Characteristics of the Top 50 Most Cited Orthopaedic Surgery Articles on Malpractice and Litigation: A Bibliometric Analysis of the Literature.

Abstract

Malpractice litigation shapes orthopaedic practice and has notable financial implications. Orthopaedic surgeons face disproportionately high claim exposure. The primary aim was to identify and characterize the 50 most-cited articles on orthopaedic malpractice and describe trends in topic, geographical region, institution, and impact. A bibliometric analysis was done for the most-cited orthopaedic malpractice or litigation articles using all Web of Science databases. Articles were included if their primary focus was orthopaedic malpractice. Articles addressing informed consent, defensive medicine, or orthopaedic-related procedures without explicit reference to malpractice or litigation were excluded. The top 50 articles on orthopaedic malpractice accrued 1967 citations (mean 39 ± 24, range 18 to 127) with mean citations per year (CPY) of 3.4 ± 1.8. Publications peaked in 2018 (n = 9). Annual citations generally increased over time, while citation density declined. The most common malpractice articles clustered into total joint arthroplasty (26%), spine (22%), and general orthopaedic malpractice (22%). Most papers originated in the United States (64%); among US articles, the Northeast produced the largest share (47%). Articles with a J.D. author (18%) had higher mean citations compared with those without (55.9 ± 38.4 vs 35.7 ± 17.7), though not statistically significant (P = 0.294). Influential orthopaedic malpractice or litigation scholarship concentrates in arthroplasty and spine, increasingly leverages database-driven methods, and is geographically centered in the US Northeast region. Rising citation activity alongside decreasing citation density indicates a maturing yet expanding field of orthopaedic malpractice literature. Malpractice articles can inform clinical risk mitigation and may shape future insurance policy changes.