Abstract
Purpose
Bibliometric studies have been established methods of analysing publications on a particular topic. These studies have been done on various orthopaedic topics and are increasing. The advantages of these studies have been highlighted in previous publications. Although some studies have been done on Indian publications from other specialties, those analysing Indian Orthopaedic Publications are lacking.
Methods
We performed a search in Scopus to look for all publications related to orthopaedics from India. Our search strategy in Scopus included ((TITLE-ABS-KEY(Orthopaedics OR Orthopaedics) AND AFFIL(India)) AND PUBYEAR > 2009 AND PUBYEAR < 2020) which resulted in 3270 articles on 02/11/2021. We analyzed the most publishing universities, city, state, specialty, authors, and anatomic location of these publications. We also mined the data to draw word clouds based on data obtained from the titles of articles, keywords and the affiliations of each of the articles published.
Results
Tamil Nadu and New Delhi and their institutes appear to be the epicenter of publication activities in Orthopaedics in India. There has been a healthy trend of growth of articles in the orthopaedic specialty. Since there is a significant overlap of technology and engineering, it is not surprising to see engineering and technology institutes among the top 10 published institutes and even journals for the publications on orthopaedics.
Conclusion
There has been a steady increase in the number of publications in the last decade. New Delhi and its Universities and Institutes appear to contribute the majority of citations and publications related to orthopaedics. Journal of Clinical Orthopaedics and Trauma was the most publishing journal for Indian authors on Orthopaedic related articles.
Keywords: Bibliometrics, Orthopaedics, Publications, Data mining, Indian orthopaedic publications
1. Introduction
Bibliometric studies look into trends on publications on a particular topic and give powerful and reasonably accurate insight into the research activities on the topics that are being studied. They give an idea of where efforts and resources are focused in a particular specialty or country or topic studied. It allows the identification of the number, citation counts and quality of publications from a specific country. They also offer information on the most happening Universities, Institutes, and authors who are publishing on the topic studied which can be used by researchers to focus their efforts to those regions to get resources and training. Multiple bibliometric studies were reported from India in the recent past ranging from sub-specialty-specific topics1,2 to even covid-19 related orthopaedic publications.3 But there was none analyzing all the publications from India alone.
As the second most populated country, India has more patients than most other countries in the world. Due to the rich clinical resources, we hypothesize the rapid growth of quantity and quality of Indian publications. Previous Publications have been done on non orthopaedic specialties from India.4, 5, 6 No previous publications have been done on bibliometrics on Indian orthopaedic publications in the literature. Hence, in the current study, we conducted a bibliometric analysis of Indian orthopaedic academic outputs to evaluate the productivity of orthopedic research in the country in the last decade to provide valuable insights for researchers and orthopaedic surgeons. This should serve as a baseline of research output in Orthopaedics in India to compare for future studies and give an insight into the academic activity in this specialty in India.
2. Methods
2.1. Search
We performed a search in Scopus to look for all publications related to orthopaedics from India. Our search strategy in Scopus included ((TITLE-ABS-KEY(Orthopaedics OR Orthopedics) AND AFFIL(India)) AND PUBYEAR >2009 AND PUBYEAR < 2020) which resulted in 3270 articles on 02/11/2021.
2.2. Selection
After going through all the articles and during the classification of the articles, those related to dentistry and anaesthesia not related to orthopaedics were excluded. Only those articles related to Orthopaedics and orthopaedic trauma were included. The majority of articles excluded belonged to the field of pure engineering and technology material science (orthopaedic material science was included), anaesthesia and dentistry.
2.3. Analysis
We analyzed the most publishing Institute, states, sub-specialty, authors, and anatomic location of these publications. Using the same software (Excel), the total number of citations of publications, the distribution of citations according to year, and the top ten most-cited institutions, universities, and states were determined.
We manually analyzed the data and created additional fields (columns in the database) to classify each of the publications into the sub-specialty, anatomical area of the body to give an idea of which specialty the publication relates to closest. Since the data from Scopus does not classify the following but includes details of the state and institute, we created these fields to further classify the data. We also determined whether the institute is run by a government or private firms.
Two authors (SK and SP) went through the titles of all the articles and classified them into categories based on anatomic location and sub-specialty. SP and VK classified them into government and private and state and Institute. Data for the state and Institute is given in the downloaded data but had to be parsed from the given data. Each institute was classified as Government-run or private depending on its funding. SK prepared a list of all Institutes publishing from the search database. SP and VK browsed through the websites of the Institutes to determine this status and prepared a list which was the reference data for each entry.
2.4. Software
Data was collected, stored, and analyzed in Excel (Microsoft Office 365). Data mining of fields from the data was done using Orange software (Mac Version 3.29.3) to create word clouds that give the most frequently used text strings from important fields in our data.
3. Results
With our search strategy as described in the methodology section, we retrieved 3270 articles from Scopus. After removing articles that were not related to orthopedics which resulted in 2684articles.These were published in 718 journals. The top 10 cited journals are given in Table 1. Six of the top 10 journals were journals published on engineering and material sciences. The total number of citations for all the articles was 21239.
Table 1.
Top 10 journals publishing Indian Orthopaedic publications. Table is arranged in two parts. Part A shows top 10 journals arranged in descending order of citation counts and Part B shows top 10 journals arranged in descending order of publication numbers.
| Part A Journal Title |
No. Publications | Sum of Citations | % of Publications | % of Citations | Citations/Publication |
|---|---|---|---|---|---|
| Journal of Clinical Orthopaedics and Trauma | 284 | 1495 | 10.58 | 7.04 | 5.26 |
| Indian Journal of Orthopaedics | 228 | 1056 | 8.49 | 4.97 | 4.63 |
| Materials Science and Engineering C | 34 | 798 | 1.27 | 3.76 | 23.47 |
| Acta Biomaterialia | 6 | 540 | 0.22 | 2.54 | 90 |
| Journal of Clinical and Diagnostic Research | 98 | 438 | 3.65 | 2.06 | 4.47 |
| Journal of the Mechanical Behavior of Biomedical Materials | 17 | 368 | 0.63 | 1.73 | 21.65 |
| Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine | 15 | 357 | 0.56 | 1.68 | 23.8 |
| Ceramics International | 14 | 353 | 0.52 | 1.66 | 25.21 |
| RSC Advances | 14 | 323 | 0.52 | 1.52 | 23.07 |
| International Orthopaedics |
30 |
304 |
1.12 |
1.43 |
10.13 |
| Part B Journal Title |
No. Publications |
Sum of Citations |
% of Publications |
% of Citations |
Citations/Publication |
| Journal of Clinical Orthopaedics and Trauma | 284 | 1495 | 10.58 | 7.04 | 5.26 |
| Indian Journal of Orthopaedics | 228 | 1056 | 8.49 | 4.97 | 4.63 |
| Journal of Clinical and Diagnostic Research | 98 | 438 | 3.65 | 2.06 | 4.47 |
| BMJ Case Reports | 59 | 60 | 2.2 | 0.28 | 1.02 |
| Malaysian Orthopaedic Journal | 46 | 80 | 1.71 | 0.38 | 1.74 |
| Chinese Journal of Traumatology - English Edition | 35 | 83 | 1.3 | 0.39 | 2.37 |
| Materials Science and Engineering C | 34 | 798 | 1.27 | 3.76 | 23.47 |
| International Orthopaedics | 30 | 304 | 1.12 | 1.43 | 10.13 |
| Materials Today: Proceedings | 30 | 150 | 1.12 | 0.71 | 5 |
| Indian Journal of Public Health Research and Development | 25 | 3 | 0.93 | 0.01 | 0.12 |
Over the last decade, the number of publications has steadily increased from 112 in 2010 to 443 in 2019 (Fig. 1) which is almost four times the number in 2010. It is a known fact that citations tend to peak after a few years after publication (on average about 7 years)2 and hence, we see the number of citations decline from the year 2016 despite an increase in the number of publications.
Fig. 1.
Year-wise publications and citations.
We analyzed the data into most publishing University, city, state, specialty and anatomic location of these publications, most cited article, and segregated the data into private and government institutions. Scopus classifies articles into articles (2083), review (219), conference paper (167), book chapter (55), letter (61), editorial (40), retracted (2), book (12), note (27) and erratum (14). An overwhelming majority of publications belong to the type “articles” as can be seen with the numbers in the brackets.
When the data was analyzed according to the most published states and union territories, Tamil Nadu was the most cited state (Fig. 2) with 4503 citations with 464 publications followed by New Delhi with 3480 citations but the greatest number of publications at 479.
Fig. 2.
Top 10 cited states (Citation and publication numbers). In the following and all subsequent figures, grey bars indicate citation numbers and blue bars indicate number of publications.
The most cited institute was Indian Institute of Technology (IIT) with 3162 citations and 175 publications followed by All India Institute of Medical Sciences (AIIMS) with 1284 and 176 publications. Post Graduate Institute of Medical Education and Research (PGIMER) was third with 777 and 111 respectively (Fig. 3). Five out of the top 10 cited institutes were non-medical scientific institutes doing work on basic sciences.
Fig. 3.
Top 10 cited institutes (Citation and publication numbers).
To know which subspecialty of Orthopedics was most published, we segregated the data into subspecialities, Basic Sciences and Trauma topped the list (Fig. 4) with 657 articles and 9314 citations and 494 articles 2196 citations respectively. All articles on metal and material research related to orthopaedics were included under basic sciences. We excluded articles that are not related to orthopaedic materials from the main data. These included articles on dental implants, engineering and technology implant research since some of the basic orthopaedic work was done in Technological institutes.
Fig. 4.
Publications and citations by Sub-specialty.
We segregated the data by anatomic location (Fig. 5) and we found that most of the articles were related to General Orthopaedics (1405) with 14517 citations, followed by knee and leg (322, 1417) and hip and thigh (223,1198) citations respectively. General category includes articles related to multiple categories as well as many basic science articles that cannot be categorized into a speciality. They also included metal and material research articles, even related to arthroplasty.
Fig. 5.
Publications and citations by anatomical location.
When we looked at the number of publications against the number of citations, we found that number of publications were more during the year 2019 (443), and the citations were greater during the year 2013–2014(2976). Though publications were more from New Delhi, Tamil Nadu (4503) had the most cited articles followed by New Delhi (3480) Fig. 2. Among the institutes, IIT had most citations (3162) followed by AIIMS (1284)Fig. 3.
Table 2 shows the top 10 first authors and authors in any position arranged in descending order of number of publications. Vaishya R. was the most prolific author, with 27 publications as the first author. Table 3 shows top 15 authors arranged in descending order of sum of citations. Kumar S had received the maximum citations of 629. There were a total of 7245 authors publishing all the studied articles. Among these, the number of unique first authors were 1818. 1519 authors did not have any citations while 208 authors were cited more than 100 times.
Table 2.
First authors and authors in any position arranged in descending order of number of publications.
| First Author | Publications | Sum of citations | Author in any position | Publications | Sum of citations |
|---|---|---|---|---|---|
| Vaishya R. | 27 | 248 | Kumar V. | 56 | 289 |
| Goel A. | 23 | 464 | Kumar S. | 54 | 629 |
| Agarwal A. | 21 | 445 | Kumar A. | 52 | 624 |
| Kumar S. | 17 | 629 | Kumar R. | 44 | 415 |
| Gupta R. | 15 | 251 | Singh S. | 44 | 449 |
| Gupta V. | 13 | 127 | Vaishya R. | 39 | 248 |
| Kumar R. | 13 | 415 | Singh A. | 33 | 300 |
| Singh R. | 12 | 195 | Agarwal A. | 32 | 445 |
| Kumar N. | 11 | 118 | Singh R. | 32 | 195 |
| Singh S. | 11 | 449 | Dhillon M.S. | 31 | 323 |
Table 3.
Top 15 Authors arranged in descending order of sum of all citations.
| Author in any position | Sum of Citations | Publications |
|---|---|---|
| Kumar S. | 629 | 54 |
| Kumar A. | 624 | 52 |
| Chatterjee K. | 585 | 22 |
| Gopi D. | 494 | 20 |
| Goel A. | 464 | 27 |
| Singh S. | 449 | 44 |
| Agarwal A. | 445 | 32 |
| Nandi S.K. | 438 | 13 |
| Kundu B. | 438 | 9 |
| Nandi S. | 438 | 1 |
| Dhillon M. | 432 | 10 |
| Rajendran N. | 416 | 16 |
| Kumar R. | 415 | 44 |
| Kavitha L. | 412 | 17 |
| Lahiri D. | 395 | 13 |
When a word cloud was created from the article titles (Fig. 6 [A]), the most prominent terms were application, management, fractures (indicating trauma). Other less prominent terms include hydroxyapatite, reconstruction, cervical, dislocation and prospective among other terms. When a word cloud from the keywords was created (Fig. 6[B]), the following terms were found prominent: clinical, fracture, male, female. Other interesting terms that were prominent include: journal, controlled, post-operative and radiography.
Fig. 6.
A. Word Cloud from titles of Indian Orthopaedic Publications B. Word cloud from the keywords.
Table 4 shows the publication numbers and citations differences between government run and privately funded institutes in India. The difference of publications is only 200 articles between the groups but government run institutes have almost 4000 citations more than the private institutes.
Table 4.
Publications and citations from Government Vs Private establishments.
| Publications | Citations | |
|---|---|---|
| Government | 1459 | 12601 |
| Private | 1225 | 8638 |
| Total | 2684 | 21239 |
4. Discussion
The most important finding in this study was that IIT in India has published and is cited more than medical institutes for orthopaedic related articles. We performed this analysis to know the number of publications from India and the Indian states between 2010 and 2020. This is a first-of-its-kind analysis done from India. Few similar studies have been done previously for other specialties. Samrat Ray et al.7 have published a similar analysis in 2016, but that article deals with research articles from medical institutes. This study includes medical institutes, private hospitals, and non-medical institutes that have published articles related to orthopaedics. There was a similar article by Samrat ray et al.8 analysing the publications from South East Asia.
It can be seen from Table 1 that the bulk of publications was done in the JCOT and IJO. The JCOT has been the most preferred journal with 10.6% publications and 7.24% citations, while IJO has been the next most preferred journal with 8.5% publications and getting 5% of all citations. Six out of the top 10 cited journals belong to the engineering sciences. It shows that the citation counts of journals publishing basic science studies are higher than the articles published in the clinical sciences journals. It can be seen that the average citations/publication is almost seven times in part A of Table 1 compared to part B.
Yusuf GÜRBÜZ et al.9 published a similar article from Turkey in 2015, but this was more focused on the analysis of articles based on the published journal Impact factor. They found 2012 to be the year of maximum publications from Turkey. We didn't take into account the impact factor of publishing the Journal. Erik Hohmann et al.10 analyzed the orthopaedic articles published between 2010 and 2014 based on city and state of origin, corrected for population size, median household income, the total number of surgeons, and the number of various subspecialties. We did not take into account the population size and number of surgeons.
Jing Sun et al.11 in 2018 analyzed the growth of orthopaedic publications originating from china in a 20 year period between 1997 and 2017. This article was more focused on the number of citations and was mainly inclined towards the articles from medical universities.2002 and 2014 were identified as periods of great growth. The public availability of the electronic search engine PubMed was thought to be a reason for rapid growth in publications in a previous study.12 In our study, there. Has been a steady increase in the number of publications with the maximum numbers published in 2019. We believe that after the onset of Covid-19, the number would significantly increase as has been found in multiple studies in the literature.3 Zhaoyang Hui et al.13 in 2013 analyzed the orthopaedic publications from 2000 to 2011. This included articles from all over the world. BM Gupta and Adarsh Bala14 in 2011 analyzed all the publications from 1999 to 2008 and included articles from all the medical and surgical branches.
We recommend using 3 or 4 standard fields for affiliations stored in search engines relating to Institute, and state, to improve ease of extracting this data from the papers. However, this information should be entered at the source in the search engine. The information thus has to be entered in this style by either the authors or the journals in a standardized format to give reproducible outputs from such studies. Otherwise, manual sorting should be done which would take a lot of time when the search includes thousands of citations making it a very exhaustive exercise. In the current listing, there is no separator that separated this information.
Since this was not done, we had to manually extract data from each citation for affiliation department, university, city, and state to get this information and classify it according to origin. As we understand the listing of citations and how databases and searches are done, the way we list citations should evolve to aid readers to get as much information as possible from their searches. Currently, there is not much change that has happened from the days before online searches were made apart from the way articles are submitted. Only keyword had been asked to be added to help sorting the citations. More classifications of citations are needed, and their entry standardized in all journals to get as much information from a search as possible.
We also found many non orthopaedic articles listed under orthopaedic search. Dental and anesthetic articles are the most prominent. If these were not manually sorted, these citations would cause false projections in such studies. These could be avoided by better classification of articles at the time of submission to the journals and this info passed on to the search engines. Classifications should start from a broad specialization to sub-specialization and finally, end with the topic and anatomic location. If the search engines make this a requirement for getting listed with them, there could be a better recording of information. This information will help analyze regional differences in diseases and conditions published and could form vital information set in determining local policies and strategies.
The orange software was used to generate word clouds from the data in different fields of the references. This is the first study in orthopaedic literature to have used this software for the given purpose. The generated word cloud creates words that were most frequently found in the given field of the data. The different colours used for the words do not bear any significance apart from easy readability and the colours may be customized. Word cloud from Fig. 6 shows the significant presence of engineering and technology in the departments contributing to the orthopaedic literature. It indicates that major research occurs in material/biomechanical/computational or engineering sciences in these institutes related to orthopaedics. Most of the basic science studies are done in these centers and from the citations, it can be seen that the research from these centers is highly cited. Basic science studies generate more citations compared to focused specialty studies. Previous studies in orthopaedics have included VOS viewer analysis for the purpose of visualizing data from known fields in the datasets.2,12,15 These are fixed and the user has limited control over the field being analyzed. The Orange software gives the flexibility to analyze, using word cloud any field from the dataset.
The numbers of publications and citations of top authors were given in Table 2, Table 3 This data may not be entirely accurate due to the nature of entries. For example, Kumar R and Kumar S may not indicate single persons due to the frequency of occurrence of the name in India. Also, for authors having more than one initial, some entries may have left an initial, reducing the number of publications registered in their name. These drawbacks may be countered by analysing the author ID systems e.g. Scopus ID or ORCID ID.
There were a total of 843 institutes publishing on this topic. Of these, 318 were run by the government (state or central) whereas 524 were run by private establishments. Table 4 shows publications and citation counts distribution among Government institutes Vs private institutes. From the table, it is clear that citation count from Government institutes are 1.5 times greater than that of private establishments while the number of publications is more than 1.2 times for the same. Academic work in government-run institutes appears to be higher than that of private institutes. Possible reasons could be: Government institutes have been established for a long period while private players entered the field recently. Major basic science studies are conducted in Government-run institutes including the IITs which have a good reputation of academics compared to private institutes. Infrastructure for some basic science studies is better funded and equipped in the government institutes as these are very expensive.
The strengths of this study include a large output of 3272 publications analyzed.
Manual analysis has excluded errors in inclusion from an inaccurate listing. This is the only study looking into orthopaedic publications from India and their distribution and analysis over the last 10 years.
Ray et al.7 in their article in 2016 recommended an overhaul of the Indian Medical education system along the lines of the Flexner model16 in beginning of the last century which standardized medical education in the USA. The Indian undergraduate (UG) and postgraduate (PG) medical education is undergoing changes with an emphasis on increasing UG and PG student numbers along with increasing medical institutions. The emphasis is also on clinical training, publications and standardization to eliminate differences in quality of education from different institutions. Future studies on this topic in the future would be able to give us an idea of how these changes have influenced academic activity in orthopaedics in India.
5. Recommendations
Improved classification and listing by the search engines to get accurate, reproducible information of the topic searched. Collaborative research practices should be encouraged between engineers and orthopaedic departments since orthopaedics is closely related to engineering. It is even more pertinent at this time when software and robotics and computers have taken over in a big way in orthopaedic management of patients.
This report would also serve as a baseline to compare the research output after the recent recommendations making it mandatory for postgraduates to publish before their exit examinations. Such a culture encouraging research would only increase the publication output from India in this specialty.
6. Limitations
This is a single search engine study. A study of multiple search engines would give a broader picture of publications. The reason we chose Scopus was that we felt it lists journals preferred/maximally published by Indian authors. PubMed does not list some journals frequently used by Indian authors. Bibliometric analysis is at a relatively early stage of development and hence different studies report differently. Inaccuracies while registering the citations could include or exclude some citations as we have discussed in the discussion section. As search engine and journal submissions are more standardized, these errors would be reduced in the future.
7. Conclusions
There has been a steady increase in the number of publications from Indian authors in the last decade. The final year of the last decade saw almost four times the number of publications seen in the year 2010. New Delhi and and Tamil Nadu and their Universities and Institutes appear to contribute the majority of citations and publications related to orthopaedics. Tamil Nadu is the most productive state when looking at the data from the states. Basic Sciences is the most cited category of articles and General category articles are the most commonly published and cited. Government institutes published more than the Privately funded institutes. Journal of Clinical Orthopaedics and Trauma was the most publishing journal for Indian authors on Orthopaedic related articles.
Declaration of competing interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
Contributor Information
Vasu Karlapudi, Email: drkarlapudi@gmail.com.
Sravya Teja Paleti, Email: drsravyapaleti89@gmail.com.
Srinivas B.S. Kambhampati, Email: kbssrinivas@gmail.com.
Raju Vaishya, Email: raju.vaishya@gmail.com.
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