Global Research on Osteoarthritis During 1994–2023: A Scientometric Assessment of Publications and Citations

Abstract

Introduction

This study presents a global research scenario in the broad domain of osteoarthritis (OA) research, using quantitative and qualitative publication and citation indicators.

Methods

The study is based on 45,368 global publications, sourced from the Scopus bibliographical database, covering three decades (1994–2023). We studied the performance of the top 12 developed and top 12 developing countries. The key countries, organizations and authors at national and international levels were identified. The broad subject areas and key journals contributing to global OA research were delineated, besides identifying the broad characteristics of highly cited papers in the field.

Results

The United States and China were the most productive countries, while the Netherlands and Canada made the largest citation impact. Harvard Medical School and the University of Sydney made the most contribution, while Boston University and Pfizer Inc., USA registered the highest citation impact. Hunter DJ and Guermazi A were the most productive authors, while Lohmander LS, and Hochberg MC registered the highest citation impact. Osteoarthritis and Cartilage (n = 4879) and Annals of the Rheumatic Diseases (n = 786) published the maximum papers, while Arthritis and Rheumatism and Nature Reviews Rheumatology registered the largest citation impact. The highly cited papers with 100 or more citations constituted 6.25% of the total publications.

Conclusions

There has been a systematic growth of publications on OA. The research on OA was mainly done in developed countries, with the maximum publications coming from the United States of America, China and Canada. The most impactful publications on OA were from the Netherlands, Canada and the United States of America.

Supplementary Information

The online version contains supplementary material available at 10.1007/s43465-024-01111-9.

Introduction

Osteoarthritis (OA) is a common degenerative joint disease, especially in older and obese people [1]. The OA causes joint pain, and disability, which affects the quality of life of the affected person. It is estimated that nearly, 528 million people globally were suffering from OA in 2019, with an increase of 113% since 1990 [2]. It is common in people older than 55 years, with a reported prevalence of 73%, and 60% of them are female [2]. The most commonly involved major joints by OA are the knee and hip [3]. It is estimated that OA will be the 4th biggest cause of disability in 2020 [4].

Bibliometrics deals with quantitative research and analysis of the literature by statistical methods, to evaluate the impact of researchers, institutions, and countries in a specific field of interest [5, 6]. Bibliometrics and information visualization are used to find the highly cited papers (HCP) in biomedical and related sub-fields [7, 8].

Some bibliometric studies exist that have examined the international and national assessment of OA research. Among the global studies, only one study [9] was conducted to identify and analyze the 100 HCPs in OA (from 1990 to 2020). Other bibliometric studies have examined the OA research output of China [10, 11] and India [12]. Some bibliometric studies were conducted in specific subsets of OA, such as post-traumatic OA [13], OA rehabilitation [14], oxidative stress and OA [15], autophagy in OA [16], macrophages associated with OA [17], osteoimmunology on OA [18], and stem cells and OA [19].

Still, there is no comprehensive study on the global publications in OA. We aimed to identify and undertake a qualitative and quantitative assessment of global research output in OA. We hope that this research will enable future researchers.

Methods

Global data on OA publications were identified in the Scopus database and retrieved from the database using a predefined search strategy (shown below), utilizing the keyword “osteoarthritis” in “Title” and “Source Title” tags, covering the period from 01 January 1994 to 03 September 2023. The search yielded 45,368 publication records. These records were further analyzed, by country, organization, author, journals and keywords using additional features of the Scopus database. From the downloaded publication records, complete bibliographical information related to countries, institutions, journals, keywords, citation counts, collaboration, funding, and the document and source type was collected. Data analysis was performed using Microsoft Excel. A few bibliometric indicators based on quantitative and qualitative aspects were applied to study the performance of OA research at the national and international levels. Our search strategy was as follows:

(TITLE (osteoarthritis) OR SRCTITLE (osteoarthritis)) AND PUBYEAR > 1993 AND PUBYEAR < 2024 AND PUBYEAR > 1993 AND PUBYEAR < 2024).

The papers that received 100 or more citations were assumed as HCPs. The most productive organizations and authors were considered as those who published the maximum number of papers. The most impactful organizations and authors were considered those who have had the highest citation impact in terms of Citations Per Paper (CPP) and Relative Citation Index (RCI). The CPP is a metric used for the evaluation of the impact and quality of a scientific work, on average per publication. It is calculated by dividing the total number of citations by the total number of papers. The RCI is a citation-based metric that is used to measure the influence of a publication. It indicates how a publication has been cited relative to other publications in its co-citation network and this is assumed to be reflective of the article’s area of research. The RCI is calculated by dividing the article citation rate by an expected citation rate that is derived from the performance of articles in the same field and benchmarked to a peer comparison group.

Results

Overall Data

We found 45,368 publications on OA, as indexed and covered in the Scopus database during the last 30 years (1994–2023). Their annual publications increased from 275 in 1994 to 3073 in 2023, with maximum publications (n = 3957) in 2022 (Fig. 1).

Fig. 1.

Yearwise growth of osteoarthritis literature (1994–2023)

The annual average and 15-year cumulative publications on OA were 9.25% and 119.25%. These publications received 1,347,325 citations, averaging 29.70 CPP (Supplementary Table 1).

Research Type and Design

The clinical studies accounted for the largest output (35.66%), followed by pathophysiology (21.12%), treatment outcome (13.99%), risk factors (8.25%), quality of life (7.12%), epidemiology (6.51%), complications (5.71%), and genetics (3.3%). Case–control studies accounted for the largest output (40.3%), followed by randomized control trials or RCT (10.51%), and clinical trials (7.25%) etc.

Anatomical Distribution

The maximum publications (44.41%) were contributed to knee OA research, followed by hip, hand, spine, ankle, and foot.

Research Funding

Only 14,783 out of 45,368 research (32.58%) received external funding support from more than 300 funding agencies. The leading institutions supporting research in this area were: the National Institute of Arthritis and Musculoskeletal and Skin Diseases (3737 papers), the National Institute of Health, United States of America (USA) (2573 papers), and the National Natural Science Foundation of China (2413 papers).

Publication Language

English constituted the most dominant group (91.29%), followed by Chinese (3.09%), German (1.79% share), French (1.54%), and Spanish (0.74%) etc.

Geographical Distribution

Contribution of Top 12 Countries

The top 12 countries (all developed countries) contributed 42,040 papers (range 1252–11,528) and received 1,576,287 citations, constituting 92.66% share in the global publication. The most publications came from the USA (11,529 papers), China (7372 papers) and the United Kingdom (U.K.) (4414 papers). The average citation impact, measured by CPP and relative citation index (RCI), registered by the top 12 countries were 37.49 and 1.26. Six countries registered citation impact more than the average citation impact of all 12 countries: Netherlands (51.03 and 1.72), Canada (47.68 and 1.61), USA (46.64 and 1.57), UK (46.58 and 1.57), France (43.57 and 1.47) and Australia (41.16 and 1.39) (Table 1).

Table 1.

Contribution of Top 12 most productive countries

S. no.	Country	TP	TC	CPP	RCI	ICP	%ICP
1	USA	11,528	537,721	46.64	1.57	4200	36.43
2	China	7372	109,609	14.87	0.50	1220	16.55
3	U.K.	4414	205,609	46.58	1.57	2189	49.59
4	Germany	2673	97,924	36.63	1.23	1382	51.70
5	Australia	2618	107,764	41.16	1.39	1489	56.88
6	Canada	2609	124,408	47.68	1.61	1232	47.22
7	Japan	2310	63,570	27.52	0.93	436	18.87
8	France	2134	92,981	43.57	1.47	862	40.39
9	Netherlands	2118	108,081	51.03	1.72	976	46.08
10	Italy	1749	57,961	33.14	1.12	741	42.37
11	Spain	1263	43,400	34.36	1.16	544	43.07
12	South Korea	1252	27,259	21.77	0.73	234	18.69
	Total of 12 countries	42,040	1,576,287	37.49	1.26	15,505	36.88
	Global total	45,368	1,347,325	29.70	1.00
	Share of top 12 countries in global total	92.66

TP Total Papers, TC Total Citations, CPP Citations Per Paper, RCI Relative Citation Index, ICP International Collaborative Papers

Contribution of Top 12 Developing Countries

The top 12 developing countries individually published 143–877 papers on OA and they together contributed 4753 papers and received 79,032 citations, constituting 10.48% share in global publications. The top developing countries were India 877 papers), Brazil (749 papers), Taiwan (617 papers) and Iran (615 papers). The average citation impact (as measured by CPP and RCI) registered by the top developing 12 countries were 16.63 and 0.56. Six countries registered citation impact more than the average citation impact of all 12 developing countries: Israel (29.70 and 1.0), Mexico (26.43 and 0.89), Taiwan (19.95 and 0.67), Saudi Arabia (19.91 and 0.67), Iran (19.51 and 0.66) and Brazil (16.93 and 0.57) (Table 2).

Table 2.

Contribution of Top 12 developing countries

S. no.	Country	TP	TC	CPP	RCI	ICP	%ICP
1	India	877	10,650	12.14	0.41	230	26.23
2	Brazil	749	12,681	16.93	0.57	264	35.25
3	Taiwan	617	12,307	19.95	0.67	155	25.12
4	Iran	615	11,997	19.51	0.66	162	26.34
5	Saudi Arabia	370	7367	19.91	0.67	215	58.11
6	Thailand	291	4480	15.40	0.52	73	25.09
7	Egypt	278	2938	10.57	0.36	85	30.58
8	Malaysia	221	2917	13.20	0.44	85	38.46
9	Israel	217	6444	29.70	1.00	94	43.32
10	Mexico	203	5366	26.43	0.89	72	35.47
11	Indonesia	172	1008	5.86	0.20	42	24.42
12	Pakistan	143	877	6.13	0.21	39	27.27
	Total of 12 developing countries	4753	79,032	16.63	0.56	1516	31.90
	Global total	45,368	1,347,325	29.70	1.00
	Share of top 12 developing countries in global total	10.48	5.87

TP Total Papers, TC Total Citations, CPP Citations Per Paper, RCI Relative Citation Index, ICP International Collaborative Papers

Subjectwise Distribution

Medicine contributed maximally (81.68%) in global output, followed by Engineering (13.94%), Immunology and microbiology (9.23%), Biochemistry, Genetics and Molecular Biology (7.97%), and Pharmacology, Toxicology and pharmaceuticals (2.38%) etc.

Significant Keywords

The authors have identified more than 20,000 keywords that appeared in 45,368 global publications on OA. From these keywords, the authors identified 49 significant keywords (Supplementary Table 2), which convey important information and ideas, reflecting the core contents of the publications. They either independently or in combination with other keywords reflect the main concepts of the OA field. Among these significant keywords, the top 12 keywords (along with their frequency of appearance) were: Osteoarthritis, Knee Osteoarthritis, Articular Cartilage, Non-steroidal Anti-inflammatory Agents, Metabolism, Chondrocytes, Hip Osteoarthritis, Protein Expression, Inflammation, Cartilage Degeneration, and Hyaluronic Acid (Supplementary Table 2).

Most Productive and Most Impactful Organizations

The top 50 organizations contributed a total of 16,837 papers (range 154–7344) and received 850,528 citations, representing 37.11% and 63.13% share, respectively, in global publications and citations (Supplementary Table 3). Of the top 50 organizations, 13 were from the USA, followed by Australia (n = 7), Canada and the U.K. (n = 6 each), France (n = 5), China and the Netherlands (n = 4 each), Sweden (n = 2), Belgium, Denmark and Germany (n = 2 each). The average publication productivity by the top 50 organizations was 336.74 and 26 organizations contributed more than the average productivity of all 50 organizations. The share of international collaborative papers of these 50 organizations varied from 20.9 to 82.07%, with an average of 54.22%. The bibliometric profile of the top eight most productive and impactful organizations is presented in Table 3.

Table 3.

Bibliometric profile of top eight most productive and impactful organizations

S. no	Organization	TP	TC	CPP	RCI	ICP	%ICP
	Most productive organization
1	Harvard Medical School, USA	734	32,514	44.30	1.49	352	47.96
2	University of Sydney, Australia	728	38,282	52.59	1.77	475	65.25
3	Boston University Chobanian & Avedisian School of Medicine, USA	724	42,933	59.30	2.00	535	73.90
4	University of California, San Francis, USA	688	36,941	53.69	1.81	353	51.31
5	University of Melbourne, Australia	623	25,920	41.61	1.40	284	45.59
6	Erasmus MC, Netherlands	612	33,149	54.17	1.82	254	41.50
7	University of Oxford, U.K	583	28,806	49.41	1.66	361	61.92
8	Brigham & Women’s Hospital, USA	514	24,299	47.27	1.59	218	42.41
	Most impactful organization
1	Boston University, USA	334	24,629	73.74	2.48	172	51.50
2	Pfizer Inc., USA	353	25,955	73.53	2.48	204	57.79
3	University of Bristol, U.K	256	18,525	72.36	2.44	100	39.06
4	Hopital Cochin AP–HP, France	303	21,637	71.41	2.40	110	36.30
5	Lunds Universitet, Sweden	489	34,108	69.75	2.35	364	74.44
6	Centre Hospitallierde L’Universite de Montreal, Canada	309	20,742	67.13	2.26	134	43.37
7	University of Southampton, U.K	292	19,121	65.48	2.20	195	66.78
8	Rush University Medical Center, USA	365	23,445	64.23	2.16	146	40.00

TP Total Papers, TC Total Citations, CPP Citations Per Paper, RCI Relative Citation Index, ICP International Collaborative Papers

Most Productive and Most Impactful Authors

The top 50 authors contributed 9027 papers (range 117–195) and received 640,779 citations, representing 19.90% and 47.56% share, respectively, in global publications and citations (Supplementary Table 4). Of them, 13 were from the USA, followed by Australia (n = 7), Canada and the U.K. (n = 6 each), France (n = 5), China and the Netherlands (n = 4 each), Sweden (n = 2), Belgium, Denmark and Germany (n = 2 each). The average publication productivity by the top 50 organizations was 70.98 and 2.39 and 18 authors’ contribution was more than the average productivity among 50 authors. The average citation impact, in terms of CPP and RCI, registered by the top 50 authors was 70.98 and 2.39. A bibliometric profile of the top eight most productive and impactful authors is provided in Table 4.

Table 4.

Bibliometric profile of top eight most productive and impactful authors

S. no.	Author	Affiliation	TP	TC	CPP	RCI	ICP	%ICP
1	D.J. Hunter	University of Sydney Australia	480	31,508	65.64	2.21	382	79.58
2	A. Guermazi	Boston University, USA	392	21,346	54.45	1.83	321	81.89
3	D.J. Felson	Boston University, USA	372	36,494	98.10	3.30	201	54.03
4	K.L. Bennell	University of Melbourne, Australia	262	10,809	41.26	1.39	123	46.95
5	M. Kloppenburg	Leids Universitair Medisch Centrum, Netherlands,	260	12,278	47.22	1.59	124	47.69
6	J. Martel–Pelletier		252	19,546	77.56	2.61	99	39.29
7	S.M. Bierma-Zeinstra	Erasmus MC, Netherlands	236	11,821	50.09	1.69	62	26.27
8	F.W. Roemer	Boston Univ, USA	225	9484	42.15	1.42	207	92.00
1	L.S. Lohmander	Lunds Universitet, Sweden	178	27,634	155.25	5.23	135	75.84
2	M.C. Hochberg	University of Maryland School of Medicine, USA	195	29,546	151.52	5.10	116	59.49
3	R.D. Altman	University of California, Los Angles, USA	118	17,185	145.64	4.90	52	44.07
4	F. Cicuttini	Monash University, U.K	125	15,751	126.01	4.24	121	96.80
5	M. Dougados	Hopital Cochin AP–HP, France	154	18,225	118.34	3.98	65	42.21
6	E.M. Roos	Syddansk Universitet, Denmark	186	21,335	114.70	3.86	148	79.57
7	M.C. Nevitt	University of California, San Francisco, USA	186	20,709	111.34	3.75	165	88.71
8	M. Doherty	Nottingham City Hospital, U.K	198	21,433	108.25	3.64	8	4.04

TP Total Papers, TC Total Citations, CPP Citations Per Paper, RCI Relative Citation Index, ICP International Collaborative Papers

Most Productive and Most Impactful Journals

The top 50 journals publishing global publications on OA have published 17,561 papers (range 128–4879) and received 755,353 citations (Supplementary Table 5). The profile of the top eight most productive and impactful journals is presented in Table 5.

Table 5.

Bibliometric profile of eight most productive and impactful journals

S. no.	Journals	TP	TC	CPP	%TP
	Most productive journals
1	Osteoarthritis and Cartilage	4879	257,158	52.71	1.30
2	Annals of the Rheumatic Diseases	786	67,576	85.97	0.39
3	BMC Musculoskeletal Disorders	733	16,483	22.49	1.73
4	Arthritis Care & Research	719	39,175	54.49	0.30
5	Journal of Rheumatology	658	37,629	57.19	0.41
6	Arthritis & Rheumatism	591	75,721	128.12	0.38
7	Arthritis Research & Therapy	467	22,846	48.92	0.47
8	Journal of Orthopaedic Research	370	13,660	36.92	1.45
	Most impactful journals
1	Arthritis & Rheumatism	591	75,721	128.12	1.30
2	Nature Reviews Rheumatology	177	16,577	93.66	0.39
3	Annals of the Rheumatic Diseases	786	67,576	85.97	1.73
4	Journal of Joint Bone & Surgery	137	11,125	81.20	0.30
5	American Journal of Sports Medicine	186	13,082	70.33	0.41
6	Current Onions in Rheumatology	171	11,061	64.68	0.38
7	Clinical Orthopaedics & Related Research	211	13,066	61.92	0.47
8	Journal of Rheumatology	658	37,629	57.19	1.45

TP Total Papers, TC Total Citations, CPP Citations Per Paper

Highly Cited Papers

Of the 45,367 global papers on OA, 6.25% (n = 2836) were assumed as HCPs, as they registered 100 to 3142 citations, together contributing 627,495 citations, averaging 221.26 CPP. External funding support was received by 39.32% of these papers, and they received a total of 189,209 citations, averaging 169.69 CPP. More than 100 countries participated in these HCPs. Among the top 12 countries, the USA (1279 papers) and U.K (500 papers) contributed above their average productivity, while Switzerland (293.04), Canada (260.52), France (253.53), Netherlands (251.64), Australia (242.64), Belgium (239.86) and USA (239.25) registered citation impact above their average impact.

The top institutions publishing the highest number of HCPs were Boston University Chobanian and Avedisian School of Medicine, USA (n = 105), University of California, San Francis, USA (n = 96), and University of Sydney, Australia (n = 90) etc. Whereas, the most impactful publications in terms of CPP came from Lunds Universitet, Sweden (370.89), Pfizer Inc., USA (309.25), and the University of Toronto, Canada (306.6) etc.

The authors that contributed the maximum HCPs were Felson J (USA) (n = 98), Hunter DJ (Australia) (n = 72), and Hochberg MC (USA) (n = 63) etc. Whereas, the most impactful authors in terms of CPP were Altman (USA) (498.0), Lohmander LS (Sweden) (494.91), and Roos ES (Denmark) (477.57) etc. The profile of the top 10 HCPs is presented in Table 6 [20–29], which shows that these HCPs received a large number of citations ranging from 1918 to 3146, and were published in high-impact journals.

Table 6.

Profile of Top 10 highly cited papers on osteoarthritis

S. no.	Authors	Title	Journal name and citation	Citations received
1	Silverstein, F.E., Faich, G. et al. [20]	Gastrointestinal toxicity with Celecoxib vs nonsteroidal anti-inflammatory drugs for osteoarthritis and rheumatoid arthritis: The CLASS study: A randomized controlled trial	Journal of the American Medical Association, 2000. 284 (10), pp. 1247–1255	3146
2	Hawker, G.A., Mian, S. et al. [21]	Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP)	Arthritis Care and Research, 2011, 63 (SUPPL. 11), pp. S240–S252	3013
3	Ganz, R., Parvizi, J et al. [22]	Femoroacetabular Impingement: A Cause for Osteoarthritis of the Hip	Clinical Orthopaedics and Related Research, 2003, 417, pp. 112–120	2675
4	Roos, E.M, Roos, H.P. et al. [23]	Knee Injury and Osteoarthritis Outcome Score (KOOS)—Development of a self-administered outcome measure	Journal of Orthopaedic and Sports Physical Therapy, 1998, 28 (2), pp. 88–96	2655
5	Cross, M., Smith, E. et al. [24]	The global burden of hip and knee osteoarthritis: Estimates from the Global Burden of Disease 2010 study	Annals of the Rheumatic Diseases, 2014, 73 (7), pp. 1323–1330	2188
6	Hochberg, M.C, Altman, R.D. et al. [25]	American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee	Arthritis Care and Research, 2012, 64 (4), pp. 465–474. Cited 2157 times	2157
7	Zhang, W., Moskowitz, R.W et al. [26]	OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines	Osteoarthritis and Cartilage, 2008, 16 (2), pp. 137–162	2155
8	McAlindon, T.E, Bannuru, R.R. et al. [27]	OARSI guidelines for the non-surgical management of knee osteoarthritis	Osteoarthritis and Cartilage, 2014, 22 (3), pp. 363–388	2077
9	Poole, J.L, Gallegos, M. et al. [28]	Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 update	Arthritis and Rheumatism, 2000, 43 (9), pp. 1905–1915	2007
10	Felson, D.T., Lawrence, R.C., et al. [29]	Osteoarthritis: New insights—Part 1: The disease and its risk factors	Annals of Internal Medicine, 2000, 133 (8), pp. 635–646	1918

The top journals publishing the HCPs were Osteoarthritis and Cartilage (n = 589), Arthritis and Rheumatism (n = 254), and Annals of the Rheumatic Diseases (n = 191) etc. More than 12,000 keywords appeared in 2836 HCPs, of which 47 significant keywords are selected and presented in Supplementary Table 6, having a frequency of occurrence varying from 42 to 1947.

Discussion

In this study, we have employed the bibliometric methods to analyze a total of 45,368 global papers on OA, using the data of SCOPUS, covering three decades (1994–2023). This study indicates a systematic growth of publications on OA, with 275 publications in 1996–3073 publications in 2023 (Fig. 1). Being a common degenerative condition of the joints, the research on it has been continuously progressive. The publications have received a substantial 1,347,325 citations, averaging 29.70 CPP. Nearly, 1/3rd of the research on OA received external funding support, which is largely due to international collaborations.

The major quantum of publications (92.66%) was from developed countries/high-income countries (HICs), with all the top 12 contributing countries from them (Table 1). The maximum contribution came from the USA (n = 11,529), China (n = 7372) and the U.K. (n = 4414). The top 12 developing/low–middle-income countries (LMICs) contributed only 143–877 papers with an average CPP of 16.63, and RCI of 0.56, which is far less compared to the top 12 developed countries' papers, where the average CPP was 37.49 and the RCI of 1.26. Most publications of LMICs came from India, Brazil, Taiwan and Iran (Table 2). It is a fact that most publications come from HICs, in various fields of medical research, due to the availability of good infrastructure, funding, etc. [30, 31]. Ironically, the majority of the population lives in LMICs where there is a large burden of musculoskeletal problems like OA and not much research output has happened from these countries. We believe that more OA research and publications must be done by the LMICs to find cost-effective solutions for their population, to reduce the locomotor disability. We believe that adequate research funding (by the government and institutions), and collaboration (national and international) are the way forward to enhance the research output [32].

The most impactful research on OA was published in high-impact medical and orthopaedic journals, with the top 50 journals together contributing 38.71% and 56.06% share of global publications and citations (Supplementary Table 5). Zang et al. [11] in a bibliometric study from China, over a 5-year period (2014–2018) and using Web of Science (WOS) data reported 2.52 times increase in the OA publications from China from 2014 to 2018. The citations during this period also increased phenomenally by 56 times, indicating an improvement in the quality and quantity of the Chinese papers on OA. However, there existed differences and gaps between China and the USA. Their results demonstrated that the average number of citations and h-index of Chinese articles were 7.39 and 45, which are much less than those of the USA, which were 8.96 and 81, respectively.

The HCPs are highly useful in providing clinical guidelines and insights into the disease [33]. We found 6.25% of papers registering 100 to 3142 citations, with an average CPP of 221.26. Among these, a large number (39.32%) were externally funded, signifying the importance of research funding for a high-quality research output [32, 34]. It is to be noted that the top 10 HCPs (Table 6) were mostly focused on basic science and medical aspects of OA [20–29]. These papers received a large number of citations (n = 1918–3146), signifying their high impact.

We describe some of the important aspects of these HCPs. Silverstein et al. [20] in a double-blind RCT investigated to find out whether Celecoxib was associated with a lower incidence of significant upper GI toxic and other adverse effects compared to conventional Non-Steroidal Anti-inflammatory Drugs (NSAIDs). Felson et al. [29] reported that there is growing evidence to support the role of systemic factors like dietary intake, genetics, estrogen use, and bone density. In addition, the role of local biomechanical factors also exists (such as muscle weakness, joint laxity, and obesity). The authors further discussed the latest advances in the management of OA, from using nutraceuticals, new NSAIDs, cartilage transplantation, and health education. The top 10 HCPs also include various guidelines and recommendations by a large group of experts and committees, like “American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in OA of the hand, hip, and knee” [25], “OARSI recommendations for the management of hip and knee OA” [26], and “American College of Rheumatology Subcommittee on OA Guidelines” [28].

Various diagnostic and therapeutic options for OA are established and also emerging. Basic aim of management of this degenerative joint disease is to reduce pain, improve mobility and function impairment [35]. Early stages of OA can be managed with non-operative means using knee braces, nutraceuticals (such as Vitamin D, Curcumin extract, Collagen peptide) [36, 37] and intra-articular injections of Hyaluronic Acid, Platelet Rich Plasma (PRP), and Stromal Vascular Fraction (SVF) etc. [38, 39]. Newer imaging techniques such as integrated positive emission tomography–magnetic resonance imaging (PET–MRI) can detect OA in very early stages [40], and the use of Artificial Intelligence (AI) through Deep Learning (DL) is able to interpret various degrees of cartilage degeneration using histological images, rather than relying on radiological grading of OA [41].

Future Directions

We agree with Zhang et al. [11] that the following actions may help improve the quality and quantity of research related to OA:

• Providing research leadership roles to the Universities and supporting them in carrying out OA research.

• Encouraging innovation in clinical and basic research.

• Strengthening cross-regional and cross-border research collaboration.

• Developing clinical guidelines derived from original research.

• Encouraging translational research in OA.

• Promoting the treatments and technologies for OA.

Limitations and Strengths of the Study

Although it is unlikely that any significant publications on AO may have been missed in the current bibliometric analysis, we acknowledge the use of a single database (Scopus) as a limitation of this study. However, the majority of bibliometric studies use a single database, and the Scopus database is the preferred one, due to its broader content, coverage, accuracy, citation analysis tools, and availability of funding information [42]. A simultaneous search in WOS, Google Scholar, Scopus etc. may have improved the bibliometric mapping, but the analytical provisions of different databases are not uniform and may cause difficulties in interpreting the extracted data [43]. The risk-of-bias assessment of the papers is a challenging task but an essential step in systematic reviews [44]. We did not undertake it as ours being a bibliometric study.

However, this bibliometric analysis provides an important and up-to-date overview of the extent of OA research activities and has identified the key players (authors, institutions, countries, publishing journals and funding agencies) in OA research. In addition, the HCPs were identified in this field of research. To the best of our knowledge, such a study has not been published before.

Conclusion

We found a total of 45,368 global papers on OA in the SCOPUS data, spanning three decades (1994–2023). There has been a systematic growth of publications with an annual average and 15-year cumulative publications on OA of 9.25% and 119.25%. The research on OA was mainly done in developed countries, with the maximum publications coming from the USA, China and Canada. The most impactful publications on OA were from the Netherlands, Canada and the USA. The highly cited papers with 100 or more citations constituted 6.25% of the total publications.

Supplementary Information

Below is the link to the electronic supplementary material.

Author Contributions

RV: conceptualization, literature search, data analysis, manuscript writing, editing, and final approval. BMG: conceptualization, data extraction and analysis, manuscript writing, editing, and final approval. GMNM: data extraction and analysis, manuscript writing, editing, and final approval. MK: data extraction and analysis, manuscript writing, editing, and final approval. AV: literature search, data analysis, manuscript writing, editing, and final approval.

Funding

No funds or grants were received for this research in any form.

Data Availability

The data are available with the corresponding author.

Declarations

Conflict of interest

None.

Ethical Approval

Not applicable for such studies.