Top 100 cited articles on infection in orthopaedics: A bibliometric analysis.

PURPOSE: The infection is an essential problem in the clinical practice in orthopedics. The bibliometric analysis was conducted to evaluate the top 100 cited articles on infection in orthopaedics.
METHODS: The Web of Science (WoS) Core Database was comprehensively searched from 1975 to 2017, and the literature search was limited in Science Citation Index Expanded (SCI-E). The subject terms included "infection", "infectious", and "infect*". All retrieved articles were filtrated by selecting the subspecialty of "Orthopedics". The searching results were listed by citation times to identify the top 100 cited articles. Significant information was elicited, including the authors, journals, countries, institutions, published year, and types of publication.
RESULTS: A significant increase was observed in the number of annual publications focusing on infection in orthopedics worldwide. Each of the top 100 cited articles was cited more than 150 times. Total citation times was positively associated with citation times in 2016 (P <.01) and mean citation times per year (P <.01). Conversely, age of the article was negatively associated with citation times in 2016 (P <.01) and mean citation times per year (P <.01). Besides, citation times in 2016 was positively related to mean citation times per year (P <.01). The United States was the most productive country, surgery was the most popular subspecialty and Journal of Bone and Joint Surgery American Volume was the most popular journal.
CONCLUSION: Infection in orthopaedics has attracted more and more researchers' concern. As for the top 100 cited articles, there were significant relationships among total citation times, citation times in 2016 and mean citation times per year as well as age of the article. The United States was the most productive country, surgery was the most popular subspecialty and Journal of Bone and Joint Surgery American Volume was the most popular journal.

Introduction

Infection is a tangible problem in the clinical practice in orthopedics, and the gold diagnostic standard for infection has typically been cultivation and subsequent identification of a bacterial sample from the wound or liquid substance from bone tissue.[ A large number of patients face the risk of infection while undergoing an orthopeadic procedure, as a matter of fact, the incidence of infection in trauma patients even has reached up to 10% in orthopaedics.[ Infection increases financial costs and prolongs course of diseases, and it even decreases the compliance of patients.[ Although great progress to prevent infection in orthopedics has been made, the understanding of infection remains unclear. In view of the aforesaid importance, a growing number of researchers pay attention to the developments of infection research in orthopedics. As a result, plenty of articles relevant to infection in orthopedics have been published,[ which increase the difficulty of catching the critical information for followers in this filed.

Citation number of one article is commonly used to assess the academic influence of the study. Bibliometric analysis is frequently used to evaluate the academic developments of specific specialties, including cancer,[ neuroscience,[ urology,[ emergency medicine[ and medical imaging.[ In recent years, bibliometric analysis becomes increasing popular in orthopedics, which mainly focus on spinal cord tumors,[ anterior cruciate ligament injuries,[ back pain,[ orthopaedic surgeries,[ knee research[, and hand surgeries.[ However, to our knowledge, no bibliometric analysis focusing on infection in orthopedics has been published up to this date. In consideration of this fact, the aim of this bibliometric analysis was to help followers to catch the most important developments of research on infection in orthopedics by assessing the top 100 cited articles.

Materials and methods

Literature searching

This study was approved by Institutional Review Board of Wuxi Second Hospital. Similar to other bibliometric analyses,[ Web of Science (WoS) Core Collection (Thomson Reuters, NY) was comprehensively searched, and the literature search was limited in Science Citation Index Expanded (SCI-E). The keywords included “infection”, “infectious”, and “infect∗”. The articles published from 1975 to 2017 were all elicited, without the restriction on language. Then, all retrieved articles were filtrated by the subspecialty of “Orthopedics”. The top 100 cited articles were finally identified and included into this bibliometric analysis.

Bibliometric analysis

This bibliometric analysis was performed based on a mature methodology used in other bibliometric studies.[ The following information was extracted: total publications, published year, top 100 cited articles, countries, journals, types of article, top productive institutions and authors.

Statistical analysis

All statistical analyses were performed using SPSS software version 20.0 (SPSS Inc., Chicago, IL). The statistical significance of the correlations among total citation times, citation times in 2016 and mean citation times per year, as well as age of the article, were determined by Spearman test. P <.05 was considered to be statistically significant.

Results

The top 100 cited articles

As shown in Figure 1, a total of 17,040 articles focusing on infection in orthopedics were identified from WoS. The number of publications concerning infection in orthopedics had an annually significant increase worldwide.

Figure 1

Publications focusing on infection in orthopedics distributing in each year.

Top 100 cited articles were listed in Table 1 . The top 1 cited article, an original study, was published in Journal of Bone and Joint Surgery American Volume in 1976 and entitled “Prevention of infection in treatment of 1000 and 25 open fractures of long bones—retrospective and prospective analyses”, and this paper was totally cited 1770 times. The mean citation times per year and citation times in 2016 of this article were 42.14 and 92, respectively. Besides, this article was also the oldest article among the top 100 cited articles. Each of the top 100 cited articles was cited more than 150 times.

Table 1

Top 100 cited articles focusing on infection in orthopaedics.

We further explored the associations among total citation times, mean citation times per year, citation times in 2016 and age of the article. The results demonstrated that total citation times was positively associated with citation times in 2016 (r = 0.412, P <.001) (Fig. 2a) and mean citation times per year (r = 0.701, P <.001) (Fig. 2b). However, no significant relationship was observed between total citation times and age of the article (r = −0.042, P = .681) (Fig. 2c). In additions, age of the article was negatively associated with citation times in 2016 (r = −0.662, P <.001) (Fig. 2d) and mean citation times per year (r = −0.679, P <.001) (Fig. 2e). Moreover, citation times in 2016 was positively related to mean citation times per year (r = 0.789, P <.001) (Fig. 2f).

Figure 2

The relationships among total citation time, mean citation per year, citation in 2016 and age of the article. (a, total citation time and citation in 2016; b, total citation time and mean citation per year; c, total citation time and age of the article; d, age of the article and citation in 2016; e, age of the article and mean citation per year; f, citation in 2016 and mean citation per year).

Journals with no less than 3 of the top 100 cited articles

Regarding to the journals of the top 100 cited articles, we analyzed the journals with no less than 3 top cited articles. As shown in Table 2. Journal of Bone and Joint Surgery American Volume was the most popular journal, with 48 articles, followed by Clinical Orthopedics and Related Research with 14 articles, Spine with 12 articles, Journal of Bone and Joint Surgery British Volume with 9 articles, Acta Orthopedic Scandinavica with 3 articles, and Journal of Arthroplasty with 3 articles. Besides, the Journal of Bone and Joint Surgery American Volume also had the highest total citation times, mean citation times per year and citation times in 2016. However, Clinical Orthopedics and Related Research had the highest mean citation times per article.

Table 1 (Continued)

Top 100 cited articles focusing on infection in orthopaedics.

Countries with no less 3 of the top 100 cited articles

As listed in Table 3, a total of 22 countries produced the top 100 cited papers. The United States was the most productive country with 75 articles, followed by England with 9 articles, Canada with 7 articles, France with 3 articles, Sweden with 3 articles and Swttzerland with 3 articles. Moreover, the United States had the highest total citation times, mean citation times per year and mean citation times in 2016, France had the highest mean citation times per article with 452.67 times.

Table 2

Journals with no less than 3 of the top 100 cited articles.

Institutions and authors with no less than 4 articles of the top 100 cited articles

With respect to institutions (Table 4), Harvard University and Massachusetts General Hospital were both the most productive institutions with 6 articles, followed by Boston University, Brigham and Women's Hospital, Hospital Special Surgery and The University of California San Francisco with 5 articles. As for authors (Table 5), Parvizi J, Katz JN, Losina E, and Mahomed NN were the most productive authors who published 5 articles.

Table 3

Countries with no less 3 of the top 100 cited articles.

Table 4

Institutions with no less 4 of the top 100 cited articles.

Publication type and subspecialty of the top 100 cited articles

Regarding to the type of the top 100 cited articles, as shown in Table 6, 91 manuscripts in the form of “Article” and 9 manuscripts in the form of “Review” were totally cited 27,793 and 2738 times, respectively. The manuscripts in the form of “Article” had higher average citation times per article with 305.42 times than “Review” with 304.22 times. When considering the subspecialty, as listed in Table 7, surgery was the most popular subspecialty, with 74 articles, followed by Neurosciences/neurology with 16 articles and sport sciences with 3 articles. The articles in the subspecialty of surgery were with the highest total citation times, mean citation times per year and citation times in 2016. However, articles in the subspecialty of neurosciences/neurology had the highest mean citation times per article among aforesaid subspecialties.

Table 5

Authors with no less than 4 of the top 100 cited articles.

Table 6

Type of articles of the top 100 cited articles.

Discussion

In our study, a significant increase was observed in the number of annual publications focusing on infection in orthopedics worldwide. Each of top 100 cited articles was cited more than 150 times. Total citation times were positively associated with citation times in 2016 and mean citation times per year. Conversely, age of the article was negatively associated with citation times in 2016 and mean citation times per year. Besides, citation times in 2016 was positively related to mean citation times per year. Journal of Bone and Joint Surgery American Volume was the most popular journal, the United States was the most productive country and surgery was the most popular subspecialty.

In this bibliometric analysis, the study entitled “Prevention of infection in treatment of 1000 and 25 open fractures of long bones—retrospective and prospective analyses” was the most popular article, which found that cephalosporin was the prophylactic antibiotic of choice to prevent the infection.[ The following reasons might account for the popularity of the study. First, this study was conducted in 1976. As is well known, articles published in earlier years were likely to be cited more frequently. Second, the severe wound and following surgery both might increase the risk of infection; therefore, infection caused by open fractures of long bones was a common and intractable problem for orthopedists. Third, the methodology of the study was scientific and strict, which guaranteed the reliability of the conclusion.

It is worth mentioning that our study first explored the relationships among total citation times, age of the article, mean citation times per article and citation times in 2016, which were not performed in previous studies.[ We unexpectedly found that total citation times was not obviously associated with age of the article, which challenged the conventional viewpoint that earlier papers were more frequently cited.[ The main reason might be that investigators paid more attention to the latest developments in this filed. In additions, another explanation for why classic papers were cited less frequently was that they had been absorbed and accepted into the body of current knowledge, therefore no longer being directly attributed to their source. Predictably, total citation times were significantly related to mean citation times per year and citation times in 2016. Our results also indicated age of the article was negatively associated with citation times in 2016, which might be explained with previous theory that peak citation usually occurred after articles were published for 3 to 10 years.

Journal of Bone and Joint Surgery American Volume had the largest number of paper, total citation times, mean citation times per year and citation times in 2016. Therefore, this journal was the most popular journal focusing on infection in orthopaedics. However, it should be noted that Clinical Orthopedics and Related Research had the highest citation times per article among top 6 journals, which demonstrated articles in this journal were of relatively higher quality. Other than that, Spine ranked third, indicating infection was also a problematic issue in spine surgeries. However, when assessing journals’ contribution, we should not ignore that those journals had different publication cycle time and circulation time. Shorter publication cycle time and longer circulation time were beneficial to increasing the citation times of articles. Furthermore, these journals were founded at different time, which also might affect the number of articles and citation times. It should be noted that none of the top 100 cited articles was published in 4 famous medical journals, including British Medical Journal, Journal of American Medical Association, Lancet and The New England Journal of Medicine. This phenomenon indicated that researchers focused on not only the impact factor but also the influence in their research field when choosing journals to publish their studies. Of course, several other factors might influence the selection process of target journal, including difficulty to be accepted, time from submission to acceptance, charges and so on, especially difficulty to be accepted.

The United States ranked first with 75 articles, which was far more than the other countries. This finding was accorded with other previous studies.[ The United States had the highest total citation times, mean citation times per year and citation times in 2016. Besides, most of productive institutions and authors were in the United States. Overall, all this information supported that the United States made the greatest contribution to the developments of research on infection in orthopaedics. Besides, our study found that no developing country such as China was selected in rankings. Previous studies have proved that China made great contribution to the progress of several biomedical fields.[ However, our results uncovered although developing countries such as China published a good deal of papers, the quality of many papers needed further improvement. Therefore, developing countries should try their best to improve the quality of articles in future.

In our study, original articles had higher mean citation times per article when compared with reviews. This finding indicated orthopedists paid more attention to the new findings in this topic. Besides, our bibliometric analysis proved that surgery was the most popular subspecialty. Infection associated with surgery was indeed a very important and common problem in orthopedics,[ which should raise more researchers’ concern.

To our knowledge, this study was the first bibliometric analysis to identify the top 100 cited papers focusing on infection in orthopedics. And this study helped researchers to catch the scientific developments and promote the cooperation in this field. Nevertheless, our study was not without limitations. First, citation time was not the “Golden Standard” when evaluating the importance of the research. The citation times could be easily affected by several factors, such as time of peer-review process and publication cycle. In recent years, increasing researchers suggested that the impact factor based on citation times should be optimized and even abandoned. Second, this bibliometric analysis was conducted based on WoS database, however, Google Scholar and Scopus were also frequently used to perform the bibliometric analysis, therefore, the results of our study might not be comprehensive. Third, despite of aforesaid methods, we could not guarantee that all retrieved articles exactly focused on this topic, which was an inherent weakness of all bibliometric analyses. Fourth, generally, joint replacement surgeries, degenerative spine surgeries, and infected non-unions were focused in clinical practice when discussing the infection in orthopedics, however, few publications concerned these topics among the top 100 cited articles. This phenomenon might be explained that many factors could affect the citation times of artciels and then determine the top 100 cited articles. In spite of limitations, we believed this study could contribute to obtaining vital developments of infection in orthopedics and providing new insights into innovation in this field.

Conclusions

Infection in orthopaedics has attracted increasing researchers’ concern. As for the top 100 cited articles, there were significant relationships among total citation times, citation times in 2016 and mean citation times per year as well as age of the article. The United States was the most productive country, surgery was the most popular subspecialty and Journal of Bone and Joint Surgery American Volume was the most productive journal.

Author contributions

Guoxing Zhu designed the study; Guoxing Zhu and Yu Jiang conducted the statistical analysis; Yu Jiang and Renjing Hu wrote the manuscript; Guoxing Zhu revised the manuscript; All authors read and approved the final manuscript.

Conceptualization: Yu Jiang.

Data curation: Yu Jiang, Renjing Hu, Guoxing Zhu.

Formal analysis: Yu Jiang, Guoxing Zhu.

Funding acquisition: Guoxing Zhu.

Investigation: Yu Jiang, Renjing Hu, Guoxing Zhu.

Methodology: Yu Jiang, Renjing Hu, Guoxing Zhu.

Resources: Guoxing Zhu.

Software: Guoxing Zhu.

Validation: Guoxing Zhu.

Writing – original draft: Yu Jiang, Renjing Hu, Guoxing Zhu.

Writing – review & editing: Yu Jiang, Renjing Hu, Guoxing Zhu.

Table 7

Subspecialty of the top 100 cited articles.