Orthopaedic Surgery Journals Research Articles

An Evaluation of Spin in Lower Extremity Joint Trials

BackgroundSpin is a specific type of reporting bias that misrepresents data and results within randomized controlled trials (RCTs). Because spin may provide a surgeon with an inaccurate representation of trial results, thus misconstruing the surgeons' interpretation thereof and possibly negatively affecting patient care, it is important that spin is identified within publications. The primary goal of our study was to determine the prevalence of spin found within the abstracts of lower extremity joint trials. MethodsUsing Google Scholar’s H-5 index, we selected the top 20 journals in the orthopedic surgery category. We then conducted a PubMed search on July 2nd, 2018 using the advanced search feature, encompassing all RCTs published in these journals from January 1, 2016 to January 1, 2017. Spin was evaluated using a standardized protocol, using a previously published protocol on the Open Science Network. ResultsOur final sample consisted of 46 trials published in 9 of the top 20 orthopedic surgery journals. Spin was found in 27 (58.7%) of the 46 abstracts. Evidence of spin in the abstract results was found in 19 (41.3%) of the 46 articles, and spin in abstract conclusions was found in 15 (32.6%) of the 46 articles. ConclusionsOur study found that a significant number of lower extremity joint RCTs contain one or more form of spin in either their abstract results, conclusions, or both. In addition, our investigation revealed that a sizable portion of these lower extremity orthopedic joint RCTs are not registered or do not report their registration, and funding sources are also underreported.

How are risk ratios reported in orthopaedic surgery journals? A descriptive study of formats used to report absolute risks

PurposeThe numerical format in which risks are communicated can affect risk comprehension and perceptions of medical professionals. We investigated what numerical formats are used to report absolute risks in empirical...

Increased Utilization of American Administrative Databases and Large-scale Clinical Registries in Orthopaedic Research, 1996 to 2016.

Introduction:Administrative databases and clinical registries provide large sample sizes that characterize specific outcomes and trends over time in orthopaedic surgery.Methods:A literature review of all English-language orthopaedic surgery journals was conducted. All publications from 1996 to 2016 were reviewed for the utilization of an administrative database or clinical registry. We performed a linear regression with logarithmic transformation to identify trends in database utilization.Results:Eight hundred forty-nine publications used a database from 1996 to 2016. Each year, 35.3% more database publications are reported than the previous year (95% confidence interval, 30.0 to 40.7), from zero articles in 1996 to 286 in 2016. The ratio of database research publications to overall orthopaedic publications increased from zero in 1996 to 2% in 2016. The most commonly used databases included the National Inpatient Sample and the National Surgical Quality Improvement Program.Conclusion:Database research in orthopaedics has grown at a faster rate than orthopaedic literature as a whole.

Correction: The Use of Twitter by Trauma and Orthopaedic Surgery Journals: Twitter Activity, Impact Factor, and Alternative Metrics.

[This corrects the article DOI: 10.7759/cureus.1931.].

RELATION BETWEEN IMPACT FACTOR IN ORTHOPEDIC JOURNALS AND LEVEL OF EVIDENCE

ABSTRACTObjective:This study aims to assess the quality of articles published in the leading orthopedic surgery journals, by measuring the relation between the impact factor and the number studies with a high level of evidence.Methods:A literature review was performed of articles published in four previously selected journals. A score of journal evidence (RER - Relation between Randomized clinical trials and Systematic reviews) was calculated, considering the number of RCTs and SR published and the total number of full-text articles.Results:The selected journals were JBJS-Am, ASMJ, BJJ-Br and Arthroscopy, with Impact factors of 5.280, 4.362, 3.309 and 3.206 respectively in 2015. In the study, the RER Scores, in the same order, were 9.408, 6.153, 7.456 and 7.779.Conclusion:The journal JBJS-Am is the best available source of information on orthopedic surgery from this point of view. It has the highest Impact Factor and clearly the highest RER Score. On the other hand, we could conclude that the number of published RCT and good quality SR is very low, with less than 10% of all the articles. Level of evidence III, Analyses based on limited alternatives and costs, and poor estimates.

The Use of Twitter by the Trauma and Orthopaedic Surgery Journals: Twitter Activity, Impact Factor, and Alternative Metrics.

AimSocial media (SoMe) platforms have become leading methods of communication and dissemination of scientific information in the medical community. They allow for immediate discussion and widespread engagement around important topics. It has been hypothesized that the activity on Twitter positively correlates with highly cited articles. The purpose of this study was to analyze the prevalence and activity of Trauma and Orthopaedic Surgery journals on Twitter, with the hypothesis that impact factor is positively associated with Twitter usage.MethodsThe top 50 Trauma and Orthopaedic Surgery journals, ranked by 2016 Impact Factor were analyzed. The Twitter profiles of each journal or affiliated society were identified. Other SoMe platforms used were also recorded. Twitonomy software (Digonomy Pty Ltd, New South Wales, Australia) was used to analyze the Twitter profiles over a one-year period. Twitter Klout Scores were recorded for each journal to approximate the SoMe influence. Altmetric Scores (the total number of mentions via alternative metrics) were also recorded. Statistical analysis was carried out to identify correlations between journal Impact Factors, SoMe activity, Twitter Klout Scores and Altmetric Scores. ResultsTwenty-two journals (44%) had dedicated Twitter profiles. Fourteen journals (28%) were associated with societies that had profiles and 14 journals (28%) had no Twitter presence. The mean Impact Factor overall was 2.16 +/- 0.14 (range, 1.07-5.16). The journals with dedicated Twitter profiles had higher Impact Factors than those without (mean 2.41 vs. 1.61; P=0.005). A greater number of Twitter followers were associated with higher Impact Factors (R2 0.317, P=0.03). Journals with higher Twitter Klout Scores had higher Impact Factors (R2 0.357, P=0.016). Altmetric Score was positively associated with Impact Factor (R2 0.310, P=0.015). Journals with higher numbers of retweets (virtual citations in the Twittersphere) had higher Altmetric Scores (R2 0.463, P=0.015).ConclusionTrauma and Orthopaedic Surgery journals with dedicated Twitter profiles have higher Impact Factors than those without. Altmetrics is likely to play a significant role in the literature evaluation going forward along with the traditional metrics. The engagement with Twitter by Trauma and Orthopaedic surgeons should be encouraged.

Osteopathic Representation on Editorial Boards of Orthopedic Surgery Journals

Osteopathic Representation on Editorial Boards of Orthopedic Surgery Journals

Potential Financial Conflict of Interest Among Physician Editorial Board Members of Orthopaedic Surgery Journals.

The practice of medicine is based on evidence from peer-reviewed literature. As can occur with author-related funding, the integrity of the process by which manuscripts are reviewed, edited, and approved for publication may be at risk due to financial conflict of interest. The purpose of our study was to assess potential financial conflict of interest among physician editorial board members of orthopaedic surgery journals. We identified the physician editorial board members of 15 orthopaedic surgery journals and searched the 2014 payments that were archived in the Centers for Medicare & Medicaid Services Open Payments system (mandated by the Physician Payments Sunshine Act). Total dollar values were calculated and tabulated in a multilevel fashion: nothing reported, >$0 and ≤$10,000, >$10,000, >$250,000, and >$950,000. We identified 908 physician editors of 15 orthopaedic surgery journals. Something of financial value was received by 78% (712 of 908) of these individuals. Rates of editorial board potential financial conflict of interest for individual journals ranged from 4% to 73% in the >$10,000 category. At the >$250,000 mark, rates ranged from 0% (2 journals) to 31%. When applying the >$950,000 criterion, physician potential conflict of interest ranged from 0% (5 journals) to 13%. Editor-related potential financial conflicts of interest exist in the orthopaedic surgery journals that we analyzed. These potential financial conflicts could possibly impact reviews.

Robert W. Williams: Forgotten Pioneer of Spinal Мicrosurgery.

In the 1970's many neurosurgeons gradually adapted microsurgical techniques to spine surgery as the benefits of magnification, illumination, and use of fine instruments in cranial surgery became apparent. In the early 1970 s, Robert W. Williams, а neurosurgeon in private practice in Las Vegas, Nevada, independently began to devise spinal microneurosurgical techniques with the goal of improving surgical outcome in lumbar and cervical surgery. Much of his initial work with microlumbar discectomies and microcervical foraminotomies was presented at annual meetings of the American Association of Neurological Surgeons and Congress of Neurological Surgeons in the 1970s and 1980s. An outsider to organized academic neurosurgery, Dг. Williams found his work was received cautiously and with significant skepticism. He found the orthopedic spine surgery community and journals more receptive, thus much of his earlier work was published in the orthopedic literature. This resulted in an orthopedic and neurosurgical following which was unique at that time. Dr. William's interesting career and contribution to spinal microsurgery is outlined, demonstrating the contributions to surgery, both neurological and orthopedic, that can be achieved by a neurosurgeon in private practice. N/A.

Reporting and Methodological Quality of Systematic Reviews in the Orthopaedic Literature

Properly designed and conducted systematic reviews can reliably produce valid pooled treatment-effect estimates and are an important resource for clinical decision-making. The purpose of this report was to assess the reporting and methodological quality of systematic reviews in orthopaedic journals. With use of the 2010 Institute for Scientific Information (ISI) Thomson Reuters Journal Citation Reports, the five orthopaedic surgery journals with the highest impact factors were searched by one individual over a five-year period (from 2006 to 2010) for systematic reviews and meta-analyses. The two authors separately and independently assessed the included studies. The reporting quality was assessed with use of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, and the methodological quality was assessed with use of the Assessment of Multiple Systematic Reviews (AMSTAR) guidelines, both of which are accepted instruments. We calculated the proportions of each item reported within and across journals. Seventy-six systematic reviews and meta-analyses were included. Of the five journals that were examined, articles from The Journal of Bone and Joint Surgery (American Volume) had the best reporting. Articles from The American Journal of Sports Medicine fulfilled the most methodological quality items. The papers from all of the journals reported an average of only 68% of the PRISMA items and only 54% of the AMSTAR quality items. Both reporting and methodological quality in the top five orthopaedic journals were poor; the reporting quality was slightly superior to the methodological quality. Although there was a wide range of reporting quality and methodological quality scores across the journals, the included articles demonstrated inadequate adherence to accepted standards of quality. The use of PRISMA and AMSTAR guidelines in designing, implementing, and writing systematic reviews is recommended to improve the quality of systematic reviews and meta-analyses in orthopaedic journals. The validity of published systematic reviews in orthopaedics is questionable, and their contribution to clinical decision-making is suboptimal. Clinicians should be careful when interpreting and applying findings of current orthopaedic systematic reviews.

Content Factor: A Measure of a Journal’s Contribution to Knowledge

Impact Factor, the pre-eminent performance metric for medical journals, has been criticized for failing to capture the true impact of articles; for favoring methodology papers; for being unduly influenced by statistical outliers; and for examining a period of time too short to capture an article’s long-term importance. Also, in the era of search engines, where readers need not skim through journals to find information, Impact Factor’s emphasis on citation efficiency may be misplaced. A better metric would consider the total number of citations to all papers published by the journal (not just the recent ones), and would not be decremented by the total number of papers published. We propose a metric embodying these principles, “Content Factor”, and examine its performance among leading medical and orthopaedic surgery journals. To remedy Impact Factor’s emphasis on recent citations, Content Factor considers the total number of citations, regardless of the year in which the cited paper was published. To correct for Impact Factor’s emphasis on efficiency, no denominator is employed. Content Factor is thus the total number of citations in a given year to all of the papers previously published in the journal. We found that Content Factor and Impact Factor are poorly correlated. We further surveyed 75 experienced orthopaedic authors and measured their perceptions of the “importance” of various orthopaedic surgery journals. The correlation between the importance score and the Impact Factor was only 0.08; the correlation between the importance score and Content Factor was 0.56. Accordingly, Content Factor better reflects a journal’s “importance”. In sum, while Content Factor cannot be defended as the lone metric of merit, to the extent that performance data informs journal evaluations, Content Factor– an easily obtained and intuitively appealing metric of the journal’s knowledge contribution, not subject to gaming– can be a useful adjunct.

Multi‐investigator collaboration in orthopaedic surgery research compared to other medical fields

An increasing emphasis has been placed across health care on evidence-based medicine with higher level studies, such as randomized trials and prospective cohort studies. Historically, clinical research in orthopaedic surgery has been dominated by studies with low patient numbers from a limited number of surgeons. The purpose of this study was to test our hypothesis that orthopaedics has fewer multi-center collaborative studies as compared to other medical disciplines. We chose three leading journals from general medicine, a leading journal from the surgical subspecialties of obstetrics and gynecology, ophthalmology and otolaryngology, and three leading journals from orthopaedic surgery based on highest impact factor. We compared the percentage of collaborative studies and the number of contributing institutions and authors in original research manuscripts published in 2009 between general medical, surgical subspecialty and orthopaedic surgery journals. A significantly higher percentage of manuscripts resulted from multicenter collaborative efforts in the general medical literature (p < 0.000001) and the other surgical subspecialty literature (p < 0.000001) compared to the orthopaedic surgery literature. Manuscripts published in the general medical journals came from more institutions (p < 0.0001) and had significantly more authors (p < 0.000001) than those published in the orthopaedic surgery journals. There is an opportunity to stimulate greater multicenter collaborative research, which correlates with increased patient numbers, a higher level of evidence and more generalizable findings, in the orthopaedic surgery community. These efforts can be supported through increased funding, surgeon participation, and appropriate expansion of authorship for multicenter studies in orthopaedic journals.

Knowledge of Levels of Evidence Criteria in Orthopedic Residents

The purpose of the levels of evidence system is to provide a framework for critical evaluation of orthopedic literature. This rating system is based on guidelines from the Oxford Centre for Evidence-Based Medicine and is currently in use in several orthopedic surgery journals. The purpose of this study was to investigate resident knowledge of the levels of evidence criteria used in classification of clinical articles. Thirty-eight residents from 5 orthopedic surgery training programs, from year-in-training 3 to 5, determined the levels of evidence rating of 10 blinded articles representing all levels of evidence types in the orthopedic literature. Residents were then provided with a levels of evidence information sheet and asked to re-rate each article. The mean percentage correct for the initial rating was 29.5% and for the post-education rating was 41.3%, with significant improvement after levels of evidence education (P<.001). The year-in-training-3 group had the highest mean percentage correct for the average of both tests (46.7%) compared to year-in-training-4 (34.2%) and year-in-training-5 (25.4%). Residents were significantly more accurate scoring therapeutic (41.1% correct pre-levels of evidence; 51.6% post-levels of evidence) than prognostic studies (6.6% correct pre-levels of evidence; 28.9% post-levels of evidence) (P<.001). Residents graded the level of evidence correctly in fewer than half the papers. These findings indicate that resident knowledge of levels of evidence criteria is limited and suggest a need for more education in this area.

The risk of false-positive results in orthopaedic surgical trials.

The risk of concluding that the results of a particular study are true, when, in fact, they really are attributable to chance (or random sampling error) is underappreciated by investigators. This erroneous false-positive conclusion is designated as a Type I or alpha error. The extent to which randomized trials in surgery risk Type I errors is unclear. The current authors hand-searched four orthopaedic journals, six general surgery journals, and five medical journals to identify recently published randomized trials (within the past 2 years). Information on outcomes and statistical adjustment for multiple outcomes was recorded for each study. The risk of a Type I error was calculated for each study that did not explicitly state a primary outcome measure for the main statistical comparison. One hundred fifty-nine studies met the inclusion criteria for the study: 60 studies from orthopaedic journals, 49 studies from nonorthopaedic surgical journals, and 50 studies from medical journals. Of the trials that did not state a primary outcome measure, the risk of Type I errors (false-positive results) in orthopaedic and nonorthopaedic surgery journals (mean 37.3% +/- 13.3% and 37.6% +/- 10.5%, respectively) were significantly greater than medical journals (10.1% +/- 1.9%). In the current review of randomized trials in surgery and medicine, the following is reported: (1) reporting of primary outcomes in trials was inadequate; (2) one in three trials in surgery and one in 10 trials in medicine risked false-positive results; and (3) few trials in surgery and medicine considered adjustment for multiple comparisons.

Finding current evidence: search strategies and common databases.

With more than 100 orthopaedic, sports medicine, or hand surgery journals indexed in MEDLINE, it is no longer possible to keep abreast of developments in orthopaedic surgery by reading a few journals each month. Electronic resources are easier to search and more current than most print sources. We provide a practical approach to finding useful information to guide orthopaedic practice. We focus first on where to find the information by providing details about many useful databases and web links. Sources for identifying guidelines, systematic reviews, and randomized controlled trials are identified. The second section discusses how to find the information, from the first stage of formulating a question and identifying the concepts of interest, through to writing a simple strategy. Sources for additional self-directed learning are provided.