Abstract
Background
Bibliometric analysis is a useful tool for measuring the scholarly impact of a topic. To date, there is no such review analyzing the characteristics and trends of publications focused on revision total hip arthroplasty (rTHA). The purpose of this study is to use bibliometric analysis to comprehensively analyze the 50 most cited articles in rTHA research.
Methods
This is a cross-sectional study that used the ISI Web of Knowledge database to identify articles published before September 2021. Articles were sorted in descending order by number of citations and those with a focus of rTHA were identified. Of these, the top 50 most cited articles were carried forward for evaluation.
Results
The 2000s (50%) and the 1990s (32%) had the greatest volume of contribution. 9 of the top 10 most cited articles were published in the 2000s. The highest impact article had 4702 citations. The level of evidence (LOE) published with the greatest frequency was LOE II (40%) followed by LOE III and LOE IV both recording 24%. The Journal of Bone and Joint Surgery-American Volume had the greatest productivity (46%) followed by The Journal of Bone and Joint Surgery-British Volume (18%). The United States was the country with the highest number of contributions to this list with 56% followed by England (12%), and Sweden and Canada both with 8%.
Conclusion
The most impactful articles focusing on rTHA research were comprehensively and objectively analyzed. The most common article type was clinical outcomes (46%) followed by natural history/epidemiology (24%) and surgical technique (16%). While this topic is highly studied with significant level of evidence to support the studies, there is a lack of influential research regarding imaging and clinical guidelines. This analysis can be used by researchers to develop further discussions and build research questions.
Keywords: Revision total hip arthroplasty, Bibliometric analysis, Most cited
1. Introduction
Revision total hip arthroplasty (rTHA) is a well-researched and commonly performed procedure in the United States.1 In 2014, there were 50,220 rTHA procedures performed and the incidence of this surgery is expected to increase by between 43% and 70% by 2030.2 The current literature supports the conclusion that rTHA is a successful intervention to improve functional outcomes and relieve pain.3,4
Bibliometric analysis is a frequently used tool which evaluates the qualities and characteristics of a particular set of published articles. Authors have used this tool to identify trends in the literature, evaluate deficits or under-researched topics, and also to provide easy access to the most influential studies.5,6 Here, influence is measured by the number of times an article has been cited.
The characteristics and trends in rTHA research have not yet been studied. The aim of this study was to comprehensively analyze the 50 most cited articles in the field of rTHA. We hypothesize that the greatest output of high impact literature comes from the United States and are focused on clinical outcomes.
2. Methods
In September 2021, articles discussing rTHA were identified using the ISI Web of Knowledge database. Articles were identified using the search terms: hip revision OR revision total hip arthroplasty OR revision THA. Two medical students trained in bibliometric review conducted the search. Only articles written in English that were published in peer-reviewed journals were included in the search. Articles were sorted by citation count, placed in descending order by number of citations, and then screened by title and abstract. Duplicates and articles not that did not discuss or pertain to rTHA were excluded.
The ISI Web of Knowledge database reported multiple variables per each article that were used in the evaluation of the literature. Any variable of interest not reported from the database was identified by full-text review of the article from a trained medical student researcher. The following variables of interest were obtained from each article: title, source journal, language, citation count, year published, country of origin, article type, and level of evidence. The level of evidence was either reported in the abstract or it was determined by full-text review using guidelines from the Journal of Bone and Joint Surgery.7 Before conducting the search, article types to be used to classify the articles were determined. Each article was only classified into only 1 category as seen best fit by the authors. The article types included: surgical technique, clinical outcomes, natural history/epidemiology, clinical guidelines, and imaging. All data were validated by a separate investigator, there were no discrepancies. Microsoft Excel was used to store all data and was used to perform all statistical analysis.
3. Results
15,601 articles were identified in the search. Articles were sorted in descending order by number of citations. The first 284 articles were reviewed by title and abstract. 224 articles did not focus on rTHA and were subsequently excluded. The top 60 most cited articles were further evaluated by full-text review. 10 of these articles were excluded due to the number of citations. The 50 remaining articles were then carried forward for analysis (Fig. 1).
Fig. 1.
Modified PRISMA flowchart.
The 50 most cited articles are listed in the Appendix (Appendix 1). The mean number of citations was 576, the range was 4702–300, and the median was 409. All articles were published between 1985 and 2014 (Appendix 1), most of which achieved publication between 2000 and 2009 (n = 25), and between 1990 and 1999 (n = 16) (Fig. 2). 9 of the top 10 most cited articles were published between 2000 and 2009 while the article ranked number 10 was published in 1999.
Fig. 2.
Frequency of top 50 articles published between the 1980s and 2010s.
15 journals combined to publish the 50 most cited articles. Of these, The Journal of Bone and Joint Surgery-American Volume was the most productive (n = 23) followed by The Journal of Bone and Joint Surgery-British Volume (n = 9). All other journals had less than 4 contributions (Fig. 3).
Fig. 3.
Frequency of articles published by journal.
Research groups from 10 different countries produced the analyzed articles. Most articles were published from researchers in the United States (n = 28), followed by England (n = 6), Sweden (n = 4), and Canada (n = 4) (Fig. 4).
Fig. 4.
Frequency of articles published by country.
The most common level of evidence was II (n = 20), followed by III (n = 12), IV (n = 12), V (n = 4) and I (n = 2) (Fig. 5). Of the different article types, most articles were classified as clinical outcomes (n = 23), followed by natural history/epidemiology (n = 12), and surgical technique (n = 8) (Fig. 6).
Fig. 5.
Frequency of articles published by level of evidence.
Fig. 6.
Frequency of articles published by article type.
4. Discussion
This bibliometric analysis comprehensively evaluated the 50 most cited articles in the field of rTHA research. Most of these influential articles came from research groups in the United States and focused on clinical outcomes.
After clinical outcomes, natural history and epidemiology then surgical technique were the leading article types. We presume this is because clinical outcomes provide insight into the efficacy of rTHA. This offers tangible metrics to help guide treatment counseling and encourages advancements in surgical approach.8 The volume of primary and revisional total hip arthroplasties performed are increasing each year.9, 10, 11, 12 The prevalence of primary total hip arthroplasty and rTHA are projected to increase by 174% and 137% from 2005 to 2030, respectively.10 Moreover, the age at which patients undergo primary and revisional arthroplasties are decreasing, with estimates of over 50% of the candidate population for total joint replacement being under the age of 65 from 2010 to 2030.11 This poses an added dilemma as younger patients are at higher risk of revision due to higher activity levels and the tendency to outlive their primary replacement.11,13,14 In this population, primary total hip replacements are projected to account for 52% of total hip replacements, while revision total hip replacements were not modeled to increase substantially in relative prevalence.11 Ultimately, with increasing prevalence of total hip arthroplasty and a growing population of younger patients requiring the procedure, it is imperative that continued research be done to identify the causes of primary implant failure with the intention of reducing the need for revisional procedures.14
The three most cited studies in the literature were published in the Journal of Bone and Joint Surgery – American Volume. The most cited paper, “Projections of Primary and Revision Hip and Knee Arthroplasty in the United States from 2005 to 2030”, provides a thorough surgical projection methodology.10 This comprehensive model provides a reliable prediction into the future prevalence of revision hip and knee arthroplasties, which we presume accounts for its popularity. The study utilized data from The Nationwide Inpatient Sample from 1990 to 2003 and the United States Census Bureau to assess the effect of demographic variables, such as gender, race, age, and census region, on the rates of revision total hip arthroplasty.10 Projections were established with a regression model taking in account historical procedure rates and population projections from 2005 to 2030.10 The study found that though hip arthroplasty revisions are currently more common than knee arthroplasty revisions, when considering the expected rise in primary knee arthroplasty in the United States by over 600% by 2030 in comparison to that of primary hip arthroplasty around 170%, the rate of revision knee arthroplasty procedures is expected to surpass that of revision hip arthroplasty by 2030. The results of this model provide an invaluable window into the future, allowing for timely resource allocation and policy planning.10
The next most cited study, “Health-related quality of life in total hip and total knee arthroplasty - A qualitative and systematic review of the literature”, provides insight into patient quality of life after total hip or knee arthroplasty, including revision procedures. This systematic review analyzed relevant studies from 1980 to 2003, using the MEDLINE and EMBASE medical literature databases, offering a wealth of information concerning post-operative outcomes.9 This review study demonstrated that hip arthroplasty procedures return patients to a greater functional capacity than knee arthroplasty procedures. They additionally reported that compared to primary hip arthroplasty, patients with revision procedures performed showed worse physical function and health perception.9 This study highlights the need for significant patient education regarding the clinical and functional outcomes of revision procedures.
The third most cited paper, “The Epidemiology of Revision Total Hip Arthroplasty in the United States,” used the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database to analyze a total of 51,345 total hip arthroplasty revisions, evaluating clinical, economic, and comprehensive demographic metrics.14 Cause of failure, length of stay, and total charges of the revision arthroplasty procedures were studied; in turn, providing the opportunity to guide focused quality improvement in areas contributing to arthroplasty failure, which seems to account for its significant popularity. For example, this study found hip instability and mechanical loosening to be the most common indication necessitating revision.14 Using this information, progress can be made in optimizing parameters of implant stability. Furthermore, the other indications for revision such as infection may be analyzed for quality improvement.14
Of the articles studied, the most common level of evidence was II, amounting to 20 studies. This suggests that articles focused on rTHA often utilized clinical controls and were often performed prospectively. The level of evidence of these articles is higher than that found in bibliometric analyses of other orthopedic topics. In a study that assessed the 50 most cited articles pertaining to hip arthroscopy, level IV was the most common level of evidence, with 30 studies in this category.15 This was similar to other orthopedic subspecialties, with analyses of articles pertaining to odontoid fracture and spine fracture both finding the most common level of evidence to be IV (40% and 36% respectively).16,17 The increased level of evidence seen in this study is likely because in such revision procedures the cohort of patients can be controlled after they receive their initial hip arthroplasty and included in the study prospectively.
The majority of these publications (56%), came from research groups in the United States, followed by England (12%). This can largely be explained by assessing the volume of hip arthroplasty procedures performed in each country. The greatest volume of hip arthroplasties are performed in the United States, with a total estimate of 2.5 million Americans living with a hip replacement.18 Within Europe, the greatest contributions came from Germany, France, and the United Kingdom respectively contributing 232,600, 158,100, and 122,800 procedures.19 Assessing the procedure volume by country, it is clear why many of the most cited papers came from the United States. England's contribution to the top 50 citations, however, with only the third most procedures performed in Europe, can be explained by the volume of orthopedic articles published. A study that assessed all orthopedic articles published and registered into Pubmed from 2000 to 2009, found that of the 46,322 articles studied, 17,569 originated from the United States, 7791 from Japan, and 5028 from the United Kingdom.20 The large contribution of total publications from the United Kingdom in this time period explains the large proportion of the most cited articles. Additionally, the immense volume of articles coming from the United States further explains its immense contribution to the most cited articles related to revision hip arthroplasty.
Despite contributing valuable information to the literature, this review did have some limitations. Notably, with all bibliometric reviews, the method of analyzing influence is determined by number of citations. Although this has been considered a good measure, it cannot completely quantify the influence an article has had. Therefore, other less cited articles may have been excluded due to their lack of citations. Additionally, there is historical bias as the earlier an article was published, the more time it has to accumulate citations. Therefore, newly published and potentially highly influential articles may have also been excluded due to lack of citations.
5. Conclusion
The most impactful articles focusing on rTHA research were comprehensively and objectively analyzed. The most common article type was clinical outcomes (46%) followed by natural history/epidemiology (24%) and surgical technique (16%). While this topic is highly studied with significant level of evidence to support the studies, there is a lack of influential research regarding imaging and clinical guidelines. This analysis can be used by researchers to develop further discussions and build research questions.
Funding
There was no funding for this bibliometric review.
CRediT author statement
David Constantinescu: conceptualization, methodology, writing – original draft, writing – review and editing, visualization, supervision, project administration. Dylan Luxenburg, Moses Isaac Markowitz: conceptualization, methodology, software, validation, formal analysis, investigation, resources, data curation, writing – original draft, writing – review and editing, visualization, supervision, project administration. Rami Hisham Helmi Mahmoud: investigation, writing – original draft. Michele D'Apuzzo: supervision, project administration, writing – original draft, writing – review and editing.
Ethical review committee statement
This study has been performed in accordance with the ethical standards in the 1964 Declaration of Helinski. This study was carried out in accordance with relevant regulations of the US Health Insurance Portability and Accountability Act (HIPAA).
All authors significantly contributed to the document and have reviewed the final manuscript.
Declaration of competing interest
The authors report no conflicts of interest.
Acknowledgements
There are no acknowledgements to report.
Appendix 1
The top 50 most cited articles.
| Rank | Article | Citation Count |
|---|---|---|
| 1 | Kurtz, S; Ong, K; Lau, E; Mowat, F; Halpern, M. Projections Of Primary And Revision Hip And Knee Arthroplasty In The United States From 2005 To 2030. Journal Of Bone And Joint Surgery-American Volume. 2007; 4:780–785. | 4702 |
| 2 | Ethgen, O; Bruyere, O; Richy, F; Dardennes, C; Reginster, JY. Health-Related Quality Of Life In Total Hip And Total Knee Arthroplasty - A Qualitative And Systematic Review Of The Literature. Journal Of Bone And Joint Surgery-American Volume. 2004; 5:963–974. | 1183 |
| 3 | Bozic, KJ; Kurtz, SM; Lau, E; Ong, K; Vail, TP; Berry, DJ. The Epidemiology Of Revision Total Hip Arthroplasty In The United States. Journal Of Bone And Joint Surgery-American Volume. 2009; 1:128–133. | 990 |
| 4 | Kurtz, S; Mowat, F; Ong, K; Chan, N; Lau, E; Halpern, M. Prevalence Of Primary And Revision Total Hip And Knee Arthroplasty In The United States From 1990 Through 2002. Journal Of Bone And Joint Surgery-American Volume. 2005; 7:1487–1497. | 977 |
| 5 | Trampuz, A; Piper, KE; Jacobson, MJ; Hanssen, AD; Unni, KK; Osmon, DR; Mandrekar, JN; Cockerill, FR; Steckelberg, JM; Greenleaf, JF; Patel, R. Sonication Of Removed Hip And Knee Prostheses For Diagnosis Of Infection. New England Journal Of Medicine. 2007; 7:654–663. | 862 |
| 6 | Kurtz, SM; Lau, E; Ong, K; Zhao, K; Kelly, M; Bozic, KJ. Future Young Patient Demand For Primary And Revision Joint Replacement: National Projections From 2010 To 2030. Clinical Orthopaedics And Related Research. 2009; 10:2606–2612. | 798 |
| 7 | Willert, HG; Buchhorn, GH; Fayyazi, A; Flury, R; Windler, M; Koster, G; Lohmann, CH. Metal-On-Metal Bearings And Hypersensitivity In Patients With Artificial Hip Joints - A Clinical And Histomorphological Study. Journal Of Bone And Joint Surgery-American Volume. 2005; 1:28–36. | 783 |
| 8 | Pandit, H; Glyn-Jones, S; McLardy-Smith, P; Gundle, R; Whitwell, D; Gibbons, CLM; Ostlere, S; Athanasou, N; Gill, HS; Murray, DW. Pseudotumours Associated With Metal-Onmetal Hip Resurfacings. Journal Of Bone And Joint Surgery-British Volume. 2008; 7:847–851. | 703 |
| 9 | Bierbaum, BE; Callaghan, JJ; Galante, JO; Rubash, HE; Tooms, RE; Welch, RB. An Analysis Of Blood Management In Patients Having A Total Hip Or Knee Arthroplasty. Journal Of Bone And Joint Surgery-American Volume. 1999; 1:2–10. | 684 |
| 10 | Tsukayama, DT; Estrada, R; Gustilo, RB. Infection After Total Hip Arthroplasty - A Study Of The Treatment Of One Hundred And Six Infections. Journal Of Bone And Joint Surgery-American Volume. 1996; 4:512–523. | 602 |
| 11 | BARRACK, RL; MULROY, RD; HARRIS, WH. Improved Cementing Techniques And Femoral Component Loosening In Young-Patients With Hip-Arthroplasty - A 12-Year Radiographic Review. Journal Of Bone And Joint Surgery-British Volume. 1992; 3:385–389. | 582 |
| 12 | Mahomed, NN; Barrett, JA; Katz, JN; Phillips, CB; Losina, E; Lew, RA; Guadagnoli, E; Harris, WH; Poss, R; Baron, JA. Rates And Outcomes Of Primary And Revision Total Hip Replacement In The United States Medicare Population. Journal Of Bone And Joint Surgery-American Volume. 2003; 1:27–32. | 549 |
| 13 | Daniel, J; Pynsent, PB; McMinn, DJW. Metal-On-Metal Resurfacing Of The Hip In Patients Under The Age Of 55 Years With Osteoarthritis. Journal Of Bone And Joint Surgery-British Volume. 2004; 2:177–184. | 539 |
| 14 | MALCHAU, H; HERBERTS, P; AHNFELT, L. Prognosis Of Total Hip-Replacement In Sweden - Follow-Up Of 92,675 Operations Performed 1978–1990. Acta Orthopaedica Scandinavica. 1993; 5:497–506. | 532 |
| 15 | GIE, GA; LINDER, L; LING, RSM; SIMON, IP; SLOOFF, TJJH; TIMPERLEY, AJ. Impacted Cancellous Allografts And Cement For Revision Total Hip-Arthroplasty. Journal Of Bone And Joint Surgery-British Volume. 1993; 1:14–21. | 530 |
| 16 | Spangehl, MJ; Masri, BA; O'Connell, JX; Duncan, CP. Prospective Analysis Of Preoperative And Intraoperative Investigations For The Diagnosis Of Infection At The Sites Of Two Hundred And Two Revision Total Hip Arthroplasties. Journal Of Bone And Joint Surgery-American Volume. 1999; 5:672–683. | 528 |
| 17 | Kurtz, SM; Ong, KL; Lau, E; Bozic, KJ. Impact Of The Economic Downturn On Total Joint Replacement Demand In The United States. Journal Of Bone And Joint Surgery-American Volume. 2014; 8:624–630. | 521 |
| 18 | Katz, JN; Losina, E; Barrett, J; Phillips, CB; Mahomed, NN; Lew, RA; Guadagnoli, E; Harris, WH; Poss, R; Baron, JA. Association Between Hospital And Surgeon Procedure Volume And Outcomes Of Total Hip Replacement In The United States Medicare Population. Journal Of Bone And Joint Surgery-American Volume. 2001; 11:1622–1629. | 514 |
| 19 | Amstutz, HC; Beaule, PE; Dorey, FJ; Le Duff, MJ; Campbell, PA; Gruen, TA. Metal-On-Metal Hybrid Surface Arthroplasty: Two To Six-Year Follow-Up Study. Journal Of Bone And Joint Surgery-American Volume. 2004; 1:28–39. | 500 |
| 20 | KARRHOLM, J; BORSSEN, B; LOWENHIELM, G; SNORRASON, F. Does Early Micromotion Of Femoral Stem Prostheses Matter - 4-7-Year Stereoradiographic Follow-Up Of 84 Cemented Prostheses. Journal Of Bone And Joint Surgery-British Volume. 1994; 6:912–917. | 489 |
| 21 | CALLAGHAN, JJ; SALVATI, EA; PELLICCI, PM; WILSON, PD; RANAWAT, CS. Results Of Revision For Mechanical Failure After Cemented Total Hip-Replacement, 1979 To 1982 - A 2 To 5-Year Follow-Up. Journal Of Bone And Joint Surgery-American Volume. 1985; 7:1074–1085. | 486 |
| 22 | LUYAO, GL; KELLER, RB; LITTENBERG, B; WENNBERG, JE. Outcomes After Displaced Fractures Of The Femoral-Neck - A Metaanalysis Of 106 Published Reports. Journal Of Bone And Joint Surgery-American Volume. 1994; 1:15–25. | 486 |
| 23 | Berry, DJ; Harmsen, WS; Cabanela, ME; Morrey, BF. Twenty-Five-Year Survivorship Of Two Thousand Consecutive Primary Charnley Total Hip Replacements - Factors Affecting Survivorship Of Acetabular And Femoral Components. Journal Of Bone And Joint Surgery-American Volume. 2002; 2:171–177. | 478 |
| 24 | Atkins, BL; Athanasou, N; Deeks, JJ; Crook, DWM; Simpson, H; Peto, TEA; McLardy-Smith, P; Berendt, AR. Prospective Evaluation Of Criteria For Microbiological Diagnosis Of Prosthetic-Joint Infection At Revision Arthroplasty. Journal Of Clinical Microbiology. 1998; 10:2932–2939. | 458 |
| 25 | Kurtz, SM; Ong, KL; Schmier, J; Mowat, F; Saleh, K; Dybvik, E; Karrholm, J; Garellick, G; Havelin, LI; Furnes, O; Malchau, H; Lau, E. Future Clinical And Economic Impact Of Revision Total Hip And Knee Arthroplasty. Journal Of Bone And Joint Surgery-American Volume. 2007; :144–151. | 410 |
| 26 | SCHULTE, KR; CALLAGHAN, JJ; KELLEY, SS; JOHNSTON, RC. The Outcome Of Charnley Total Hip-Arthroplasty With Cement After A Minimum 20-Year Follow-Up. Journal Of Bone And Joint Surgery-American Volume. 1993; 7:961–975. | 408 |
| 27 | Parvizi, J; Tan, TL; Goswami, K; Higuera, C; Della Valle, C; Chen, AF; Shohat, N. The 2018 Definition Of Periprosthetic Hip And Knee Infection: An Evidence-Based And Validated Criteria. Journal Of Arthroplasty. 2018; 5:1309-. | 398 |
| 28 | Berry, DJ. Epidemiology - Hip And Knee. Orthopedic Clinics Of North America. 1999; 2:183-. | 396 |
| 29 | Chang, RW; Pellissier, JM; Hazen, GB. A Cost-Effectiveness Analysis Of Total Hip Arthroplasty For Osteoarthritis Of The Hip. Jama-Journal Of The American Medical Association. 1996; 11:858–865. | 394 |
| 30 | Kennedy, JG; Rogers, WB; Soffe, KE; Sullivan, RJ; Griffen, DG; Sheehan, LJ. Effect Of Acetabular Component Orientation On Recurrent Dislocation, Pelvic Osteolysis, Polyethylene Wear, And Component Migration. Journal Of Arthroplasty. 1998; 5:530–534. | 393 |
| 31 | Bhandari, M; Devereaux, PJ; Swiontkowski, MF; Tornetta, P; Obremskey, W; Koval, KJ; Nork, S; Sprague, S; Schemitsch, EH; Guyatt, GH. Internal Fixation Compared With Arthroplasty For Displaced Fractures Of The Femoral Neck - A Meta-Analysis. Journal Of Bone And Joint Surgery-American Volume. 2003; 9:1673–1681. | 384 |
| 32 | Cooper, HJ; Della Valle, CJ; Berger, RA; Tetreault, M; Paprosky, WG; Sporer, SM; Jacobs, JJ. Corrosion At The Head-Neck Taper As A Cause For Adverse Local Tissue Reactions After Total Hip Arthroplasty. Journal Of Bone And Joint Surgery-American Volume. 2012; 18:1655–1661. | 380 |
| 33 | Sundfeldt, M; Carlsson, LV; Johansson, CB; Thomsen, P; Gretzer, C. Aseptic Loosening, Not Only A Question Of Wear - A Review Of Different Theories. Acta Orthopaedica. 2006; 2:177–197. | 376 |
| 34 | KAVANAGH, BF; ILSTRUP, DM; FITZGERALD, RH. Revision Total Hip-Arthroplasty. Journal Of Bone And Joint Surgery-American Volume. 1985; 4:517–526. | 373 |
| 35 | Havelin, LI; Engesaeter, LB; Espehaug, B; Furnes, O; Lie, SA; Vollset, SE. The Norwegian Arthroplasty Register - 11 Years And 73,000 Arthroplasties. Acta Orthopaedica Scandinavica. 2000; 4:337–353. | 372 |
| 36 | Herberts, P; Malchau, H. Long-Term Registration Has Improved The Quality Of Hip Replacement - A Review Of The Swedish Thr Register Comparing 160,000 Cases. Acta Orthopaedica Scandinavica. 2000; 2:111–121. | 370 |
| 37 | Bozic, KJ; Ries, MD. The Impact Of Infection After Total Hip Arthroplasty On Hospital And Surgeon Resource Utilization. Journal Of Bone And Joint Surgery-American Volume. 2005; 8:1746–1751. | 368 |
| 38 | Smith, AJ; Dieppe, P; Vernon, K; Porter, M; Blom, AW. Failure Rates Of Stemmed Metal-On-Metal Hip Replacements: Analysis Of Data From The National Joint Registry Of England And Wales. Lancet. 2012; 9822:1199–1204. | 363 |
| 39 | Campbell, P; Ebramzadeh, E; Nelson, S; Takamura, K; De Smet, K; Amstutz, HC. Histological Features Of Pseudotumor-Like Tissues From Metal-On-Metal Hips. Clinical Orthopaedics And Related Research. 2010; 9:2321–2327. | 363 |
| 40 | Raphel, J; Holodniy, M; Goodman, SB; Heilshorn, SC. Multifunctional Coatings To Simultaneously Promote Osseointegration And Prevent Infection Of Orthopaedic Implants. Biomaterials. 2016; :301–314. | 356 |
| 41 | Biedermann, R; Tonin, A; Krismer, M; Rachbauer, F; Eibl, G; Stockl, B. Reducing The Risk Of Dislocation After Total Hip Arthroplasty - The Effect Of Orientation Of The Acetabular Component. Journal Of Bone And Joint Surgery-British Volume. 2005; 6:762–769. | 348 |
| 42 | Phillips, CB; Barrett, JA; Losina, E; Mahomed, NN; Lingard, EA; Guadagnoli, E; Baron, JA; Harris, WH; Poss, R; Katz, JN. Incidence Rates Of Dislocation, Pulmonary Embolism, And Deep Infection During The First Six Months After Elective Total Hip Replacement. Journal Of Bone And Joint Surgery-American Volume. 2003; 1:20–26. | 346 |
| 43 | SHANBHAG, AS; JACOBS, JJ; GLANT, TT; GILBERT, JL; BLACK, J; GALANTE, JO. Composition And Morphology Of Wear Debris In Failed Uncemented Total Hip-Replacement. Journal Of Bone And Joint Surgery-British Volume. 1994; 1:60–67. | 341 |
| 44 | Tunney, MM; Patrick, S; Curran, MD; Ramage, G; Hanna, D; Nixon, JR; Gorman, SP; Davis, RI; Anderson, N. Detection Of Prosthetic Hip Infection At Revision Arthroplasty By Immunofluorescence Microscopy And Pcr Amplification Of The Bacterial 16S Rrna Gene. Journal Of Clinical Microbiology. 1999; 10:3281–3290. | 337 |
| 45 | Doorn, PF; Campbell, PA; Worrall, J; Benya, PD; McKellop, HA; Amstutz, HC. Metal Wear Particle Characterization From Metal On Metal Total Hip Replacements: Transmission Electron Microscopy Study Of Periprosthetic Tissues And Isolated Particles. Journal Of Biomedical Materials Research. 1998; 1:103–111. | 327 |
| 46 | Santaguida, PL; Hawker, GA; Hudak, PL; Glazier, R; Mahomed, NN; Kreder, HJ; Coyte, PC; Wright, JG. Patient Characteristics Affecting The Prognosis Of Total Hip And Knee Joint Arthroplasty: A Systematic Review. Canadian Journal Of Surgery. 2008; 6:428–436. | 322 |
| 47 | Schafer, P; Fink, B; Sandow, D; Margull, A; Berger, I; Frommelt, L. Prolonged Bacterial Culture To Identify Late Periprosthetic Joint Infection: A Promising Strategy. Clinical Infectious Diseases. 2008; 11:1403–1409. | 303 |
| 48 | Schinsky, MF; Della Valle, CJ; Sporer, SM; Paprosky, WG. Perioperative Testing For Joint Infection In Patients Undergoing Revision Total Hip Arthroplasty. Journal Of Bone And Joint Surgery-American Volume. 2008; 9:1869–1875. | 303 |
| 49 | Labek, G; Thaler, M; Janda, W; Agreiter, M; Stockl, B. Revision Rates After Total Joint Replacement Cumulative Results From Worldwide Joint Register Datasets. Journal Of Bone And Joint Surgery-British Volume. 2011; 3:293–297. | 302 |
| 50 | Ridgeway, S; Wilson, J; Charlet, A; Kafatos, G; Pearson, A; Coello, R. Infection Of The Surgical Site After Arthroplasty Of The Hip. Journal Of Bone And Joint Surgery-British Volume. 2005; 6:844–850. | 300 |
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