Bibliometric Analysis of Robotic Orthopedic Surgery

By Megan Craig, M.Sc.Jan 25 2022

Robotic technology has become integrated into a range of different fields, including orthopedic surgery. An article published in the journal BMC Musculoskeletal Disorders has analyzed the trends of robotic orthopedic surgeries in a clinical setting employing bibliometrics.

Image Credit: Gorodenkoff/Shutterstock.com

Orthopedic techniques continue to evolve at a rapid pace, even more so following the technological explosion of robotic surgery, deep learning approaches, 3D printing, and virtual reality.

Robotic technology use in the medical sector continues to rise, and many surgical robots have obtained approval for clinical practice in the USA from the Food and Drug Administration. There are also reports that robotic surgery is highly precise in orthopedic implant placement. However, orthopedic robotics remains a challenging and complex technique.

Bibliometrics is a research technique commonly utilized to investigate the characteristics and development of a subject area. Until now, there is no comprehensive analysis of the clinical study of orthopedic robots by bibliometric analysis.

Here, the researchers aim to use bibliometric analysis to identify the features in robotic orthopedic surgery, including study design, kind of surgery, robot information and country of use. 

The team also set out to complete data visualization to explore the relationship between various institutions, journals, countries and investigate research hotspots and trends.

Methodology

The electronic database, Web of Science, was explored between 2000 and 2019 (no language restrictions) using the search for various keywords. The search results and the cited literature were reviewed.

Inclusion criteria depended on the article elaborating clinical research on the application of robotic surgery in orthopedics and review article, clinical trial, meta-analysis, and guideline. Book chapters, animal studies, conference proceedings, and cadaveric investigations were included under exclusion criteria.

The information was exported from the WoS, summarized, and examined with the WPS office. The widely employed approach of coupling, co-citation, co-occurrence analysis was carried out.

Results

A total of 1013 primary research results, 186 publications, and 1124 cited papers were reviewed and 224 clinically-related publications were selected for bibliometric analysis.

The selected publications comprised 164 articles, 47 reviews, and 13 meta-analyses. Figure 1 shows the complete global contribution of publications from 2000 to 2019.

Figure 1. Graphs indicating the total annual number of global contributions. Image Credit: Li, et al., 2021

The articles were from 23 countries (see Figure 2).

Figure 2. Global distribution according to country. Image Credit: Li, et al., 2021

During 2018 and 2019, major contributions were from the United States, China, and the United Kingdom (see Figure 3).

Figure 3. Annual contributions according to country. Image Credit: Li, et al., 2021

The minimum number of publications from a country was set to two publications with 17 countries meeting the criteria (see Figure 4).

Figure 4. Coupling analysis of countries on global robotic orthopedic surgery research. Image Credit: Li, et al., 2021

Table 1 lists the institutions with at least eight publications.

Table 1. Global institutions with at least eight publications on orthopedic robotic surgery. Source: Li, et al., 2021

Coupling analysis indicated the top three institutions with the highest total link strengths (see Figure 5).

Figure 5. Coupling analysis of institutions on robotic orthopedic surgery. Image Credit: Li, et al., 2021

Table 2 enlists the top nine authors who according to the number of publications.

Table 2. The top nine authors in the orthopedic robotic surgery field ranked according to the number of publications. Source: Li, et al., 2021

Analyzing the top 30 most cited papers Spine had the highest number of publications with five papers. It was noted that 69 journals published the use of robotics in orthopedic surgery (see Table 3).

Table 3. Journals with at least six publications in orthopedic robotic surgery. Source: Li, et al., 2021

Table 4 shows the top 10 journals on orthopedic robotic surgery based on the impact factor.

Table 4. Top 10 journals on orthopedic robotic surgery ranked according to impact factor. Source: Li, et al., 2021

The minimum number of publications of a journal was then set to two papers and coupling analysis of 32 journals was carried out (Figure 6).

Figure 6. Coupling analysis of journals on robotic orthopedic surgery. Image Credit: Li, et al., 2021

Then the minimum number of publications of a journal was set to at least 30 citations and co-citation analysis of the 30 journals was carried out (see Figure 7).

Figure 7. Co-citation analysis of journals on robotic orthopedic surgery. Image Credit: Li, et al., 2021

Around 152 studies detailed the kind of robot and surgical information and the most common surgical sites were the knee, spine, and hip. It was also noted that pedicle screw implantation was performed mostly (see Table 5).

Table 5. Type of robotic orthopedic surgery and the surgical site. Source: Li, et al., 2021

It was noted that 14 types of orthopedic robots were employed and the most diverse were utilized in the knee and spine. The widely used one was TiRobot, succeeded by DA Vinci (see Figure 8).

Figure 8. Types of robots in orthopedic surgery and corresponding surgical sites. Image Credit: Li, et al., 2021

Six countries developed 14 kinds of surgical robots, with more than half originating from the United States (see Figure 9).

Figure 9. Six countries produce robots for orthopedic use. Image Credit: Li, et al., 2021

The study exported 950 author keywords from the included studies. Table 6 lists the most frequently used 20 keywords.

Table 6. Top 20 most frequently used keywords in robotic orthopedic surgery publications. Source: Li, et al., 2021

All keywords were examined by VOSviewer software. The red-colored group in Figure 10 was associated with robotic surgery in joint replacement and the green-colored group was linked to spinal surgery.

Figure 10. Co-occurrence network of robotic orthopedic surgery. Image Credit: Li, et al., 2021

Figure 11 shows the overlay visualization between 2000 and 2019 in robotic orthopedic surgery.

Figure 11. Overlay visualization from 2000–2019 in robotic orthopedic surgery. Image Credit: Li, et al., 2021

Discussion

This research identified 224 related papers in the 2000 to 2019 timespan. Bibliometric analysis analyzed the characteristics of the robotic technique in orthopedics.

The bibliometric analysis showed an increasing trend in the global contributions from 2000 to 2019. Most numbers of relevant publications were from the United States, and currently, only 23 countries are involved in orthopedic robot research. 

It is likely that the lack of competition may create market monopolies.

It was noted that the authors Tian Wei and Mont Michael A made the majority of the contributions in the orthopedic robot field. Bibliographic coupling networks of institutions revealed that most institutions were from the United States.

Research from the Cleveland Clinic was found to be the most relevant, followed by Beijing Jishuitan Hospital and the University of London.

Bibliographic coupling and co-citation network of the journal showed that the Journal of Arthroplasty was the most influential and relevant in the orthopedic robot field. MAKO and Mazor were the most widely used orthopedic robot in spine and lower limb joint surgery.

Limitations

The bibliometric analysis missed numerous publications from databases like PubMed and Scopus. 

Citation time may also have been affected by the time sequence of publications, self-citation, and controversial articles. The study also did not consider publications involving cadaveric or animal studies.

Conclusion

Robotic technology in clinical orthopedics is an emerging field, and many researchers and institutions will play a vital role in broadening its use. 

Fracture fixation, in particular, is a hopeful application for further development in robotic trauma surgery. 

Robotic Microswimmers: The Next Biomedical Breakthrough.

Journal Reference:

Li, C., Wang, L., Perka, C., Trampuz, A. (2021) Clinical application of robotic orthopedic surgery: a bibliometric study. BMC Musculoskeletal Disorders, 22, p. 968. Available online: https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-021-04714-7#citeas.

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