The most influential papers in unicompartmental knee arthroplasty (2024)

Associated Data

Data Availability Statement

Abstract

Keywords: Unicompartmental knee arthroplasty, Unicondylar knee arthroplasty, Bibliometric study, Citation analysis

Introduction

Unicompartmental knee arthroplasty (UKA) dates back to the 1950s, following the introduction of the MacIntosh and McKeever hemiarthroplasty [1]. Since then, patient management, implant design, and surgical techniques, such as patient-specific instrumentation, have advanced [1, 2]. Nowadays, UKA is considered a less-invasive treatment option for anteromedial osteoarthritis than total knee (TKA) arthroplasty [3–5]. As a result, the number of UKA has been increasing constantly worldwide in recent decades [6–8]. Due to the clinical relevance of UKA, numerous scientific papers related to this topic were published, that is, more than 2000 articles.

A citation is a reference or a quotation from previous scientific work that has been published in books or scientific journals [9]. The number of citations of published scientific articles is considered a parameter of its influence and impact in the scientific community. The impact factor of a journal is a widely accepted as a parameter of scientific quality and importance. It is calculated by the number of citations [9].

Analyses of citations in a specific scientific field allow us to give an overview of the most influential articles and offer physicians, researchers, and residents insight on the relevant current literature. Such studies have been done in different medical disciplines such as orthopedic surgery or general surgery; in a variety of orthopedic subspecialties including arthroplasty, arthroscopy, or hand surgery; and for conditions such as osteoporosis or anterior cruciate ligament rupture [10–21].

The aim of this study was to determine the most cited scientific articles related to UKA and to establish a ranking of the most influential papers by the use of the Web of Science® database.

Material and methods

Results

The absolute number of citations for the fifty most cited articles on UKA range from 110 to 453 times. The fifty articles were cited, in total, 8436 times. The mean number of citations of an included paper was 169 times (± 69). The top ten papers reached at least 219 citations since publication.

The absolute numbers of citations for the fifty most influential articles on UKA are shown in Table1, and the top ten papers, according to their relative number of citations (highest citation density), are presented in Table2.

Thirty-three articles were allocated to the “Clinical Science” category, which was the most frequently noted category. Figure1 presents the distribution according to the different categories.Within the category “Clinical Science,” the level of evidence was analyzed. Eighteen studies of this category were categorized as level IV studies. The distribution of the level of evidence is shown in Fig.2.

The Journal of Bone and Joint Surgery (British volume) has published most papers of the list (n = 16). The Journal of Bone and Joint Surgery (American volume), Clinical Orthopaedics and Related Research, Acta Orthopaedica (Scandinavica), Journal of Arthroplasty, Lancet, and Knee were other journals that contributed to the list (Fig.3).

Research institutions from the UK had the highest number of contributions (n = 17). Nine further countries contributed to the top 50 list: the USA with 16; Sweden with six; France with four; Finland with two; and Australia, Austria, Canada, India, and Norway with one each. Thirty-one publications were from Europe and 17 from North America.

The publication years of these articles span 1981 to 2014. Figure4 shows the decade in which the research was published. Most articles were published in the 2000s (n = 23), followed by the 1990s (n = 13), and then the 1980s and 2010s with seven publications per decade.

Discussion

UKA is considered an alternative treatment option for anteromedial osteoarthritis to TKA. Because of the growing scientific interest in the field of UKA, we tried to identify the most influential articles related to UKA as guidance for clinical practice and future research. Publications on UKA were cited up to 453 times since publication, with the top ten articles in this field being cited at least 219 times. The citation number of articles in UKA is lower than in other fields of orthopedics, such as total hip and knee arthroplasty, cartilage surgery, and anterior cruciate ligament injury [13, 16, 20, 21]. However, compared to articles on hand surgery or pediatric orthopedics, articles on UKA are well cited [15, 18]. This indicates that the field of UKA is a highly driven industry such as the field of arthroplasty on the whole [24, 25].More than two-thirds of the articles were attributed to the category “Clinical Science.” Most of these were level IV studies, which indicates a low level of evidence in the field of UKA. This points to a need for clinical studies in UKA with better study design so as to gain more evidence in the future. Only three articles were level I studies. Two of these were prospective randomized controlled trials comparing UKA and TKA in the treatment of osteoarthritis of the knee.

The second most frequent category was “Registry and Database,” with ten articles. This indicates the great interest in implant performance and survival. Only six papers were in the category “Basic Science.” Product developments in the field of UKA are mostly done by commercial companies. These products are then used in clinical practice and studied clinically. Interestingly, the most highly cited contributions in the field of UKA were from the UK (n = 17). This is in contrast to most bibliometric analyses done so far, in which the USA contributed most of the scientific work [10–21]. Furthermore, in the field of UKA, a high number of contributions are from European countries, especially Scandinavian ones. This is also confirmed by the publishing journals. A large proportion of the articles was published in the Journal of Bone and Joint Surgery (British volume). Another seven articles were published in European journals. This finding is also in contrast to other bibliometric analyses in orthopedic surgery so far [10–21]. Interestingly, most articles have been published since 2000. This indicates an increasing trend in UKA in the last recent decades.

In general, bibliometrics has its limitations. The identification of the fifty most cited papers still remains a selection, even when using predefined search criteria. In this study, the absolute number of citations was considered an objective parameter. Among the scientific community, the impact factor is an accepted parameter of an article’s influence. The impact factor is directly influenced by the number of citations. However, the citation numbers of articles can be manipulated by various factors such as self-citations (in small numbers) and therefore might not necessarily represent the objective value of scientific work [9].

The literature search was performed in the Web of Science®. Textbooks, doctoral theses, presentations, and new media are not included in this database. Therefore, citations of articles of such sources might have been missed.

Another limiting factor might be the cross-sectional study design based on total citation numbers. As a result, more recent influential papers might not have been identified and were not considered eligible for the list.

Conclusions

This study provides a list of the fifty most influential articles on UKA, which will help physicians and scientists to obtain an overview on past and current trends in the field of UKA. Most articles could be attributed to the category Clinical Science and provided a low level of evidence. This provides a basis for both further discussion and highlights the need for future research.

Acknowledgements

Not applicable.

Authors’ contributions

LAH designed the study, collected and analyzed the data, wrote the initial manuscript draft, and read and approved the final version of the manuscript. GH designed the study, analyzed the data, and read and approved the final version of the manuscript. All authors read and approved the final manuscript.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Availability of data and materials

The datasets developed during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Footnotes

References