2006 (21) 442 #42 Widuchowski 2007 (46) 294
#18 Ginsberg 2008 (22) 429 #43 Nejadnik 2010 (47) 292
#19 Hawker 1998 (23) 427 #44 Kerr 2008 (48) 291
#20 Peersman 2001 (24) 425 #45 Fulkerson 2002 (49) 288
#21 Glasson 2007 (25) 405 #46 Shelbourne 1991 (50) 283
#22 Freedman 2003 (26) 400 #47 Yagi 2007 (51) 280
#23 Bathis 2004 (27) 374 #48 Muneta 2007 (52) 278
#24 Baker 2007 (28) 370 #49 Harris 2001 (53) 275
#25 Kreuz 2006 (29) 354 #50 Phillips 2006 (54) 274
Figure 1. Graph of research themes. Figure 2. Graph of frequency of publications by year.
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[page 194] [Orthopedic Reviews 2019; 11:8322]
being conducted within the area of orthope-
dic knee surgery should serve to promote
more informed scientific discourse between
researchers, facilitating more focused
exploration of research areas within the
field.
Whilst scientists and researchers are
often mindful of the intrinsic biases and
heuristics, further analysis into paper selec-
tion and the motivating factors which
underpin these decisions could potentially
develop a new approach to finding articles,
which can limit the impact of these heuris-
tics. Such a framework may require a
review of the most recently published arti-
cles in addition to the most cited articles to
enable a balanced and informed research
approach. Whilst some journals may
implicitly seek out recent references,
embedding this within a framework could
redefine the approach to literature review.
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