The global state of clinical research and trends in periprosthetic joint infection: A bibliometric analysis

The global state of clinical research and trends in periprosthetic joint infection: A bibliometric analysis Cheng Li a , Cristina Ojeda-Thies b , Nora Renz a , Donara Margaryan a , Carsten Perka a , Andrej Trampuz a, * a Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Centre for Musculoskeletal Surgery (CMSC), Berlin, Germany b Hospital Universitario 12 de Octubre, Madrid, Spain A R T I C L E I N F O Article history: Received 5 April 2020 Received in revised form 1 May 2020 Accepted 3 May 2020 Keywords: Bibliometrics Arthroplasty Periprosthetic joint infection Publications Medical information sciences A B S T R A C T Objectives: The purpose of this study was to estimate the trends and state of research in periprosthetic joint infection (PJI). Methods: Publications on PJI published between 1998 and 2018 were searched in the Web of Science database and analyzed using bibliometrics. The Altmetric score and Research Interest score were combined to provide a weighted count. The scope of the Altmetric score includes >16 weighted composite scores from websites such as Twitter, Facebook, and YouTube, whereas the Research Interest score is calculated from information derived from ResearchGate. Results: Total of 3245 published documents were identified. The largest contribution was made by the United States, with the institution contributing most being the Rothman Institute. The most relative articles were published by the Journal of Arthroplasty, whereas the highest citation frequency journal was Clinical Orthopaedics and Related Research. There was a positive correlation between citation counts and Research Interest scores, while the Altmetric Attention score showed a negative value for highly cited articles. Conclusions: Based on the current trends of globalization, there is a rising trend in publications on PJI, with the largest annual contributions made by the United States. The most influential contributors are researchers from the United States and Europe. Twitter is used as a platform to communicate knowledge by most PJI researchers. The most recent research has focused on the diagnosis and risk factors of PJI. © 2020 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/). Introduction Arthroplasty is a common surgical procedure used by orthopedic surgeons and significantly improves quality of life in patients with joint disease. However, infection after joint replacement remains difficult and challenging, not only because infection cannot be avoided in the short-term, but also due to the lack of gold standards in managing periprosthetic joint infection (PJI). In special cases, such as rheumatoid arthritis patients, this further increases the difficulty of diagnosis and treatment (Fagotti et al., 2018; Premkumar et al., 2018). The recent literature has reported that infection has become a major complication after joint replacement (Jafari et al., 2010; Kulshrestha et al., 2019). Therefore, the management of PJI has become increasingly important. Bibliometrics – a method of statistical analysis – can be used to assess the characteristics and major developmental trends of a given research subject based on published research. Bibliometric analysis has been used previously to evaluate orthopedic research based on orthopedic disease, orthopedic journal, operative site, surgical technique, and the development of a country's conditions (Ahmad et al., 2014; Jia et al., 2015; Seetharam et al., 2018; Vaishya et al., 2018; Jani et al., 2019). However, a bibliometric analysis of PJI has not yet been performed. Traditionally, the number of citations has been the best method available to assess the quality of a publication. However, in today's social network era, citations no longer represent the only means of evaluating an academic article (Bellini, 2012; 2017). Due to the increasing numbers of individuals who read, share, or comment on * Corresponding author at: Centre for Musculoskeletal Surgery, Charité – University Medicine Berlin, Charitéplatz 1, D-10117 Berlin, Germany. E-mail address: [email protected] (A. Trampuz). https://doi.org/10.1016/j.ijid.2020.05.014 1201-9712/© 2020 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). International Journal of Infectious Diseases 96 (2020) 696–709 Contents lists available at ScienceDirect International Journal of Infectious Diseases journal homepage: www.elsevier.com/locate/ijid Descargado para Cristina Escudero Gomez ([email protected]) en Community of Madrid Ministry of Health de ClinicalKey.es por Elsevier en octubre 24, 2025. Para uso personal exclusivamente. No se permiten otros usos sin autorización. Copyright ©2025. Elsevier Inc. Todos los derechos reservados. literature online, altmetrics provides another means to alternative or complementary citation metrics, which is mainly based on network data (Priem et al., 2010). The Research Interest score and Altmetric score are two different altmetric tools to evaluate the impact of publications; however, there is no article in the literature simultaneously contrasting the relationship between these two tools and citations. The aim of this study was to provide a comprehensive understanding for further advancement in the field. First, a bibliometric analysis of PJI was performed. Second, all keywords were exported from the identified articles to identify hot topics. Third, the top 50 most cited articles were collected and analyzed via logistic regression to determine the relationship between altmetric tools, impact factor, publication year, and citations in highly cited papers. Social media data from Altmetric scores were also analyzed to determine the social media habits of researchers. Methods Search strategy Data were retrieved from the Web of Science (WoS) electronic database (SCI-Expanded), which is optimal for bibliometric analysis (Aggarwal et al., 2016). A search for articles published between 1998 and 2018 was performed using all fields with the terms “periprosthetic joint infection or prosthetic joint infection” without any language restriction. Figure 1. Flowchart of the identification of relevant articles. Figure 2. The total annual number and citation of publications. C. Li et al. / International Journal of Infectious Diseases 96 (2020) 696–709 697 Descargado para Cristina Escudero Gomez ([email protected]) en Community of Madrid Ministry of Health de ClinicalKey.es por Elsevier en octubre 24, 2025. Para uso personal exclusivamente. No se permiten otros usos sin autorización. Copyright ©2025. Elsevier Inc. Todos los derechos reservados. Data collection Two authors (CL and COT) independently screened the literature and extracted data. All fundamental research was excluded (such as biofilm or antibiotic studies, in vitro and animal experiments), and references in eligible studies were reviewed. In the case of disagreement, a third author (DM) was consulted to reach a consensus. Full records from the WoS database were exported to plain text. Microsoft Excel (Microsoft, Redmond, WA, USA) and Endnote reference manager software version X9 (Thomson Reuters, New York, NY, USA) were used to analyze all keywords from the literature. The top 50 most cited articles were exported from the WoS database. The Research Interest score was searched by title or digital object identifier (DOI) number in ResearchGate (https:// www.researchgate.net/). The Altmetric score was determined using the Altmetric bookmarklet (https://www.altmetric.com). All information, including the number of citations, Research Interest score, Altmetric score, and social media habits for the top 50 most cited articles were also collected. Only social media information from Facebook and Twitter was included, as some social media information cannot be traced using the Altmetric website. Extraction of keywords and most cited paper for different subjects In the Endnote database, the articles were divided into different groups according to the title or abstract: location, prevention, risk factor, diagnosis, microorganism, and treatment. Some undefined literature articles were included or excluded through further fulltext reads. Publications on location were separated into hip, knee, shoulder, elbow, and ankle. Keywords from publications on treatment were divided into surgery and antibiotic therapy. The Figure 3. Global distribution of PJI research. Table 1 List of top 10 countries according to the total number of publications, number of times cited, average citations per item, and h-index. Rank Country Number of articles Sum of times cited Average citations per item h-Index 1 USA 1226 37 238 36.28 98 2 Germany 358 4728 16.18 40 3 United Kingdom 298 6304 27.73 47 4 Spain 200 2813 17.43 31 5 France 196 2889 17.54 30 6 China 171 1460 11.41 25 7 Switzerland 151 5647 42.71 35 8 Italy 130 1682 15.74 26 9 Canada 84 2322 31.89 26 10 Netherlands 81 1406 20.9 21 698 C. Li et al. / International Journal of Infectious Diseases 96 (2020) 696–709 Descargado para Cristina Escudero Gomez ([email protected]) en Community of Madrid Ministry of Health de ClinicalKey.es por Elsevier en octubre 24, 2025. Para uso personal exclusivamente. No se permiten otros usos sin autorización. Copyright ©2025. Elsevier Inc. Todos los derechos reservados. top five most cited articles related to the subject were included. The top 10 keywords in the different areas were calculated, and the most relevant and frequent keyword was included. In the event that the keyword had the same occurrence number, sorting was performed according to alphabetical order. To show more valuable information, high-frequency keywords, such as “periprosthetic joint infection”, “prosthetic joint infection”, and “infection”, were deleted. Visualized analysis VOSviewer (Leiden University, Leiden, The Netherlands) was used for visualization and analysis of the literature. VOSviewer software was used for bibliographic coupling, co-citation analysis, and co-occurrence analysis. If the VOSviewer database had the author's name, country, and similar terms in duplicate, a thesaurus file was created and used to combine the identical information. Statistical analysis All data were analyzed using IBM SPSS Statistics version 23.0 (IBM Corp., Armonk, NY, USA). Spearman rank correlation was used for non-normally distributed data. For normally distributed data or approximate normal distribution, the equation of linear regression was established. A p-value of <0.05 (two-sided) was considered statistically significant. Results Of the 3985 primary literature articles retrieved, 47 were excluded due to duplication. An additional 1456 were excluded following a review of the title, abstract, and full article. Altogether, 11026 cited references without self-citations from 2529 articles published between 1998 and 2018 were reviewed. Finally, 716 publications were included. A flowchart of the study search strategy is given in Figure 1. General data A total of 3245 articles on PJI were collected from the WoS. Most of these articles were in English (94%), followed by German and Table 2 List of top 10 countries according to total number of publications annually. Table 3 List of top 10 contributing institutions and countries. Name of institution Country Publications Rothman Institute USA 245 Mayo Clinic USA 219 Cleveland Clinic USA 80 Rush University USA 80 University of Barcelona Spain 79 University of California System USA 75 Harvard University USA 70 Charité Medical University of Berlin Germany 59 Hospital for Special Surgery USA 54 Helios ENDO-Klinik Hamburg Germany 52 C. Li et al. / International Journal of Infectious Diseases 96 (2020) 696–709 699 Descargado para Cristina Escudero Gomez ([email protected]) en Community of Madrid Ministry of Health de ClinicalKey.es por Elsevier en octubre 24, 2025. Para uso personal exclusivamente. No se permiten otros usos sin autorización. Copyright ©2025. Elsevier Inc. Todos los derechos reservados. Spanish. Of these, 2626 (81%) were original articles. The total number of citations of these articles was 69 358. The number of publications and citations peaked in 2018. From 1998 to 2018, the global publications and total citations showed an upward annual trend (Figure 2). Countries Publications originated from 58 countries, with most from Europe (n = 32), followed by Asia (n = 16) and the Americas (n = 9). The country with the most publications in Asia was China, in Africa was Egypt, in Europe was Germany, in South America was Brazil, in Oceania was Australia, and in North America was the United States (Figure 3). Out of the 58 nations, the United States had the highest total number of publications, total citations, and h-index. The top average number of citations was found for publications originating from Switzerland (42.71), followed by the United States (36.28) and Canada (31.89) (Table 1). From 1998 to 2018, the United States had the greatest number of publications, followed by Germany (n = 12) and United Kingdom (n = 8). Germany had the greatest number of third place (n = 5), followed by Spain (n = 4). The top 10 countries with the greatest numbers of publications encompassed most of the global publications, particularly in 1998, 2004, and 2006 (Table 2). Institutions The first-ranking institution was the Rothman Institute, with 245 articles, followed by the Mayo Clinic (n = 219) and Cleveland Clinic and Rush University (n = 80 each). Seven institutions in the United States were in the top 10 for the highest number of publications on PJI, while the remaining three institutions were in Europe (Table 3). Authors The author with the highest number of publications and highest h-index was Javad Parvizi (204 and 57, respectively), followed by Arlen D. Hanssen (85 and 38, respectively) and Douglas R. Osmon (77 and 37, respectively). The top average number of citations was observed for Andrej Trampuz (83.85), followed by Douglas R. Osmon (75.52) and Robin Patel (70.77). All authors in the top 10 for the number of publications were from the top 10 institutions. Seven of the positions were occupied by authors from the United States, with Javad Parvizi the first ranked author. In Spain, the first ranked author was Alex Soriano, Table 5 List of top 10 journals with the most publications and their impact factors. Journal Number of publications Impact factor Journal of Arthroplasty 466 3.524 Clinical Orthopaedics and Related Research 276 4.154 Journal of Bone and Joint Surgery -American Volume 156 4.716 Bone Joint Journal 147 3.652 International Orthopaedics 100 2.384 Acta Orthopaedica 72 3.217 Journal of Clinical Microbiology 71 4.959 Clinical Infectious Diseases 63 9.055 Journal of Shoulder and Elbow Surgery 60 2.865 HIP International 52 1.25 Table 4 List of top 10 authors with most publications and the h-index, average citations, country, specialized subject, and institution. Author Number of publications h-Index Average citations per item Country Specialized subject Institution Javad Parvizi 204 57 51.69 USA Orthopedic surgery Rothman Institute Arlen D. Hanssen 85 38 66.09 USA Orthopedic surgery Mayo Clinic Douglas R. Osmon 77 37 75.52 USA Infectious diseases Mayo Clinic Alex Soriano 64 21 21.16 Spain Infectious diseases University of Barcelona Craig J. Della Valle 60 29 43.45 USA Orthopedic surgery Rush University Andrej Trampuz 53 22 83.85 Germany Infectious diseases Charité - University Hospital Berlin Elie F. Berbari 49 25 68.82 USA Infectious diseases Mayo Clinic Robin Patel 48 23 70.77 USA Clinical microbiology Mayo Clinic Michael A. Mont 43 18 29.6 USA Orthopedic surgery Cleveland Clinic Thorsten Gehrke 40 19 33.88 Germany Orthopedic surgery Helios ENDO-Klinik Hamburg Table 6 List of top 10 journals by highest impact factor, with the number of publications. Journal Impact factor Number of publications New England Journal of Medicine 70.67 6 Lancet 59.102 2 BMJ British Medical Journal 27.604 3 Lancet Infectious Diseases 27.516 7 Clinical Microbiology Reviews 17.75 2 Annals of the Rheumatic Diseases 14.299 4 American Journal of Gastroenterology 10.241 1 Clinical Infectious Diseases 9.055 63 Arthritis and Rheumatism 9.002 3 BMC Medicine 8.285 2 700 C. Li et al. / International Journal of Infectious Diseases 96 (2020) 696–709 Descargado para Cristina Escudero Gomez ([email protected]) en Community of Madrid Ministry of Health de ClinicalKey.es por Elsevier en octubre 24, 2025. Para uso personal exclusivamente. No se permiten otros usos sin autorización. Copyright ©2025. Elsevier Inc. Todos los derechos reservados. Table 7 The 50 most cited publications ranked by citation. Rank Title Times cited Impact factor Research Interest score Attention score Media use habits a 1 Zimmerli W, Trampuz A, Ochsner PE. Prosthetic-joint infections. N Engl J Med 2004; 351: 1645–1654. 1461 70.67 946 13 Twitter 2 Trampuz A, Piper KE, Jacobson MJ, et al. Sonication of removed hip and knee prostheses for diagnosis of infection. N Engl J Med 2007; 357: 654– 663. 672 70.67 382.3 18 Twitter 3 Osmon DR, Berbari EF, Berendt AR, et al. Executive summary: diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 2013; 56: 1–10. 587 9.055 353.7 57 Twitter 4 Pulido L, Ghanem E, Joshi A, Purtill JJ, Parvizi J. Periprosthetic joint infection: the incidence, timing, and predisposing factors. Clin Orthop Relat Res 2008; 466: 1710–1715. 572 4.154 349.9 7 None 5 Kurtz SM, Lau E, Watson H, Schmier JK, Parvizi J. Economic burden of periprosthetic joint infection in the United States. J Arthroplasty 2012; 27: 61–65.e1. 543 3.524 304.5 21 None 6 Kurtz SM, Lau E, Schmier J, Ong KL, Zhao K, Parvizi J. Infection burden for hip and knee arthroplasty in the United States. J Arthroplasty 2008; 23: 984–991. 486 3.524 268.2 3 None 7 Bozic KJ, Kurtz SM, Lau E, et al. The epidemiology of revision total knee arthroplasty in the United States. Clin Orthop Relat Res 2010; 468: 45–51. 482 4.154 280 14 Twitter 8 Parvizi J, Jacovides C, Zmistowski B, Jung KA. Definition of Periprosthetic joint infection: is there a consensus? Clin Orthop Relat Res 2011; 469: 3022–3030. 470 4.154 64.4 1 Twitter, Facebook 9 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. J Bone Joint Surg Am 1999; 81: 672–683. 464 4.716 269.3 3 None 10 Berbari EF, Hanssen AD, Duffy MC, et al. Risk factors for prosthetic joint infection: case–control study. Clin Infect Dis 1998; 27: 1247–1254. 455 9.055 298.7 6 None 11 Peersman G, Laskin R, Davis J, Peterson M. Infection in total knee replacement: a retrospective review of 6489 total knee replacements. Clin Orthop Relat Res 2001; (392): 15–23. 436 4.154 214.4 NA* None 12 Del Pozo JL, Patel R. Infection associated with prosthetic joints. N Engl J Med 2009; 361: 787–794. 407 70.67 257.5 18 None 13 Atkins BL, Athanasou N, Deeks JJ, et al. Prospective evaluation of criteria for microbiological diagnosis of prosthetic-joint infection at revision arthroplasty. J Clin Microbiol 1998; 36: 2932–2939. 384 4.959 110.6 NA None 14 Havelin LI, Engesaeter LB, Espehaug B, Furnes O, Lie SA, Vollset SE. The Norwegian Arthroplasty Register: 11 years and 73 000 arthroplasties. Acta Orthop Scand 2000; 71: 337–353. 346 3.217 194.8 NA None 15 Tunney MM, Patrick S, Curran MD, et al. Detection of prosthetic hip infection at revision arthroplasty by immunofluorescence microscopy and PCR amplification of the bacterial 16S rRNA gene. J Clin Microbiol 1999; 37: 3281–3290. 311 4.959 178.9 NA None 16 Tande AJ, Patel R. Prosthetic joint infection. Clin Microbiol Rev 2014; 27: 302–345. 308 17.75 172.6 33 Twitter, Facebook 17 Bozic KJ, Ries MD. The impact of infection after total hip arthroplasty on hospital and surgeon resource utilization. J Bone Joint Surg Am 2005; 87: 1746–1751. 299 4.716 142.9 6 None 18 Trampuz A, Hanssen AD, Osmon DR, Mandrekar J, Steckelberg JM, Patel R. Synovial fluid leukocyte count and differential for the diagnosis of prosthetic knee infection. Am J Med 2004; 117: 556–562. 296 4.76 198.2 22 Twitter 19 Parvizi J, Gehrke T, Chen AF. Proceedings of the International Consensus on Periprosthetic Joint Infection. Bone Joint J 2013; 95-B: 1450–1452. 294 3.652 182.2 19 Twitter, Facebook 20 Kurtz SM, Ong KL, Lau E, Bozic KJ, Berry D, Parvizi J. Prosthetic joint infection risk after TKA in the Medicare population. Clin Orthop Relat Res 2010; 468: 52–56. 293 4.154 177.1 NA None 21 Phillips JE, Crane TP, Noy M, Elliott TSJ, Grimer RJ. The incidence of deep prosthetic infections in a specialist orthopedic hospital: a 15-year prospective survey. J Bone Joint Surg Br 2006; 88: 943–948. 285 3.652 174.7 7 None 22 Marculescu CE, Berbari EF, Hanssen AD, et al. Outcome of prosthetic joint infections treated with debridement and retention of components. Clin Infect Dis 2006; 42: 471–478. 271 9.055 164.6 NA None 23 Segawa H, Tsukayama DT, Kyle RF, Becker DA, Gustilo RB. Infection after total knee arthroplasty. A retrospective study of the treatment of eighty-one infections. J Bone Joint Surg Am 1999; 81: 1434–1445. 262 4.716 163.2 3 None 24 Trampuz A, Widmer AF. Infections associated with orthopedic implants. Curr Opin Infect Dis 2006; 19: 349–356. 253 3.752 189.2 17 None 25 Patel VP, Walsh M, Sehgal B, Preston C, DeWal H, Di Cesare PE. Factors associated with prolonged wound drainage after primary total hip and knee arthroplasty. J Bone Joint Surg Am 2007; 89: 33–38. 249 4.716 153.9 10 Twitter 26 Schinsky MF, Della Valle CJ, Sporer SM, Paprosky WG. Perioperative testing for joint infection in patients undergoing revision total hip arthroplasty. J Bone Joint Surg Am 2008; 90: 1869–1875. 245 4.716 151.6 3 None C. Li et al. / International Journal of Infectious Diseases 96 (2020) 696–709 701 Descargado para Cristina Escudero Gomez ([email protected]) en Community of Madrid Ministry of Health de ClinicalKey.es por Elsevier en octubre 24, 2025. Para uso personal exclusivamente. No se permiten otros usos sin autorización. Copyright ©2025. Elsevier Inc. Todos los derechos reservados. Table 7 (Continued) Rank Title Times cited Impact factor Research Interest score Attention score Media use habits a 27 Schäfer P, Fink B, Sandow D, Margull A, Berger I, Frommelt L. Prolonged bacterial culture to identify late periprosthetic joint infection: a promising strategy. Clin Infect Dis 2008; 47: 1403–1409. 237 9.055 150.9 17 Twitter 28 Lentino JR. Prosthetic joint infections: bane of orthopedists, challenge for infectious disease specialists. Clin Infect Dis 2003; 36: 1157–1161. 237 9.055 152.7 10 None 29 Bauer TW, Parvizi J, Kobayashi N, Krebs V. Diagnosis of periprosthetic infection. J Bone Joint Surg Am 2006; 88: 869–882. 235 4.716 135 NA None 30 Trampuz A, Zimmerli W. Prosthetic joint infections: update in diagnosis and treatment. Swiss Med Wkly 2005; 135: 243–251. 235 1.821 144.8 NA None 31 Piper KE, Jacobson MJ, Cofield RH, et al. Microbiologic diagnosis of prosthetic shoulder infection by use of implant sonication. J Clin Microbiol 2009; 47: 1878–1884. 230 4.959 126.5 6 None 32 Jiranek WA, Hanssen AD, Greenwald AS. Antibiotic-loaded bone cement for infection prophylaxis in total joint replacement. J Bone Joint Surg Am 2006; 88: 2487–2500. 227 4.716 121 6 None 33 Jämsen E, Huhtala H, Puolakka T, Moilanen T. Risk factors for infection after knee arthroplasty. A register-based analysis of 43149 cases. J Bone Joint Surg Am 2009; 91: 38–47. 224 4.716 138.1 10 None 34 Ong KL, Kurtz SM, Lau E, Bozic KJ, Berry DJ, Parvizi J. Prosthetic joint infection risk after total hip arthroplasty in the Medicare population. J Arthroplasty 2009; 24: 105–109. 223 3.524 138.7 NA None 35 Zimmerli W, Ochsner PE. Management of infection associated with prosthetic joints. Infection 2003; 31: 99–108. 223 2.927 151.1 NA None 36 Parvizi J, Zmistowski B, Berbari EF, et al. New definition for periprosthetic joint infection: from the Workgroup of the Musculoskeletal Infection Society. Clin Orthop Relat Res 2011; 469: 2992–2994. 212 4.154 352.3 16 Facebook 37 Hailer NP, Garellick G, Kärrholm J. Uncemented and cemented primary total hip arthroplasty in the Swedish Hip Arthroplasty Register: evaluation of 170 413 operations. Acta Orthop 2010; 81: 34–41. 212 3.217 12.4 NA None 38 Namba RS, Inacio MCS, Paxton EW. Risk factors associated with deep surgical site infections after primary total knee arthroplasty: an analysis of 56 216 knees. J Bone Joint Surg Am 2013; 95: 775–782. 207 4.716 107.9 16 Twitter 39 Sperling JW, Kozak TK, Hanssen AD, Cofield RH. Infection after shoulder arthroplasty. Clin Orthop Relat Res 2001; (382): 206–216. 204 4.154 119.1 3 None 40 Crockarell JR, Hanssen AD, Osmon DR, Morrey BF. Treatment of infection with debridement and retention of the components following hip arthroplasty. J Bone Joint Surg Am 1998; 80: 1306–1313. 204 4.716 126 NA None 41 Bozic KJ, Lau E, Kurtz S, et al. Patient-related risk factors for periprosthetic joint infection and postoperative mortality following total hip arthroplasty in Medicare patients. J Bone Joint Surg Am 2012; 94: 794–800. 202 4.716 105.4 11 Twitter, Facebook 42 Parvizi J, Gehrke T, International Consensus Group on Periprosthetic Joint Infection. Definition of periprosthetic joint infection. J Arthroplasty 2014; 29: 1331. 201 3.524 61.2 NA None 43 Spirt AA, Assal M, Hansen ST Jr. Complications and failure after total ankle arthroplasty. J Bone Joint Surg Am 2004; 86: 1172–1178. 200 4.716 121.8 NA None 44 Osmon DR, Berbari EF, Berendt AR, et al. Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 2013; 56: e1–25. 198 9.055 181.7 57 Twitter, Facebook 45 Kerkhoffs GMMJ, Servien E, Dunn W, Dahm D, Bramer JAM, Haverkamp D. The influence of obesity on the complication rate and outcome of total knee arthroplasty: a meta-analysis and systematic literature review. J Bone Joint Surg Am 2012; 94: 1839–1844. 192 4.716 92.6 10 None 46 Berbari E, Mabry T, Tsaras G, et al. Inflammatory blood laboratory levels as markers of prosthetic joint infection: a systematic review and metaanalysis. J Bone Joint Surg Am 2010; 92: 2102–2109. 191 4.716 126.9 1 None 47 Cui Q, Mihalko WM, Shields JS, Ries M, Saleh KJ. Antibiotic-impregnated cement spacers for the treatment of infection associated with total hip or knee arthroplasty. J Bone Joint Surg Am 2007; 89: 871–882. 191 4.716 122.4 11 Twitter, Facebook 48 Saleh K, Olson M, Resig S, et al. Predictors of wound infection in hip and knee joint replacement: results from a 20 year surveillance program. J Orthop Res 2002; 20: 506–515. 191 3.043 128 4 Twitter 49 Malinzak RA, Ritter MA, Berend ME, Meding JB, Olberding EM, Davis KE. Morbidly obese, diabetic, younger, and unilateral joint arthroplasty patients have elevated total joint arthroplasty infection rates. J Arthroplasty 2009; 24: 84–88. 189 3.524 106.6 19 Twitter 50 Berbari EF, Marculescu C, Sia I, et al. Culture-negative prosthetic joint infection. Clin Infect Dis 2007; 45: 1113–1119. 184 9.055 119.2 NA None a Not available. 702 C. Li et al. / International Journal of Infectious Diseases 96 (2020) 696–709 Descargado para Cristina Escudero Gomez ([email protected]) en Community of Madrid Ministry of Health de ClinicalKey.es por Elsevier en octubre 24, 2025. Para uso personal exclusivamente. No se permiten otros usos sin autorización. Copyright ©2025. Elsevier Inc. Todos los derechos reservados. whereas in Germany, Andrej Trampuz was the first ranked author, followed by Thorsten Gehrke (Table 4). Journals Articles were published in 362 different journals. The Journal of Arthroplasty (14.4%) had the highest number of publications, followed by Clinical Orthopaedics and Related Research (8.5%). Third on the list was the Journal of Bone and Joint Surgery (4.8%) (Table 5). Based on the WoS database, 325 journals had an impact factor in 2018. The highest impact factor was for The New England Journal of Medicine (70.67), followed by The Lancet (59.10), and the British Medical Journal (27.60) (Table 6). Top 50 most cited publications The 50 most cited articles on PJI (Table 7) were cited between 184 and 1461 times. The most cited article was a study by Zimmerli et al. (Zimmerli et al., 2004). The second most cited article was one by Trampuz et al. (Trampuz et al., 2007) and the third was by Osmon et al. (Osmon et al., 2013). All papers were published in English. Of the 14 journals that published these articles, The New England Journal of Medicine (70.67) had the highest impact factor, followed by Clinical Microbiology Reviews (17.75) and Clinical Infectious Diseases (9.055). Most publications were from the Journal of Bone and Joint Surgery (n = 15), followed by Clinical Infectious Diseases and Clinical Orthopaedics and Related Research (n = 7 each). Univariate analysis demonstrated that the Research Interest score and impact factor were associated with the number of times cited (p < 0.05). There was no significant association between the Attention score or year and the number of times cited (p > 0.05). Multivariate analysis showed no significant difference between impact factor or year and the number of times cited (p > 0.05). The Research Interest score was positively correlated with the number of citations, whereas a negative correlation was found for the Attention score (Table 8). Keywords and most cited paper for the different subjects Significant keywords were screened to show potential trending topics. To obtain a better understanding of PJI, different infection sites were also analyzed (Table 9). Visualized analysis Bibliographic coupling analysis Of the 58 countries, the minimum threshold of five publications stemming from a particular country was met by 37 countries (Figure 4a). The top three countries with the highest total link strengths were the United States (n = 941808), Germany (n = 417402), and United Kingdom(n = 313 201). Five hundred authors were identified with a minimum threshold of five publications from a single author (Figure 4b). The top three authors with greatest total link strengths were Javad Parvizi (n = 639 792), Douglas R. Osmon (n = 235 931), and Arlen D. Hanssen (n = 230 809). Of the 362 journals, 100 met the minimum threshold of five (Figure 4c). The top three journals with the greatest total link strengths were the Journal of Arthroplasty (n = 334 278), Clinical Orthopaedics and Related Research (n = 256 512), and Journal of Bone and Joint Surgery (n = 143 655). Co-citation analysis Journals with a minimum of 20 citations were included. Criteria were met by 349 journals (Figure 5b). The top three journals with greatest total link strengths were Clinical Orthopaedics and Related Research (n = 465160), Journal of Bone and Joint Surgery (n = 383 465), and Journal of Arthroplasty (n = 312 366). Five hundred authors with a minimum of 20 citations were identified (Figure 5a). The top three authors with greatest total link strengths were Javad Parvizi (n = 37408), Werner Zimmerli (n = 28 627), and Andrej Trampuz (n = 27 744). Co-occurrence analysis Hot topics and research areas were identified through cooccurrence analysis. Identified keywords were divided into three clusters: “diagnosis”, “treatment”, and “risk factor and prevention” (Figure 6a). In the cluster “diagnosis”, the most frequently used keywords were culture, C-reactive protein, and synovial fluid culture, whereas the primary keywords in the cluster “treatment” were spacer, debridement, and week. The main keywords for the “risk factor and prevention” cluster were complication, total knee arthroplasty, and age. The most recent studies focused on “diagnosis” and “risk factor and prevention”. In the “diagnosis” cluster, new topics included synovial fluid culture, alpha-defensin, and dithiothreitol, whereas new topics in the “risk factors and prevention” cluster included body mass index, operative time, and day readmission (Figure 6b). The most frequent keywords used from 2010 to 2018 were also exported from VOSviewer. ‘Diagnosis’ was the most frequently used word in 2010–2013, 2015, and 2018, in contrast to ‘risk factor’ in 2016 and 2017. ‘Treatment’ was the most frequently used word in 2014. Discussion Bibliometric analysis is a significant evaluation method that can be used to reflect the current research status and trends. This study presents the first comprehensive analysis of PJI based on publications from the WoS database. Over the 21 years of reporting on PJI studied (1998–2018), there was an increasing annual trend of global publications. Articles in the field originated from 58 countries. However, most publications originated from 10 countries. The United States contributed most to global research in terms of both the quantity and quality of publications, followed by Germany and United Kingdom. China was the only Asian country amongst the top 10 contributors, placed third in 2017 and 2018. The most influencing scholars in PJI research were from the United States and Europe. All of the top 10 authors with the highest numbers of publications originated from the top 10 institutions with the greatest contributions. Amongst the top 10 authors, five were orthopedic surgeons, four were infectious disease experts, and one was a microbiologist, demonstrating a multidisciplinary approach in the management of PJI. A report by the European Bone and Joint Infection Society Survey has also provided evidence that infectious diseases specialists and microbiologists represent the most common medical specialists Table 8 Multivariate analysis. β SE t p-Value 95% CI for β Lower Upper Constant 2.55 0.552 4.618 0 1.422 3.677 Research Interest 0.742 0.113 6.547 0 0.511 0.974 Attention score 0.178 0.063 2.803 0.009 0.307 0.048 Impact factor 0.129 0.067 1.912 0.066 0.009 0.266 Year 0.225 0.147 1.533 0.136 0.525 0.075 SE, standard error; CI, confidence interval. C. Li et al. / International Journal of Infectious Diseases 96 (2020) 696–709 703 Descargado para Cristina Escudero Gomez ([email protected]) en Community of Madrid Ministry of Health de ClinicalKey.es por Elsevier en octubre 24, 2025. Para uso personal exclusivamente. No se permiten otros usos sin autorización. Copyright ©2025. Elsevier Inc. Todos los derechos reservados. Table 9 List of top 10 keywords and top 5 most cited articles on various topics. 704 C. Li et al. / International Journal of Infectious Diseases 96 (2020) 696–709 Descargado para Cristina Escudero Gomez ([email protected]) en Community of Madrid Ministry of Health de ClinicalKey.es por Elsevier en octubre 24, 2025. Para uso personal exclusivamente. No se permiten otros usos sin autorización. Copyright ©2025. Elsevier Inc. Todos los derechos reservados.