Citation Velocity and Social Media Impact Analysis of Hip and Knee Arthroplasty Randomized Controlled Trials

Randomized controlled trials (RCTs) remain crucial in establishing evidence-based care, yet little is known about which studies drive the most academic and public attention. This study aimed to identify the most impactful hip and knee arthroplasty RCTs published from 2014 through 2023 using traditional citation metrics and Altmetric data as well as determining study characteristics associated with greater impact.

Clinically oriented hip and knee arthroplasty RCTs were identified and analyzed from 4 leading orthopedic journals published from 2014 through 2023. Article impact was assessed by citation velocity (citations per year) and Altmetric Attention Scores (AAS). Inequality in citation and AAS distributions was measured using Gini coefficients. Mann-Whitney U tests were used to explore associations between impact metrics and study characteristics such as funding and the presence of statistically significant findings.

Among the 566 RCTs, the mean citation velocity was 5.3 citations per year, and the mean AAS was 12.3. Citation velocity and AAS were weakly correlated (r = 0.34, P < .01). Gini coefficients were 0.42 and 0.77 for citation velocity and AAS, respectively, indicating a highly unequal distribution of both scholarly and online attention. Industry funding was not associated with citation velocity (P = .988) or AAS (P = .957). However, studies with statistically significant results in the primary outcome favoring the experimental intervention had an 18% higher citation velocity than those without (P = .018).

The impact of hip and knee arthroplasty RCTs is highly skewed, with a small number of articles receiving a disproportionate amount of attention. Importantly, RCTs with statistically significant results were more likely to be cited, suggesting that favorable findings may disproportionately shape the arthroplasty literature.