The most influential articles in total elbow arthroplasty: bibliometric analysis of the top 100 most-cited articles

The literature surrounding total elbow arthroplasty (TEA) has evolved as advances in prosthetic design, surgical technique, and patient selection have shaped its modern role in elbow reconstructive surgery. We hope to identify and examine the characteristics of the 100 most-cited articles on TEA in the orthopedic literature.

A bibliometric analysis was conducted using the Web of Science databases with the search term: "total" AND "elbow arthroplasty." Articles were included if the primary focus was on TEA. Studies addressing epicondylitis, elbow stiffness, or general elbow surgery without explicit reference to TEA were excluded. The top 100 most-cited articles were analyzed for publication year, total citations, citations per year, level of evidence, study design, authors, institutions, country of origin, and journal impact.

The top 100 most-cited TEA articles received a total of 8,225 citations, averaging 82 citations per article. Citations have steadily increased since 1990, with the most productive publication year being 2005. The most cited article, by Day et al, examined national trends in upper extremity arthroplasty and projected future growth in procedure volumes. The 3 most cited articles were each cited more than 250 times. The top journals were Journal of Bone and Joint Surgery-American Volume (3,632 citations), Journal of Shoulder and Elbow Surgery (1,550 citations), and Journal of Bone and Joint Surgery-British Volume (753 citations). Dr. Bernard Morrey was the most prolific author with 35 publications and 3,125 citations, followed by Dr. Robert Adams. The United States led in publication volume (n = 58), specifically Mayo Clinic (n = 30). Most studies were level 4 evidence (n = 59). No significant correlation was found between level of evidence and total citations (P = .21) or between journal impact factor and citation rate when adjusted for study design and evidence level (P = .08). Keyword network analysis identified central themes around TEA, elbow, arthroplasty, arthritis, and revision.

The Day et al study on national trends and projections in upper extremity arthroplasty is the most cited work in the TEA literature. The growing number of citations over time reflects TEA's rising clinical relevance and the evolving landscape of elbow reconstruction. Despite most articles being lower level of evidence, the citation impact surrounding TEA appears more closely tied to its clinical relevance than its methodology.