A scientometric analysis of India's publications in arthroplasty in the last two decades from the SCOPUS database

Abstract

Objectives

This study evaluates the publication output of the Indian authors on the topic of Arthroplasty research from 2002 to 2021, using bibliometric methods.

Methods

The Indian publications as listed in the Scopus database were identified by using “Arthroplasty” or “Joint Replacement” in the keyword (“Key”) tag.

Results

India contributed 872 publications on Arthroplasty research, constituting a 1.36% share of global output, in the last two decades. Knee Arthroplasty accounted for the largest share (52.4%) in India's output, followed by Hip (35.7%) and others. 841 authors from 413 organizations participated unevenly in the research on this topic, with IISc-Bangalore contributing the largest number of publications (97), followed by Indraprastha Apollo Hospitals (46), Breach Candy Hospital, Bombay(40), and PGIMER, Chandigarh(38). R. Malhotra contributed the largest number of publications (55), followed by R. Vaishya (35 papers) and G.M. Shetty (23 papers). S. Bhan (31.0 and 3.17), A.B. Mullaji (30,13 and 3.08), N.P. Jain (25.75 and 2.63) and H.Pandit (21.88 and 2.24) registered the highest CPP & RCI. The journals which published the highest number of Arthroplasty articles were the Journal of Arthroplasty (123), followed by the Journal of Clinical Orthopaedics & Trauma (50) and International Orthopaedics (32).

Conclusion

India's contribution in the field of Arthroplasty-related publication is still low on a global platform, however, has shown a positive and increasing trend in the last two decades. The maximum publications were related to knee and hip arthroplasty and were from institutions in the major Indian cities of Delhi and Mumbai. More international and multicentric collaboration and external funding may help improve the number of arthroplasty publications in the future.

1. Introduction

Only a few publications in the past have examined the overall global and Indian orthopedics and arthroplasty research output. In the area of orthopedics, two recent studies^1,2 made a bibliometric assessment of literature from India. They analyze research characteristics and performances of leading organizations, authors, and cities, identify core journals and broad subjects,-specialties, and significant keywords and classify literature by anatomical classification covering different periods. In the area of arthroplasty, two global studies were published. Among them, O'Neill et al.³ examined the global literature (43470 records) on arthroplasty research from 2001 to 2016, using the Web of Science (WOS) platform. The number of articles and citations per article were analyzed to assess the quantity and quality of research from individual countries. Catal, Akman, Sukur, and Azboy⁴ evaluated the worldwide research productivity and status of Turkey in the field of arthroplasty using bibliometric methods and to provide an insight into the arthroplasty research for surgeons and researchers, using the Web of Science database between 2006 and 2016. The contributions of countries were evaluated based on publication count, citation average, h-index, and publication rate in the top 10 ranked journals. Each country's publication output was adjusted according to population size. Mirghaderi et al.⁵ identified the top 50 most-cited recent articles in the field of knee and hip arthroplasty from the Scopus database from 2015 to 2019, characterized their traditional and alternative scientometric measures, and determined the relationship between traditional and alternative scientometric measures. Ramamurti et al.⁶ review the global publications with the highest Altmetric scores related to total hip arthroplasty (THA) and total knee arthroplasty (TKA) and assess the correlation with traditional bibliometrics. Specific global bibliometric studies on arthroscopy were also carried output focusing on different anatomical locations, such as the knee,^7,8 hip,⁹ shoulder,¹⁰ ankle,¹¹ and spine ¹².

Besides global studies, studies at the national level are useful. In this context only one study regarding Turkish publications is available. Catal et al.⁴ evaluated the productivity of global research and the status of Turkey in the field of arthroplasty using bibliometric methods between 2006 and 2016. It aimed to provide insight into arthroplasty research, using the WOS database. The contributions of countries were evaluated based on publication count and citation rates, h-index, and citation average in the top 10 ranked journals. They adjusted the country's publication output according to the size of their population. In the absence of any comprehensive study from India, we decided to assess the Indian research output in Arthroplasty research, based on select quantitative and qualitative bibliometric indicators. Our study aims to assess India's publications output on this topic on several parameters viz., the Indian output and its global share, international collaboration, funded research, citation impact, leading research organizations and authors from India, and the journals publishing their work on Arthroplasty. We also evaluated the collaborative linkages and the characteristics of high-cited papers (HCPs).

2. Methodology

We identified the publications on “Arthroplasty”, that were listed in the Scopus database (https://www.scopus.com), with at least one Indian author. We used a relevant search strategy (as shown below), with the keyword “Arthroplasty” or “Joint replacement” in the field tag, “Keyword” for the search, in the first week of May 2022. Subsequently, the search was limited to publications from the world and India in the last two decades (2002–2021). The search on the topic yielded 64168 global records and when the same search strategy was restricted to India, we found a total of 872 publications, and these were studied.

The analytical provisions provided in the database of Scopus were utilized. We ascertained the distribution of publications by broad subject areas, contributing authors, collaborating countries, affiliating organizations, and the journals publishing these articles. The citations to publications were counted from the date of their publication till the 1st of April 2022. The study used selected qualitative and quantitative indicators to evaluate and quantify the performance of the most productive authors, organizations, and publishing journals.

In order to visualize and evaluate the collaborative interaction amongst the most productive authors, organizations, countries, and keywords, we have used the VOSviewer and Biblioshiny app for bibliometrix evaluation. KEY (arthroplasty or joint and replacement∗) and PUBYEAR >2001 and PUBYEAR <2022 KEY (arthroplasty or joint and replacement∗) and PUBYEAR >2001 and PUBYEAR <2022 and (LIMIT-TO (AFFILCOUNTRY, "India")).

3. Results

3.1. Global publication output

The global output of Arthroplasty research comprised 64,168 publications, which annually increased from 979 in 2002 to 5,571 in 2021, registering a 9.94% average growth. The global cumulative publications increased from 19,759 during 2002–2011 to 44,409 during 2012–2021, registering 124.75% absolute growth (Table 1).

Table 1.

Annual growth of global and India's publications on arthroplasty research.

Year	Global	India				Year	Global	India
	TP	TP	TC	CPP	%TP		TP	TP	TC	CPP	%TP
2002	979	5	117	23.40	0.51	2014	4,128	47	869	18.49	1.14
2003	1,160	5	195	39.00	0.43	2015	4,213	62	493	7.95	1.47
2004	1,325	6	148	24.67	0.45	2016	4,312	70	731	10.44	1.62
2005	1,771	10	431	43.10	0.56	2017	4,576	88	697	7.92	1.92
2006	2,038	10	210	21.00	0.49	2018	4,484	67	455	6.79	1.49
2007	2,057	17	434	25.53	0.83	2019	4,960	75	309	4.12	1.51
2008	2,273	15	293	19.53	0.66	2020	5,571	100	230	2.30	1.80
2009	2,719	39	548	14.05	1.43	2021	5,571	121	162	1.34	2.17
2010	2,633	25	472	18.88	0.95	2002–11	19,759	159	3, 142	19.76	0.80
2011	2,804	27	294	10.89	0.96	2012–21	44,409	713	5,383	7.55	1.61
2012	3,163	41	640	15.61	1.30	2002–21	64,168	872	8,525	9.78	1.36
2013	3, 431	42	797	18.98	1.22

TP: Total Publications, TC: total Citations, CPP: Citation Per Paper.

Among these global publications on Arthroplasty research, 16,128 publications (83.54%) emerged from the top 10 countries. On finer analysis of the publications, it was observed that only four countries out of the top 20 contributed more than the average group productivity (966.6). These countries were USA (6,361 publications, 33.67% share), U.K. (2,704 publications and 11.07% share), Germany (1,780 publications and 7.82% share) and Canada (1,060 publications and 4.61% share). The global publication share decreased in 8 countries namely Belgium, Taiwan, Netherlands, France, Sweden, Canada, Germany, and the U.K. (from 0.085 to 3.785), as against an increase in all other 12 countries (from 0.065 to 6.25%) from 2002 to 11 to 2012–2021 [Table 2].

Table 2.

Profile of top 20 countries in global output in arthroplasty research.

S.No	Name of the country	TP			%TP
		2002–11	2012–21	2002–21	2002–11	2012–21	2002–21
1	USA	6,361	15,247	21,608	32.19	34.33	33.67
2	U.K.	2,704	4,397	7,101	13.68	9.90	11.07
3	China	701	4,352	5,053	3.55	9.80	7.87
4	Germany	1,780	3,238	5,018	9.01	7.29	7.82
5	Canada	1,060	1,896	2,956	5.36	4.27	4.61
6	Japan	851	2,090	2,941	4.31	4.71	4.58
7	France	841	1,738	2,579	4.26	3.91	4.02
8	Italy	660	1,669	2,329	3.34	3.76	3.63
9	Australia	599	1,617	2,216	3.03	3.64	3.45
10	South Korea	454	1,351	1,805	2.30	3.04	2.81
11	Netherlands	571	1,232	1,803	2.89	2.77	2.81
12	Switzerland	511	1,221	1,732	2.59	2.75	2.70
13	Spain	356	951	1,307	1.80	2.14	2.04
14	Sweden	463	735	1,198	2.34	1.66	1.87
15	Denmark	294	850	1,144	1.49	1.91	1.78
16	India	159	713	872	0.80	1.61	1.36
17	Austria	259	608	867	1.31	1.37	1.35
18	Turkey	216	651	867	1.09	1.47	1.35
19	Belgium	273	579	852	1.38	1.30	1.33
20	Taiwan	219	447	666	1.11	1.01	1.04
	Total of 20 countries	19,332	45,582	64,914	97.84	102.64	101.16
	Global total	19,759	44,409	64,168	100.00	100.00	100.00
	Share of top 20 countries in global total	97.84		101.16			0.16

TP: Total Publications; %TP: Percentage of total publications.

3.2. Indian Publication output

3.2.1. Overall aspects

India's publications output on Arthroplasty research comprised 872 publications, which annually increased from 5 publications in 2002 to 121 publications in 2021, registering a 24.01% average growth. India's cumulative publications increased from 159 from 2002 to 2011 to 713 during 2012–2021, registering 348.43% absolute growth. Of the 64,168 global publications, only 872 (1.36%) publications had one author from India during 2002–2021. The share of India's publications in global output increased from 0.80% during 2002–2011 to 1.61% during 2012–2021. The 872 Indian publications received 8,525 citations, averaging 9.78 citations per paper (CPP) [Table 1].

Of the 872 India publications, only 54 (6.19%) received external funding support from 100+ agencies. India's publications based on funding increased from 3 during 2002–2011 to 51 during 2012–2021 and have received 424 citations, averaging 7.85 CPP. The major Indian funding agencies supporting India's research on “Arthroplasty” were the Council of Scientific & Industrial Research (CSIR), Department of Biotechnology, West Bengal, Department of Biotechnology, India, Department of Science & Technology, India, and Welcome Trust–DBT Indian Alliance (4 papers each), etc. Of the 872 India's publications, articles constituted the largest publication share (646, 74.08%), followed by letters (91, 10.44%), reviews (74, 8.49%), conference papers (40, 4.59%), notes (9, 1.03%) and others less than 1.0%: editorials (4, 0.46%), book chapters (3, 0.34%), books and short surveys (2, 0.23% each) and Retracted (1, 0.11%).

Among the population considered in 872 arthroplasty research papers, the major focus was on adults and aged (363 and 313 papers), followed by middle-aged (295 papers) and adolescents (29 papers). The types of published studies include controlled studies (208), prospective studies (138), procedures (136), retrospective studies (131), case reports (96), comparative studies (79), follow-up studies (65), randomized control trials (59), clinical trials (25), systematic reviews (22), observational studies (15).

Of the 872 India publications, 209 (21.50%) were published as international collaborative publications (ICPs). The share of ICPs increased from 12.92% (27) during 2002–2011 to 87.08% (182) during 2012–2021. These India's ICPs received 2,748 citations, averaging 13.14 CPP. The USA contributed the largest publication share (36.36%) with India's ICPs, followed by the U.K. (25.36%), South Korea (11.48%), Germany (10.05%), etc. (Table 3). India's ICPs have increased from the USA, Egypt, Thailand, Germany, Australia, Italy, and Singapore (from 0.14% to 11.99%) and decreased from the U.K., South Korea, and Canada among the top 10 from 0.41% to 26.17% during 2002–2011 to 2012–2021 (Table 3).

Table 3.

Distribution of papers by foreign collaborative country participation in India's arthroplasty research.

S.No.	Name of Collaborating country	ICP			%ICP
		2002–11	2012–21	2002–21	2002–11	2012–21	2002–21
1	USA	7	69	76	25.93	37.91	36.36
2	U.K.	13	40	53	48.15	21.98	25.36
3	South Korea	4	20	24	14.81	10.99	11.48
4	Germany	2	19	21	7.41	10.44	10.05
5	Australia	1	10	11	3.70	5.49	5.26
6	Egypt	0	10	10	0.00	5.49	4.78
7	Italy	1	8	9	3.70	4.40	4.31
8	Singapore	1	7	8	3.70	3.85	3.83
9	Thailand	0	8	8	0.00	4.40	3.83
10	Canada	1	6	7	3.70	3.30	3.35
		27	182	209	100.00	100.00	100.00

Among 872 arthroplasty papers from India, Delhi contributed the largest number and share of papers (302 papers, 34.63%), followed by Mumbai (194 papers, 22.25%), Chennai (102 papers, 11.69%), Chandigarh (63 papers, 7.22%), Bangalore (50 papers, 5.73%), Hyderabad (48 papers, 5.50%), Lucknow (32 papers, 3.67%), Kolkata (28 papers, 3.21%), Manipal (24 papers, 2,75%) and Jaipur (17 papers, 1.94%). In terms of impact, Mumbai registered the highest (15.41) citation impact per paper, followed by Chandigarh (11.47), Delhi (10.99), Lucknow (9.78), Bangalore (8.80), Kolkata (8.71), Chennai (7.33), Jaipur (6.88), Hyderabad (6.72), and Manipal (5.08).

3.2.2. Subject-wise distribution of papers

India's publications on “Arthroplasty” research may be classified under five broad subjects as per the Scopus database classification. The largest contribution (88.22%) was made by Medicine followed by Engineering (12.62%), Materials Science (6.25%), and Pharmacology, Toxicology & Pharmaceutics(1.56%). Amongst these five broad subjects, Materials Science registered the highest citation impact per paper (10.77) and Pharmacology, Toxicology & Pharmaceutics the least (3.69) [Table 4].

Table 4.

Broad subject-wise distribution of India's research on arthroplasty.

S.No.	Name of the subject∗	TP	TC	CPP	%TP
1	Medicine	734	7,436	10.13	88.22
2	Engineering	105	982	9.35	12.62
3	Materials Science	52	560	10.77	6.25
4	Computer Science	26	190	7.31	3.13
5	Pharmacology, Toxicology & Pharmaceutics	13	48	3.69	1.56
	India's total	872	8525	9.78
•There is overlapping of literature under various subjects
TP = Total papers; TC = Total citations; CPP=Citations per paper

3.2.3. Type of arthroplasty by anatomical location

Among India's 872 papers, the largest number of arthroplasty papers (457, 52.41%) were focused on Knee, followed by Hip (311 papers, 35.67%), Ankle (21 papers, 2.41%), Spine/Disc (14 papers, 1.61%), Elbow (11 papers, 1.26%) and Wrist (1 paper, 0.11%). The share of publications increased in Knee Arthroplasty (from 49.69% to 53.02%) and Spine/Disc Arthroplasty (from 0.0% to 1.96%), but decreased in Hip Arthroplasty (from 38.99% to 34.92%), Ankle Arthroplasty (from 3.77% to 2.10%), Elbow Arthroplasty (from 1.89% to 1.12%) and Wrist Arthroplasty (from 0.63% to 0.0%) during 2002–11 to 2012–2021 [Table 5].

Table 5.

Classification of Indian Arthroplasty Research by Anatomical location.

S.No.	Type of Arthroplasty	TP			%TP			TC	CPP
		2002–11	2012–21	2002–21	2002–11	2012–21	2002–21
1	Knee	79	378	457	49.69	53.02	52.41	5062	11.08
2	Hip	62	249	311	38.99	34.92	35.67	2689	8.65
3	Ankle	6	15	21	3.77	2.10	2.41	277	13.19
4	Elbow	3	8	11	1.89	1.12	1.26	45	4.09
5	Wrist	1	0	1	0.63	0	0.11	26	26.00
6	Spine/Disc	0	14	14	0	1.96	1.61	98	7.00
	India's total	159	713	872	100	100	100

TP = Total papers; TC = Total citations; CPP=Citations per paper.

3.2.4. Type of studies

Among India's 872 papers, the largest number of papers (362, 37.24%) are focused on Clinical Studies, followed by Treatment Studies (229 papers, 23.56%). Complications (168 papers, 17.28%), Pathophysiology (88 papers, 9.05%), Adverse Effects (79 papers, 8.13%), Epidemiology (62 papers, 6.38%), and Risk Factors (52 papers and 5.35%). Among the type of studies, Epidemiology registered the highest citation impact per paper (14.76), followed by Risk Factors (14.71), Treatment Studies (13.72), Clinical Studies (12.09), Complications (10.92), Pathophysiology (9.30) and Adverse Effects (6.78).

3.2.5. Significant keywords

The 57 most frequent indexing keywords (from Keyword Plus and author keywords) and their frequency of occurrence (at least 24 times) in India's “Arthroplasty” 872 research publications are presented in Table 6.

Table 6.

List of Top 57 Significant Keywords appearing in India's Literature on Arthroplasty.

S.No	Name of the keyword	Frequency	S.No	Name of the keyword	Frequency
1	Knee Replacement Arthroplasty	332	30	Weight Bearing	48
2	Total Knee Anthroplasty	252	31	Blood Transfusion	47
3	Arthroplasty	175	32	Computer Assisted Tomography	45
4	Hip Replacement Anthroplasty	169	33	Rheumatoid Arthritis	43
5	Knee Osteorthritis	163	34	Operative Blood Loss	42
6	Knee Osteorthritis	163	35	Ostertomy	42
7	Postopeative Complications	111	36	Body Mass	40
8	Knee Prosthesis	102	37	Analgesia	38
9	Range of Motion	96	38	Bone	38
10	Range of Motion, Articular	93	39	Tranexamic Acid	38
11	Total Hip Replacement	87	40	Harris Hip Score	37
12	Range of Motion	96	41	NMR Imaging	37
13	Range of Motion, Articular	93	42	Recovery ofFunction	37
14	Total Hip Replacement	87	43	Postoperative Care	36
15	Hip Prosthesis	73	44	Musculoskeletal System Parameters	35
16	Femur	72	45	Postoperative Hemmorrhage	35
17	Surgery	70	46	Osteolysis	34
18	Diagnostic Imaging	68	47	Bone Cement	30
19	Joint CHaracterstics& Functions	68	48	Femoral Neck Fractures	30
20	Radiograposishy	68	49	Nerve Block	29
21	Hip Prosthesis	73	50	Prosthesis Complications	29
22	Femur	72	51	Bupivacaine	27
23	Surgery	70	52	Deep Vein Thrombosis	27
24	Diagnostic Imaging	68	53	Osteosynthesis	27
25	Joint CHaracterstics& Functions	68	54	Periprosthetic Fracture	27
26	Radiograposishy	68	55	Spinal Anesthesia	26
27	Prosthesis Failure	50	56	Avascular Necrosis	25
28	Computer Assisted Surgery	49	57	Ankylosing Spondylitis	24
29	Knee Society Score	48

The co-occurrence of keywords also throws light on the existing important concepts in the field and the present trends of research in the field. Fig. 1 presents the co-occurrence of important keywords in 26 high-cited papers, presented in different clusters represented by different colors.

Fig. 1.

All Keywords network of 26 High-Cited Papers.

3.2.6. Profile of top 25 organizations

Overall, 413 organizations participated unevenly in Indian literature on Arthroplasty research, of which 364 organizations contributed 1–5 papers each, 33 organizations 6–10 papers each, 11 organizations 11–20 papers each, 4 organizations 21–50 papers each, and 1 organization 97 papers.

A large share of the publications emerged from authors belonging to the top 25 organizations out of 413 participating organizations and they together contributed 472 papers and 4819 citations, constituting 54.13% share of Indian publications and 56.53% share of Indian citations. On further analysis, it was observed that five organizations contributed papers higher than the group average (18.88) of the top 25 organizations and six organizations had CPP and RCI above the group average (10.21 and 1.04) for the top 25 organizations. Table 7 lists the top 8 most productive and 8 most impactful Indian organizations.

Table 7.

Top 8 most productive and most impactful organizations on India's research on arthroplasty.

S.No	Name of the Organization	TP	TC	CPP	HI	ICP	% ICP	RCI	%TP
Top 8 Most Productive Organizations
1	All India Institute of Medical Sciences (AIIMS), New Delhi	97	1190	12.27	16	20	20.62	1.25	11.12
2	Indraprastha Apollo Hospital, New Delhi	46	349	7.59	7	4	8.70	0.78	5.28
3	Breach Candy Hospital, Bombay	40	846	21.15	16	3	7.50	2.16	4.59
4	Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh	38	406	10.68	11	4	10.53	1.09	4.36
5	Lilavati Hospital & Research Center, Bombay	21	214	10.19	10	1	4.76	1.04	2.41
6	Fortis Healthcare Ltd.	18	125	6.94	7	4	22.22	0.71	2.06
7	P D Hinduja National Hospital & Medical Research Center, Bombay	16	65	4.06	5	0	0.00	0.42	1.83
8	Seth G S Medical College & KEM Hospital, Bombay	16	155	9.69	6	3	18.75	0.99	1.83
Top 8 Most Impactful Organizations
1	Bombay Hospital & Medical Research Center, Bombay	15	526	35.07	7	3	20.00	3.59	1.72
2	Breach Candy Hospital, Bombay	40	846	21.15	16	3	7.50	2.16	4.59
3	Dr L H. Hiranandani Hospital, Bombay	7	95	13.57	4	2	28.57	1.39	0.80
4	Tata Memorial Hospital, Bombay	9	120	13.33	5	2	22.22	1.36	1.03
5	All India Institute of Medical Sciences (AIIMS), New Delhi	97	1190	12.27	16	20	20.62	1.25	11.12
6	Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh	38	406	10.68	11	4	10.53	1.09	4.36
7	Lilavati Hospital & Research Center, Bombay	21	214	10.19	10	1	4.76	1.04	2.41
8	Seth G S Medical College & KEM Hospital, Bombay	16	155	9.69	6	3	18.75	0.99	1.83

TP: total Publications; TC: Total Citations; CPP: Citations per paper; HI: H- Index; RCI: Relative Citation Index; ICP: International collaboration papers; % ICP: percentage of international collaboration papers.

3.2.6.1. Collaboration among top 25 organizations

The collaborative linkages among the top 25 organizations are shown in Fig. 2. The total collaborative linkages (TCL) of the top 25 organizations varied from 0 to 90, with maximum collaborative linkages (90) depicted by All India Institute of Medical Sciences (AIIMS) -New Delhi, followed by Indraprastha Apollo Hospital (34 linkages), Post Graduate Institute of Medical Education & Research or PGIMER-Chandigarh (33 linkages), Fortis Healthcare Ltd (31), Breach Candy Hospital (30), etc.

Fig. 2.

Top 25 prolific indian institutional collaboration map.

Except for three, the total collaborative linkages among the top 25 organizations (TCL-TOP25) varied from 1 to 17, with the largest collaborative linkages (17) depicted by Indraprastha Apollo Hospital with 9 other organizations, followed by AIIMS-New Delhi (15 linkages with 10 other organizations), Fortis Healthcare Ltd (13 linkages with 6 other organizations), AIIMS-Bhubaneswar and Lilavati Hospital & Research Center (11 linkages with 6 and 4 organizations), etc.

The top Indian institutional collaborative pairs were from “Breach Candy Hospital, Mumbai – Lilavati Hospital & Research Center, Mumbai” which collaborated in the highest publications (n = 6), followed by “Kasturba Medical College, Manipal –Manipal Academy of Higher Education” that collaboratively published 4 papers, etc.

3.2.7. Profile of top 25 authors

The top 25 authors out of 841 total participated authors individually contributed 8 to 55 papers each and together contributed to 413 papers and 5503 citations, constituting 47.36% share and 54.92% share of India's total publications and citations. On further analysis, it was observed that eight authors contributed papers higher than their group average (16.52) for the top 25 authors and nine authors registered CPP and RCI above the group average (13.32 and 1.36) for the top 25 authors. Table 8 lists the top 8 most productive and 8 most impactful Indian authors.

Table 8.

Profile of the top 8 most productive and the most impactful Indian authors in the research on Arthroplasty.

S.No	Name of the author	Affiliation of the author	TP	TC	CPP	HI	ICP	%ICP	RCI	%TP
Top 8 Most Productive Authors
1	R. Malhotra	AIIMS-New Delhi	55	671	12.2	2	8	14.55	1.25	6.31
2	A.B. Mullaji	Breach Candy Hospital, Bombay	38	1145	30.13	19	4	10.53	3,08	4.36
3	R. Vaishya	Indraprastha Apollo Hospital	35	296	8.46	6	3	8.57	0.87	4.01
4	G.M. Shetty	Breach Candy Hospital, Bombay	23	522	22.7	12	1	4.35	2.32	2.64
5	V. Vijay	Indraprastha Apollo Hospital	23	107	4.65	6	1	4.35	0.48	2.64
6	V. Kumar	AIIMS-New Delhi	19	271	14.26	9	7	36.84	1.46	2.18
7	R.N. Maniar	Lilavati Hospital & Research Center, Bombay	18	198	11	9	1	5.56	1.12	2.06
8	A.Rajgopal	Medanta-The Medicity, Gurgaon, Haryana	17	197	11.59	8	4	23.53	1.19	1.95
Top 8 Most Impactful Authors
1	S. Bhan	AIIMS-New Delhi	16	496	31.0	10	0	0	3.17	1.83
2	A.B. Mullaji	Breach Candy Hospital, Bombay	38	1145	30.13	19	4	10.53	3.08	4.36
3	N.P. Jain	P D Hinduja National Hospital & Medical Research Center, Bombay	8	206	25.75	3	2	25	2.63	0.92
4	G.M. Shetty	Breach Candy Hospital, Bombay	23	522	22.7	12	1	4.35	2.32	2.64
5	H. Pandit	AIIMS-New Delhi	8	175	21.88	5	8	100	2.24	0.92
6	N.A. Shah	Bombay Hospital & Medical Research Center, Bombay	11	216	19.64	4	2	18.18	2.01	1.26
7	A. Vaish	Indraprastha Apollo Hospital	14	226	16.14	5	1	7.14	1.65	1.61
8	K.K. Eachempati	Max Cure Hospital, Hyderabad	13	198	15.23	8	4	30.77	1.56	1.49

TP: total Publications; TC: Total Citations; CPP: Citations per paper; HI: H- Index; RCI: Relative Citation Index; ICP: International collaboration papers; % ICP: percentage of international collaboration papers.

3.2.7.1. Collaboration among top 25 authors

The total collaborative linkages (TCL) of the top 25 authors varied from 10 to 154, with maximum collaborative linkages (154) depicted by R. Malhotra (of AIIMS-New Delhi), followed by R.Vaishya (of Indraprastha Apollo Hospital (84 linkages), V. Vijay (of Indraprastha Apollo Hospital (58 linkages), K.K. Eachempati (Max CureHospital, Hyderabad)(53 linkages), T.Goyal (AIIMS-Rishikesh)(48 linkages), etc.

Except for three, the total collaborative linkages with the top 25 authors (TCL-TOP25) (national) varied from 1 to 6, with the largest collaborative linkages (55) depicted by R. Vaishya (of Indraprastha Apollo Hospital) with 6 authors, followed by R. Malhotra (of AIIMS-New Delhi)(55 linkages with 6 other authors), V. Vijay (of Indraprastha Apollo Hospital) (44 linkages with 3 authors), S.K.Tripathi (of AIIMS-Bhubaneswar)(13 linkages with 3 other authors), K.K. Eachempati (of Max Cure Hospital, Hyderabad)(8 linkages with 4 other authors), T.Goyal (of AIIMS-Rishikesh)(8 linkages with 2 other authors), etc.

Among author-to-author collaboration linkages, the largest number of collaborative linkages (23) were between R.Vaishya – V.Vijay (Indraprastha Apollo Hospital), followed by R.Malhotra – V. Kumar (AIIMS-New Delhi) (16 linkages), R.Malhotra – D. Gautam (AIIMS-New Delhi) and R. Vaishya – A.K. Agarwal (Indraprastha Apollo Hospital) (14 linkages each), etc.

3.2.8. Profile of top 25 journals

Of the 872 publications with one author from India in the area of Arthroplasty, 841(96.44%) were published in 179 journals, 18 (2.06%) in conference proceedings, 7(0.80%) in book series, 5 (0.57%) as books and 1 (0.115) as undefined. Of the 179 journals, 152 journals published 1–5 papers each, 15 journals 6–10 papers each, 6 journals 11–20 papers, 5 journals 21–50 papers each, and 10 journals 123 papers.

The top 25 journals individually contributed 6 to 123 publications each and together published 492 papers, constituting a 58.50% share of India's total publications in journals. We noticed that the top 8 most productive journals were the Journal of Arthroplasty (123 papers), Journal of Clinical Orthopaedics & Trauma (50 papers), International Orthopaedics (32 papers), Indian Journal of Orthopaedics (25 papers), European Journal of Orthopaedic Surgery & Traumatology (23 papers), Journal of Arthroscopy & Joint Surgery (21 papers), Clinical Orthopaedics & Related Research and Journal of Orthopaedic Surgery (19 papers each). The top 8 journals in terms of CPP were the Journal of Bone & Joint Surgery. Series B (31.33), Knee Surgery Sports Traumatology Arthroscopy (21.69), Trends in Biomaterials and Artificial Organs (18.71), International Orthopaedics (18.25), Journal of Arthroplasty (16.54), Haemophilia (16.50), Orthopedics (15.70) and Archives of Orthopaedic and Trauma Surgery (13.40).

3.2.9. High-cited papers

Of the 872 papers, only 24(2.75%) received 63 or more citations (assumed here as high-cited papers (HCPs) and they together received 2319 citations, averaging 96.62 citations per paper. Of the 24 HCPs, 6 were in citation range 101–180 and the remaining 18 were in citation range 63–97.

Among the participating countries, 2 papers were contributed by the USA and 1 paper each by 19 other countries. The 24 HCPs involved 42 organizations (20 Indian) and 56 authors (18 Indian). Among the participating organizations from India, the largest number of papers (5) were contributed by AIIMS-New Delhi and Breach Candy Hospital, Mumbai, 2 papers each by PGIMER-Chandigarh and Bombay Hospital & Medical Research Center, Mumbai, and 1 paper each by 16 other Indian organizations. The 24 HCPs were published in 15 journals, of which 9 papers were published in the Journal of Arthroplasty, 2 papers each in International Orthopaedics and Journal of Bone & Joint Surgery, Series A, and 1 paper each in 12 other journals. A bibliometric profile of the top 10 high-cited papers is presented in Table 9.

Table 9.

Bibliometric profile of top 10 high-cited papers.

S.No	Name of authors	Title	Source	Citations
1	Vaishya, R, Chauhan, M., Vaish, A.	Bone cement	Journal of Clinical Orthopaedics and Trauma, 2013, 4 (4), pp. 157–163.	180
2	Prasad, N., Padmanabhan, V., Mullaji, A.	Blood loss in total knee arthroplasty: An analysis of risk factors	International Orthopaedics, 2007, 31 (1), pp. 39–44.	165
3	Bhan, S., Malhotra, R., Kiran, E.K et al.,.	A comparison of fixed-bearing and mobile-bearing total knee arthroplasty at a minimum follow-up of 4.5 years	Journal of Bone and Joint Surgery - Series A, 2005, 87 (10), pp. 2290–2296.	138
4	Kulkarni, K, Karssiens, T., Kumar, V. et al.	Obesity and osteoarthritis	Maturitas, 2016, 89, pp. 22–28.	102
5	Khanuja, H.S., Banerjee, S., Jain, D. et al.	Short bone-conserving stems in cementless hip arthroplasty	Journal of Bone and Joint Surgery - American Volume, 2014.96 (20), pp. 1742–1752.	101
6	Mullaji, A., Kanna, R., Shetty, G.M. et al.	Efficacy of periarticular injection of bupivacaine, fentanyl, and methylprednisolone in total knee arthroplasty. A prospective, randomized trial	Journal of Arthroplasty, 2010, 25 (6), pp. 851–857.	101
7	Diomidis, N., Mischler, S., More, N.S., Roy, M.	Tribo-electrochemical characterization of metallic biomaterials for total joint replacement	Acta Biomaterialia,2012, 8 (2), pp. 852–859. Cited 97 times.	97
8	Roy, S.P., Tanki, U.F., Dutta, A. et a	Efficacy of intra-articular tranexamic acid in blood loss reduction following primary unilateral total knee arthroplasty	Knee Surgery, Sports Traumatology, Arthroscopy, 2012, 20 (12), pp. 2494–2501.	96
9	Shah, N.A.and, Jain, N.P.	Is continuous adductor canal block better than continuous femoral nerve block after total knee arthroplasty? Effect on ambulation ability, early functional recovery and pain control: A randomized controlled trial	Journal of Arthroplasty, 2014, 29 (11), pp. 2224-2229	95
10	Mullaji, A.B., Padmanabhan, V, Jindal, G.	Total knee arthroplasty for profound varus deformity: Technique and radiological results in 173 knees with varus of more than 20°	Journal of Arthroplasty, 2005, 20 (5), pp. 550-561	87

4. Discussion

There has been a significant increase in Arthroplasty being performed across the globe, including in India in the last couple of decades (4). Hence, there is a growing importance of arthroplasty research both at the national and international levels. There has been a paucity of knowledge about the patterns of publication from India in the field of Arthroplasty, although there are a few bibliometric studies available in the field of Arthroscopy (3,4,5,6). The present study examines international and India's contributions in particular to arthroplasty research using the Scopus database in the last two decades (during 2002–21).

Globally, 64,168 publications were published on Arthroplasty during 2002–21. Of the global publications, 83.54% (16128) share of publication share emerged from the top 10 countries. The USA (33.7%) contributed the largest share to global output, followed by the U.K. (11.1%), Germany (7.8%), Canada (4.6%), etc. We observed that a 1.36% share in global research output with 16th rank on the topic, emerged from India during 2002–21 (Table 2), with an average citation impact of 19.78 CPP. India's Arthroplasty-related publications output was only 872 papers but showed an annual increase from 5 publications in 2002 to 121 publications in 2021 (24.01% average growth). India's cumulative publications increased from 159 (during 2002–11) to 713 (from 2012 to 2021), registering an absolute growth of 348.43%. The share of India's publications in global output doubled from 0.80% (during 2002–11) to 1.61% (from 2012 to 2021). The 872 Indian publications received 8,525 citations, averaging 9.78 citations per paper (CPP)[Table 1].

Of the 872 publications with one of the authors from India, 6.2% and 21.5% were published with external funding support and as international collaborative publications. Among 872 India's total publications, Knee Arthroplasty research constituted the largest publication share (52.4%), followed by Hip Arthroplasty (35.7%), Ankle Arthroplasty (2.41%), %), Spine/Disc Arthroplasty (1.61%), Elbow Arthroplasty (1.3%) and Wrist Arthroplasty (0.90%) (Table 4). Among types of studies in India's output, Clinical Studies (37.2%) constituted the largest share of papers, followed by Treatment Studies (23.6%). Complications (17.3%), Pathophysiology (9.0%), Adverse Effects (8.1%), Epidemiology (6.4%) and Risk Factors (5.3%).

The most frequently used keywords in this area of research, included Knee Replacement Arthroplasty (332), Total Knee Arthroplasty (252), Arthroplasty (175), Hip Replacement Arthroplasty (169), and Knee Osteoarthritis (163), etc.

The majority share of the publications in this study was found to be from authors belonging to the top 30 organizations (Table 6). These authors contributed 472 papers (54.1% share) and received 4819 citations (56.5% share). We noticed that the research from India was not limited to a few centers only and 413 organizations participated unevenly in the Arthroplasty publications.

We observed that the majority of the publications were published by the institutes like AIIMS (New Delhi), Indraprastha Apollo Hospital (New Delhi), Breach Candy Hospital (Mumbai), PGIMER (Chandigarh), and Lilavati Hospital & Research Center (Mumbai). But, in terms of CPP and RCI, authors from institutes like Bombay Hospital & Medical Research Center (Mumbai), Breach Candy Hospital (Mumbai), Dr. L H. Hiraanandani Hospital (Mumbai), Tata Memorial Hospital (Mumbai), AIIMS (New Delhi), and PGIMER (Chandigarh) had the highest citation impact.

These findings suggest that the present funding mechanism is likely responsible for a change in the Indian Research landscape and it may have a significant positive impact on the Indian research output. The present bibliometric study also suggests that the Indian research was not limited to a few authors only and 841 authors from 413 organizations participated unevenly on this topic, though a majority of the publications emerged from authors belonging to the top 30 organizations only. The majority of the publications emerged from the top 25 authors and they together account for 46.4% share and 64.3% of share respective share of Indian publications and citations suggesting that the research output of various authors was heterogeneous. Hence, we believe that there is a need to improve the research capacity across the country, where arthroplasty surgeries are being done regularly. It was also observed that the majority of the publications were from some authors such as R. Malhotra (55 papers), A.B. Mullaji (38 papers), R. Vaishya (35 papers), G.M. Shetty (23 papers), V. Vijay (23 papers), and V. Kumar (19 papers)(Table 7). But, in terms of CPP and RCI, authors such as S.Bhan (31.0 and 3.17), A.B. Mullaji (30.13 and 3.06), N.P. Jain (25.75 and 2.63), G.M. Shetty (22.70 and 2.32), and H. Pandit (21.88 and 2.24) had registered comparatively the highest citation impact.

The majority of the papers were published in well-recognized journals, with a maximum number of publications (123) in the Journal of Arthroplasty, followed by the Journal of Clinical Orthopaedics & Trauma (50 papers), International Orthopaedics (32 papers), Indian Journal of Orthopaedics (25 papers), European Journal of Orthopaedic Surgery & Traumatology (23 papers), Journal of Arthroscopy & Joint Surgery (21 papers), etc.

Taken together, the present study suggests that the research base in India is becoming more wide-base, and need constant growth in the publications from centers across the country that are involved in Arthroplasty work. The pooling of information on Arthroplasty cases in the form of registries has also been initiated (4), which is a welcome move and should help in bringing out high-impact publications from the large data.

We acknowledge the major limitation of this study, being searching the data from one search engine of SCOPUS only, and hence some of the publications related to the journals that are not included in this database would be missing. We chose to do this scientometric analysis from the SCOPUS because it has the largest number of journals included and also provides the maximum bibliometric information, compared to other databases like WOS, Cochrane, etc. Moreover, including the information from the other sources would have been different, and not including all the required parameters to make the analysis complex and non-informative.

5. Conclusion

In the field of Arthroplasty Research and Publication, Indian authors have shown a significant rise in publications in the last decade, with a 348.13% growth and the global share of their publications has also doubled. Currently, the overall global research contribution by the Indian authors is minimal at 1.36%, but with a healthy trend of availability of more external funding and international collaboration, it is expected that the Indian authors' contribution to Arthroplasty-related publications would continue to rise in the future. Both Government and Private Indian institutions are active in publishing their research on Arthroplasty.

Funding

None.

Ethical committee approval

Not required.

Author's contribution

All three authors (RV, BMG, and MK) were involved in conceptualizing the research, literature search, data analysis, and writing and editing of the manuscript.

Declaration of competing interest

None of the authors have any interest to declare.