Orthopaedic Journals Research Articles

A meta-analysis assessing time for return to sport following hip resurfacing.

Hip resurfacing arthroplasty (HRA) is associated with excellent functional outcomes and return to pre-disease level of activity. The time for return to sport (RTS) following HRA remains unknown. The aim of this meta-analysis was to establish the time for RTS following HRA. A search was performed on PUBMED, MEDLINE, EMBASE, and the Cochrane Library for trials on HRA and RTS, in the English language, published from the inception of the database to October 2020. In addition, a manual search was performed of relevant sports medicine and orthopaedic journals, and the bibliographies reviewed for eligible trials. All clinical trials reporting on time to RTS following HRA were included. Data relating to patient demographics, methodological quality, operation type, RTS, clinical outcomes, and complications were recorded by two independent reviewers. The PRISMA guidelines for reporting meta-analyses was used to undertake this study. The initial literature search identified 1559 studies and nine further studies were found. Of these, 11 studies with a total of 659 patients matched the inclusion criteria. Two studies involving a total of 94 patients demonstrated an overall pooled proportion of 91.8% (95% CI 71.8-100) of patients RTS by three months post-operatively. Four studies including a total of 265 patients determined a pooled proportion of 96.8% (95% CI 91.0-99.7) of patients able to RTS by the 6-month post-operative stage. Pooled proportion analysis from all 11 studies comprising 659 patients showed 90.9% (95% CI 82.2-96.9) of patients were able to RTS by final follow up of 3years. Pooled proportion analysis showed an increasing number of patients were able to RTS after HRA over the first one year after surgery. There remains marked inter and intra-study variations in time for RTS but the pooled analysis shows that over 80% of patients were able to RTS at 6 to 12months after HRA. The findings of this meta-analysis will enable more informed discussions between patients and healthcare professionals about time for RTS following HRA.

The Statistical Fragility of Operative vs Nonoperative Management for Achilles Tendon Rupture: A Systematic Review of Comparative Studies.

Background:The statistical significance of randomized controlled trials (RCTs) and comparative studies is often conveyed utilizing the P value. However, P values are an imperfect measure and may be vulnerable to a small number of outcome reversals to alter statistical significance. The interpretation of the statistical strength of these studies may be aided by the inclusion of a Fragility Index (FI) and Fragility Quotient (FQ). This study examines the statistical stability of studies comparing operative vs nonoperative management for Achilles tendon rupture.Methods:A systematic search was performed of 10 orthopaedic journals between 2000 and 2021 for comparative studies focusing on management of Achilles tendon rupture reporting dichotomous outcome measures. FI for each outcome was determined by the number of event reversals necessary to alter significance (P < .05). FQ was calculated by dividing the FI by the respective sample size. Additional subgroup analyses were performed.Results:Of 8020 studies screened, 1062 met initial search criteria with 17 comparative studies ultimately included for analysis, 10 of which were RCTs. A total of 40 outcomes were examined. Overall, the median FI was 2.5 (interquartile range [IQR] 2-4), the mean FI was 2.90 (±1.58), the median FQ was 0.032 (IQR 0.012-0.069), and the mean FQ was 0.049 (±0.062). The FI was less than the number of patients lost to follow-up for 78% of outcomes.Conclusion:Studies examining the efficacy of operative vs nonoperative management of Achilles tendon rupture may not be as statistically stable as previously thought. The average number of outcome reversals needed to alter the significance of a given study was 2.90. Future analyses may benefit from the inclusion of a fragility index and a fragility quotient in their statistical analyses.

Tooth auto-transplantation: A bibliometric analysis of the top 100 most-cited articles.

Tooth auto-transplantation has recently gained high clinical acceptance. The aim of this study was to identify the top 100 most-cited articles regarding tooth auto-transplantation, to analyse multiple citations and publication metrics and to outline the historical scientific advancements in this field. An advanced search of the Clarivate Analytics' Web of Science 'Core Collection' and Elsevier's Scopus databases utilising specific keywords related to tooth auto-transplantation between 1971 and 2021 was performed. The retrieved articles were ranked in descending order based on their Web of Science citation counts and further cross-matched with citation data from Scopus. The extracted data included citation counts, citation density, level of evidence, year of publication, contributing authors names and institutes, corresponding author's address, journal of publication, journal local citations index, cumulative growth index, keywords and keywords Plus. Data analysis was performed using descriptive statistics and graphical mapping. A total of 1290 articles were retrieved. The top 100 most-cited articles received a total of 4899 (Web of Science) and 5250 (Scopus) citations. Among these, cohort studies (29%) and case series (18%) were the most common study designs. Scandinavian countries produced major contributions in defining the top 100 most-cited articles and ranked within the top 5 countries based on the number of publications and citations per year. The greatest contributing authors were Schwartz O (n= 12), Andreasen JO (n= 8) and Paulsen HU (n= 6), and they were affiliated with Copenhagen, Denmark. The top contributing journals were American Journal of Orthodontics and Dentofacial Orthopedics, International Journal of Oral and Maxillofacial Surgery, Oral Surgery Oral Medicine Oral Pathology Oral Radiology, European Journal of Orthodontics, Dental Traumatology and Journal of Oral and Maxillofacial Surgery. This bibliometric analysis revealed a large geographical scientific interest and broad development in the field of tooth auto-transplantation spanning multiple dental disciplines.

The Altmetric Attention Score Is Associated With Citation Rates and May Reflect Academic Impact in the Total Joint Arthroplasty Literature.

Background: Given the increasing interest and potential use of social media for the promotion of orthopedic literature, there is a need to better understand Altmetrics. Purposes: We sought to determine the relationship between the Altmetric Attention Score (AAS) and the number of citations for articles on total joint arthroplasty (TJA) published in orthopedics journals. We also sought to determine the predictors of greater social media attention for these articles. Methods: Articles on TJA published in Bone and Joint Journal (BJJ), Journal of Bone and Joint Surgery (JBJS), Clinical Orthopedics and Related Research (CORR), Journal of Arthroplasty, Journal of Knee Surgery, Hip International, and Acta Orthopaedica in 2016 were extracted (n = 498). One-way analysis of variance with Bonferroni corrections was used to compare AAS and citations across journals. Multivariate regressions were used to determine predictors of social media attention and number of citations. Results: The mean AAS and number of citations were 7.5 (range: 0-289) and 16.7 (range: 0-156), respectively. Significant between-group effects were observed according to journal for AAS and number of citations. Publishing an article in JBJS was the strongest predictor of higher number of citations. Publishing an article in BJJ was the only independent predictor of higher AAS, while publishing an article in JBJS or CORR trended toward statistical significance. A higher AAS was a significant predictor of a higher number of citations. Number of citations and number of study references were positive predictors of greater social media attention on Twitter and Facebook. Conclusions: In articles on TJA published in 7 journals in 2016, a higher AAS was a associated with a higher number of citations. Various bibliometric characteristics were found to be significantly associated with greater social media attention; the most common influences were number of citations and number of references. Researchers in orthopedics can use this information when considering how to assess the impact of their work.

Journal Discipline Plays a Significant Role in Academic Attention But Not in Social Media Attention in the Peripheral Nerve Literature.

Evaluating the impact of articles can be performed through bibliometric analysis or social media impact using the Altmetric Attention Score (AAS). The purpose of this study was to report on the social media impact of peripheral nerve studies; how article demographic factors, such as journal specialty (hand, orthopedics, plastic surgery), affect AAS; and how AAS correlates with bibliometrics, namely citation number. While orthopedic journals received the highest academic attention, there was no significant difference in social media attention between journal groups. These findings suggest AAS may be useful to authors in deciding which journal in which to pursue publication. [Orthopedics. 2023;46(3):e143-e148.].

Reporting Race in Orthopaedic Journal Articles: Commentary on an article by Cody Crnkovic, BS, et al.: "Low Rates of Reporting Race, Ethnicity, and Socioeconomic Status in Studies Published in Top Orthopaedic Journals".

Commentary Whether or not it is proper to include race as a variable in clinical research studies has been a subject of debate for decades1. Crnkovic et al. lament the “underreporting” of race in articles published in Clinical Orthopaedics and Related Research and The Journal of Bone & Joint Surgery and call on the editors to remedy this perceived deficiency by requiring that race be recorded for all human research subjects. The authors quote from recent guidelines published in the Journal of the American Medical Association (JAMA) and from the recommendations of the International Committee of Medical Journal Editors (ICMJE) to support their view. In doing so, the authors greatly simplify a complex issue and mischaracterize the published guidelines. Thoughtful journal editors have long acknowledged that although race is a social construct without biological basis and that racialized medicine has been utilized repeatedly throughout history to mark a particular group as different, inferior, and defective, it is still sometimes necessary and helpful to collect meaningful data on race in order to identify, understand, and improve inequitable health outcomes2. The question is how best to do this. There is widespread agreement that when racial data are utilized in a study, there should be a valid reason. The JAMA guidelines state that “if race and ethnicity categories were collected for a study, the reasons that these were assessed also should be described.” The ICMJE guidelines state only that authors “should define how they determined race or ethnicity and justify their relevance.” Ioannidis et al. presented arguments for and against the inclusion of race in research and stated that “a large amount of research involving race variables has been, in hindsight, pedestrian and arguably lies among the greater waste of spurious, nonusable biomedical evidence.”3 He adds that “it is important to think carefully about the fundamental question. Why should race variables be used, if at all?” Some researchers, including Crnkovic et al., suggest that there is a universally applicable justification for including, even requiring, race data to be collected and reported. Knowledge of patient race is thought to be important for establishing the generalizability of the study results and for supporting research into inequities in health outcomes and processes. Although there are valid reasons to support the recruitment of diverse populations into research studies, the claim that it is important to know the racial makeup of a study population in order to assess the applicability to a reader’s own patients is questionable. The harm caused by the use of race as a cognitive framing device for clinical decision-making may be substantial4. The limitations of race as an explanatory variable are due both to its indistinct social construction and to its connection with other social determinants of health. The mutability of race is reflected in the JAMA guidelines, which recommend that authors include “an explanation of who identified participant race and ethnicity and the source of the classifications used (e.g., self-report or selection, investigator observed, database, electronic health record, survey instrument).” Cerdeña et al. stated that hypotheses that utilize racial labels “should make the definition and operationalisation of race explicit,” adding that “structural barriers to health that overlap with race should be considered, including socioeconomic status, discrimination, transportation, environmental exposures, criminal history, documentation status, English proficiency, and neighbourhood violence.”5 Winker noted that although the National Institutes of Health (NIH) requires race and ethnicity to be assessed, “the NIH does not require that authors consider thoroughly the implications of race in their study and measure other factors that might confound apparent associations of outcomes with race, such as socioeconomic status.”2 When considering race, Cooper et al. stated that to “resist racialized thinking, clinicians and researchers need to become better at appreciating social context and the potential personal and economic challenges that mediate susceptibility or lead to poor quality of care, and consider what all of that means for the analysis that contributes to a scientific report.”6 Simply reporting standard measures of socioeconomic status along with race does not accomplish this. There is a need for high-quality studies of what Ioannidis et al. called “the multifarious consequences of long-entrenched and continuously transformed racism” in medicine. Not every article published in The Journal of Bone & Joint Surgery will meet the high bar required, nor should they be expected to. Studies that seek to comment meaningfully on the effects of race should state a hypothesis, explain in detail how the race of subjects was determined, report relevant measures of socioeconomic status, consider alternative explanations for the findings, and place the results in the context of the health-care system. To do less adds to the cloud of unknowing that good journals try to dispel.

The Fragility of Statistical Findings in Distal Radius Fractures: A Systematic Review of Randomized Controlled Trials

PurposeProbability analysis with reporting of P values is often used to determine the statistical significance of study findings in the orthopedic literature. The fragility index (FI) has been used to evaluate the robustness of a significant result. The purpose of this study was to determine the utility of applying a fragility analysis to randomized controlled trials (RCTs) evaluating distal radius fractures (DRFs). MethodsWe identified all dichotomous outcome data for randomized controlled trials of distal radius fractures (DRFs) published in 13 orthopedic journals from 2000 to 2020. The fragility index (FI) was determined by the number of event reversals required to change a P value from less than 0.05 to greater than 0.05, or vice-versa. The associated fragility quotient (FQ) was determined by dividing the FI by the sample size. The interquartile ranges (IQR) for the FI and FQ were calculated as the difference between the 25th and 75th percentiles for the overall study. ResultsOf the 7352 studies screened, 221 met the search criteria, with 34 randomized controlled trials evaluating distal radius fractures and 151 total outcome events included for analysis. The overall FI was 9 (IQR 6.5–11) with an associated fragility quotient of 0.097 (IQR 0.060–0.140). However, a majority of outcomes (78.8%) were not significant. Fragility analysis of statistically significant outcomes had an FI of 4 (IQR 1–10). All of the studies reported lost to follow-up (LTF) data where 20.6% reported lost to follow-up of greater or equal to 9. ConclusionThe RCTs in distal radius fracture outcomes have comparable statistical robustness to literature in other orthopedic surgical specialties, are not as statistically stable as previously thought and should be interpreted with caution. We recommend that orthopedic literature report the FI and FQ along with the P values to help the reader draw reliable conclusions based on the fragility of outcome measures. Level of EvidenceLevel I

Business Articles in Shoulder and Elbow Surgery Support Outpatient Total Shoulder Arthroplasty and Identify Factors Impacting Surgery Cost

Objectives: Review business related shoulder and elbow articles in tope general orthopaedic journals and compare to top shoulder and elbow subspecialty journals. Design: Literature review. Intervention: General orthopaedic vs subspecialty journals. Main outcome measurement: Publication type, subject, methods Results: There were a total of 21 shoulder and elbow related business articles across JBJS, B&amp;JJ, CORR, and AAOS during the study time period. That accounts for 0.3% of total publications (21/6098) and 8% of the business publications (21/261) in these journals over this 5 year span. Shoulder and elbow business publications accounted for a wide range of editorial space, ranging from 0% of CORR business publications to 11% of BJ&amp;J publications. Across the five shoulder and elbow surgery journals of interest, there were 57 business related articles published for the 5-year duration. The Journal of Shoulder and Elbow Surgery accounted for 77% of these publications (44/57). Business articles represented 0.8% of articles in the fine shoulder and elbow publications (57/7155) over the study time period. Conclusions: This analysis demonstrates the tendency of shoulder and elbow oriented orthopaedic journals to publish a higher percentage of business articles related to shoulder and elbow surgery compared to general orthopaedics journal. The composition of these business articles demonstrates the recent focus on cost analysis of outpatient shoulder arthroplasty as well as factors that drive cost of shoulder and elbow procedures. The subject of shoulder and elbow business related articles in these journals over the last 5 years demonstrates that this field is increasingly interested in outpatient procedures and identifying ways to safely improve cost efficiency. Level of Evidence: IV review Keywords: Orthopaedic business, shoulder and elbow, cost, value based care, finance, shoulder arthroplasty, total shoulder. (J Ortho Business 2022; Volume 2, Issue 3:pages 18-31)

Is there a biomechanical “Rule of Thirds” after ACL injury and reconstruction?

Purpose and objectiveThe purpose of this study was to analyze the biomechanical outcomes of patients with Anterior Cruciate Ligament (ACL) deficiency or insufficiency and ACL reconstruction and to determine if they follow a biomechanical “Rule of Thirds.” Background and principle resultsThe Cincinnati Group reported nearly four decades ago that approximately one-third of patients do not experience a decline in biomechanical function in the absence of an ACL, one-third adapt their biomechanics to avoid knee symptoms, and one-third of patients do not adapt biomechanically to the loss of their ACL in order to function during activities of daily living without pain, swelling and giving way episodes. Subsequently, three decades ago the San Diego Group developed the Surgical Risk Factor (SURF) algorithm, which was designed to prospectively classify the biomechanics of patients who are ACL deficient. These classification systems have also delineated patient function into three categories. Currently, especially over the last decade, a growing body of work has documented that the incidence of second ACL injuries is consistent with the division of patient function by thirds. Approximately one-third of young, active individuals who return to high intensity sports sustain a second injury to either the ipsi- or contralateral knee. Summary and major conclusionsIn this Biomechanics focused article in the Journal of Orthopedics, the authors describe differential patient outcomes with a Rule of Thirds concept, including the original study performed by our former group in Cincinnati and the SURF algorithm out of San Diego, the authors also present second ACL injury rates and how they are consistent with the Rule of Thirds, as well as the biomechanical implications for patient care.

Qualitative Research: Linking Evidence to Practice.

Previous article Next article Evidence in PracticeQualitative Research: Linking Evidence to PracticeSteven J. Kamper, Bronwyn Lennox ThompsonAuthorsSteven J. Kamper1,2Search for more papers by this author, Bronwyn Lennox Thompson3Search for more papers by this authoraffiliations1School of Health Sciences, The University of Sydney, Camperdown, Australia.2Nepean Blue Mountains Local Health District, Penrith, Australia.3Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand.Journal of Orthopaedic & Sports Physical TherapyPublished Online:June 1, 2022Volume52Issue6Pages408-409https://www.jospt.org/doi/10.2519/jospt.2022.0701SectionsPDFPDF PLUSFull Text ToolsAdd to FavoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinkedInRedditEmail About"Qualitative Research: Linking Evidence to Practice." Journal of Orthopaedic & Sports Physical Therapy, 52(6), pp. 408–409

Uneven global and racial representation in major orthopaedic clinical trials: Trends over a decade

BackgroundThe presence of geographic and demographic disparities in randomized controlled trials (RCTs) may affect the external validity of trials. While some studies have addressed racial or ethnic disparities, they have been limited to a certain region, and there is limited information about the global representation in orthopaedic research. MethodsRCTs published in major medical and orthopaedic journals from 2010 to 2019 were identified. After screening 6961 articles, 1769 trials enrolling 323,506 patients were included. The details of individual trials such as the country of origin, the proportion of women, and the proportion of different racial groups were recorded. Factors associated with reporting and representation of specific demographic groups, and annual changes were assessed. ResultsMajority of the trials were from were from United States (US) (N = 380, 21.5%). US (30.7%, N = 99,356), United Kingdom (15.7%, N = 50,691) and Canada (8.3%, N = 26,890) accounted for majority of the enrolled patients. 59.1% of the patients were women. Among US trials reporting race, 81.2% were White, and 9.9% were African American. There was no significant variation in the global distribution (p = 0.056), percentage of women (p = 0.811), or percentage of Whites (p = 0.389) over the years. ConclusionThe top three countries contributed to about 55% of the enrolled patients, whereas they contributed to only 6% of the world population. Overall, women appeared to be adequately represented in the trials, while racial minorities were underrepresented. There has not been any considerable improvement in the representation of developing regions or minorities over the last decade.

Global research in arthroscopy of the anterior cruciate ligament: A bibliometric and visualized study

PurposeTo carry out a bibliometric analysis of the scientific articles that address the topic of arthroscopy of the anterior cruciate ligament (ACL). MethodsA bibliographic search of the original articles published in orthopedics journals indexed in the Web of Science database until 2020 was carried out. Evaluation of compliance with the inclusion criteria was carried out in the Rayyan web application. The Bibliometrix package in the R programming language and VOSviewer were used to perform the bibliometric analysis. Results2249 articles published in 87 journals were included. The first publication on the subject was in 1980, and the highest number of publications was registered in 2020 (151) (annual percentage growth rate of 5.7). Fu FH was the author with the highest number of published articles, and the institutional affiliation with the highest number of original articles was the University of Pittsburgh. The most cited article was the study by Peterson et al. (2000) and the journal with the highest number of publications was Arthroscopy: the journal of arthroscopic and related surgery. United States had the highest frequency of publications and the highest number of total citations received by country. It was found on the network that the largest number of published studies had keywords such as: injuries and follow-up, whereas, in the most recent articles, the most common terms were risk-factors and outcomes. ConclusionsThere is a sustained increase in scientific production on ACL arthroscopy among the world scientific community. Our results can be used for collaborative research purposes and by professionals seeking training in this topic.

Statistical Fragility of Single-Row Versus Double-Row Anchoring for Rotator Cuff Repair: A Systematic Review of Comparative Studies.

Background:Comparative studies and randomized controlled trials (RCTs) often use the P (probability) value to convey the statistical significance of their findings. P values are an imperfect measure, however, and are vulnerable to a small number of outcome reversals to alter statistical significance. The inclusion of a fragility index (FI) and fragility quotient (FQ) may aid in the interpretation of a study’s statistical strength.Purpose/Hypothesis:The purpose of this study was to examine the statistical stability of studies comparing single-row to double-row rotator cuff repair. It was hypothesized that the findings of these studies would be vulnerable to a small number of outcome event reversals, often fewer than the number of patients lost to follow-up.Study Design:Systematic review; Level of evidence, 3.Methods:We analyzed comparative studies and RCTs on primary single-row versus double-row rotator cuff repair that were published between 2000 and 2021 in 10 leading orthopaedic journals. Statistical significance was defined as a P < .05. The FI for each outcome was determined by the number of event reversals necessary to alter significance. The FQ was calculated by dividing the FI by the respective sample size.Results:Of 4896 studies screened, 22 comparative studies, 10 of which were RCTs, were ultimately included for analysis. A total of 74 outcomes were examined. Overall, the median FI was 2 (interquartile range [IQR], 1-3), and the median FQ was 0.035 (IQR, 0.020-0.057). The mean FI was 2.55 ± 1.29, and the mean FQ was 0.043 ± 0.027. In 64% of outcomes, the FI was less than the number of patients lost to follow-up.) Additionally, 81% of significant outcomes needed just a single outcome reversal to lose their significance.Conclusion:Over half of the studies currently used to guide clinical practice have a number of patients lost to follow-up greater than their FI. The results of these studies should be interpreted within the context of these limitations. Future analyses may benefit from the inclusion of the FI and the FQ in their statistical analyses.

Low Rates of Reporting Race, Ethnicity, and Socioeconomic Status in Studies Published in Top Orthopaedic Journals.

Although there have been calls for the routine reporting of patient demographics associated with health disparities, including race, ethnicity, and socioeconomic status (SES), in published research, the extent to which these variables are reported in orthopaedic journals remains unclear. We identified and examined all research articles with human cohorts published in 2019 in the 2 highest-ranked U.S. general orthopaedics journals, Clinical Orthopaedics and Related Research and The Journal of Bone & Joint Surgery. Excluded from analysis were studies with no U.S.-based institution and those that did not report any demographic data. Articles were reviewed to determine study type; reporting of race, ethnicity, and any of 3 SES variables (i.e., income, education, and health-care insurance); and the inclusion of these demographics in multivariable analyses. A total of 156 articles met the inclusion criteria. Of these, 56 (35.9%) reported patient race and 24 (15.4%) reported patient ethnicity. Income was reported in 13 (8.3%) of the articles, education in 23 (14.7%), and health insurance in 18 (11.5%). Of the 97 papers that reported results of multivariable analyses, 30 (30.9%) included race in the analysis and 21 (21.6%) reported significance associated with race. Income, education, and health insurance were included in multivariable analyses in 7 (7.2%), 11 (11.3%), and 10 (10.3%) of the articles, respectively. Race, ethnicity, and SES were infrequently reported and analyzed within articles published in 2 of the top orthopaedic journals. This problem may be remedied if orthopaedic journals impose standards for the reporting and analysis of patient demographics in studies with human cohorts. Failure to report key demographics makes it difficult for practitioners to determine whether study results apply to their patient populations. In addition, when orthopaedic interventions are evaluated without accounting for potential disparities by demographics, clinicians may incorrectly assume that the overall benefits and risks reported in studies apply equally to all patients.

A Systematic Review of Propensity Score Matching in the Orthopedic Literature.

Propensity score matching (PSM) is a statistical technique used to reduce bias in observational studies by controlling for measured confounders. Given its complexity and popularity, it is imperative that researchers comprehensively report their methodologies to ensure accurate interpretation and reproducibility. This systematic review sought to define how often PSM has been used in recent orthopedic research and to describe how such studies reported their methods. Secondary aims included analyzing study reproducibility, bibliometric factors associated with reproducibility, and associations between methodology and the reporting of statistically significant results. PubMed and Embase databases were queried for studies containing "propensity score" and "match*" published in 20 orthopedic journals prior to 2020. All studies meeting inclusion criteria were used for trend analysis. Articles published between 2017 and 2019 were used for analysis of reporting quality and reproducibility. In all, 261 studies were included for trend analysis, and 162 studies underwent full-text review. The proportion of orthopedic studies using PSM significantly increased over time. Seventy-one (41%) articles did not provide justification for covariate selection. The majority of studies illustrated covariate balance through P values. We found that 19% of the studies were fully reproducible. Most studies failed to report the use of replacement (67.3%) or independent or paired statistical methods (34.0%). Studies reporting standardized mean differences to illustrate covariate balance were less likely to report statistically significant results. Despite the increased use of PSM in orthopedic research, observational studies employing PSM have largely failed to adequately report their methodology.

Representation of Women on Editorial Boards of Medline-Indexed Spine, Neurosurgery, and Orthopedic Journals.

Both neurosurgery and orthopedic surgery are male-dominated specialties. However, the prevalence of women appears to be even lower in the spine surgery field. We intend to determine this prevalence on the editorial boards of spine, neurosurgery, and orthopedic journals. The gender of editorial board members of Medline-indexed spine, neurosurgery, and orthopedic journals was systematically analyzed in 2019, and female representation was compared among these fields. In the 34 journals included (5 spine, 13 neurosurgery, and 16 orthopedic journals), women represented 8.84% (N = 185/2094) of editorial board members. Their representation was 5.53% (N = 30/542) in spine, 8.58% (N = 47/548) in neurosurgery, and 10.77 % (108/1003) in orthopedic journals. Only 5.4% (N = 2/37) of the editors-in-chief were women. The likelihood of having female members was higher in orthopedic than in spine journals (OR = 2.06; 95% CI = 1.35-3.13; P = 0.001). Neurosurgery journals did not show a significant greater likelihood of having female editorial board members than spine journals (OR = 1.60; 95% CI = 0.99-2.57; P = 0.058). The representation of women on editorial boards of spine, neurosurgery, and orthopedic journals is very low and appears to be even lower for spine surgery. However, it is still not understood whether or not women are barred from advancing in academics by gender bias within these specialties.

Optimizing the Impact of Your Foot and Ankle Research: Publication Trends in the Orthopedic Literature

Category:OtherIntroduction/Purpose:Research plays a central role in advancing orthopedic medicine. Not only do high publication volumes encourage greater transparency and evidence-based practice, early-career physicians are also often evaluated by the number and impact of their publications. According to 2020 NRMP match data, 81% of medical students who successfully matched into orthopedics have five or more publications. With the expanded number and variety of journals available today, however, it can be burdensome for authors to effectively determine the journal that is most suitable for a given project. This study aims to provide a comprehensive guide to the current foot and ankle orthopedic literature and to help physicians quickly identify where they may have the greatest impact.Methods:We examined 61 orthopedic journals, including both general orthopedic and foot and ankle (FA) specialty journals. We applied the National Library of Medicine's MEDLINE database for keyword searches, and Web of Science's (WOS) Journal Citation Report for citation data. Journals were excluded from this study if they were not indexed in both MEDLINE and WOS over the last five years (2016-2020). As a measure of relevance, we used a keyword search to determine the number of articles that are foot and ankle specific for each journal (FA %). We calculated the five-year impact factor for both the total journal (Total IF) and specifically for foot and ankle articles in the journal (FA IF). Impact factors were calculated following standard Journal Citation Reports methods. Other variables, such as publishing nationality, number of authors, and article type were also collected to identify variables that may be associated with higher impact.Results:43/61 journals met the indexing inclusion criteria and 47,680 publications were thereafter analyzed (Table 1). Foot and ankle articles make up less than 20% of all non-FA journals, with KSSTA (17% FA) and JOT (15% FA) publishing the most. While there is a fair correlation between the impact factor of a journal and the impact factor of FA articles (R2=0.89), journal-wide impact factors do not always predict success. KSSTA, for example, has a high FA article impact factor of 4.11 despite a journal- wide impact factor of 3.74. Author demographics also vary widely depending on the journal publishing country. While 42.4% of all articles feature an author from the US, the number of US authors in American and international journal articles is 64.3% and 20.3%, respectively.Conclusion:There are few tools specific to foot and ankle topics that authors can use to assess journals appropriate for a given project. Bibliometric analyses offer an efficient and objective method for authors to identify relevant journals, and readerships, they may not have otherwise considered. While some non-FA journals offer a higher average impact for FA articles, FA articles compose a small percentage of the journal portfolio. Journals vary in acceptance of review articles and case reports versus original research. A better understanding of journal publication trends may facilitate optimal journal selection, and improve publication efficiency and impact.

The Influence of Orthopedic Journals in Knee Arthritis Treatment Research: Evaluation Using Relative Citation Ratio.

IntroductionThe iCite database, developed by the National Institute of Health (NIH), utilizes a bibliometric known as the relative citation ratio (RCR) to gauge scholarly impact. The goal of this study was to use the RCR to evaluate the influence of orthopedic journals in regard to knee arthritis treatment literature, as no such studies exist to date.Materials and methodsThe 100 highest RCR-rated articles published between 2007 and 2017 were obtained in the following categories: physical therapy (PT), viscosupplementation (VS), nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroid injection (CSI), results of total knee arthroplasty (TKA), platelet-rich plasma (PRP), and meniscectomy (MS). Journals were categorized with respect to the following specialties: general orthopedics (GO), orthopedic subspecialty (OSS), nonsurgical musculoskeletal (NSMSK), general medicine (GM), and basic science/nonclinical (BS/NC).ResultsAcross the seven domains, GO journals held the highest median RCR, while OSS ranked fourth (RCR, 6.60 versus 3.95; p=0.0027). GO journals were considered the most influential specialty in CSI (RCR, 2.99), while OSS journals held the highest median RCR in PRP (RCR, 4.10). OSS and GO journals ranked third (RCR, 4.79) and fourth (RCR, 4.21), respectively, in NSAIDs, lagging behind NSMSK and GM journals.ConclusionsBibliometric tools, such as the RCR, can inform the orthopedic field of current and future research trends and help guide further research efforts. Currently, publications in GO journals hold a strong influence in CSI but less so in PT and NSAIDs. The use of bibliometrics allows the identification of highly influential non-orthopedic articles and journals to read while identifying influential non-orthopedic researchers to promote interdisciplinary collaboration.

Industry Payments Among Editorial Board Members of Orthopaedic Journals: An Open Payments Analysis From 2014 to 2019.

Although industry payments to physicians and surgeons remain a subject of controversy, relationships between industry and orthopaedic surgeons continue to grow. Notably, recent analyses have demonstrated significant increases in the rate and magnitude of payments among orthopaedic surgeons, despite the passing of the Physician Payments Sunshine Act in 2010. Given the concerns regarding how these relationships may affect the peer-review process, our analysis aimed to evaluate how payments among editorial board members of orthopaedic journals have changed over a contemporary time frame. The Clarivate Analytics Impact Factor tool was used to identify all orthopaedic journals with a 2019 impact factor of ≥1.5. Editorial board members from these respective journals were identified from each journal's website. Subsequently, the Open Payments database by the Centers for Medicare and Medicaid Services was queried to identify industry payments received by these board members between 2014 and 2019. The quantity and magnitude of payments were then evaluated and compared over this study period. All monetary values were adjusted for inflation. A total of 18 orthopaedic journals were included in our analysis. Of the 1,519 editorial board members identified, 711 (46.81%) received some form of industry payment in 2019. The total, average, and median payments over this study period decreased for 6 (31.6%), 7 (36.8%), and 8 of the included journals (44.44%), respectively. Six hundred twenty board members had higher average payments in 2019 than in 2014. Our analysis demonstrated high rates of industry payments among editorial board members of high-impact orthopaedic journals. In addition, we demonstrated marked growth in the total, average, and median magnitude of these payments since the inception of the Open Payments database. Our findings encourage a continued need for transparency in related payments to ensure a fair and unbiased peer-review process, one that is separated from undue industry influence.

Evolution and Trends in Male Versus Female Authorship of Articles in Flagship Orthopaedic Journals From 1995 to 2020.

The gender disparity in orthopaedic surgery has been recognized for many years. Because research affects promotions, this study investigates trends in female authorship in three journals over the past 25 years for both first and senior authors. All articles from Journal of Bone and Joint Surgery, Journal of the American Academy of Orthopaedic Surgeons, and Clinical Orthopaedics and Related Research from 1995 to 2020 in 5-year intervals were downloaded, and the data for first and senior authors were extracted. The sex of the first and senior authors was determined using the validated Genderize algorithm. The demographics of the first and senior author cohorts were analyzed using chi square tests. The trends in female authorship controlling for year and journal were assessed with logistic regression models. Within the studied journals, 5,636 individuals were identified as first authors and 4,572 as senior authors. Sex was determined for 82.59% of the authors. Female first authorship increased significantly from 1995 to 2020 (6.70% to 15.37%, P < 0.001). Similarly, female senior authorship increased significantly from 1995 to 2020 (8.22% to 13.65%, P < 0.001). Overall, there was no significant difference in gender composition of authors between journals (P = 0.700 first author and P = 0.098 senior author). Women were much more likely to publish as first or senior author in later years, regardless of the journal (P < 0.001 first author and P < 0.001 senior author). Female authorship in prominent orthopaedic journals has increased markedly from 1995 to 2020 with interjournal differences in senior author gender disparity. Although female orthopaedic surgeons publish at rates equal to or greater than their representation in the specialty, additional research is needed into the persistence of gender disparities in orthopaedics.