The 45 Most Cited Publications in Total Ankle Arthroplasty Revisions: A Bibliometric Analysis

Category: Ankle Arthritis; Ankle Introduction/Purpose: The understanding of total ankle arthroplasty (TAA) and optimal surgical management of end-stage ankle arthritis has significantly expanded over the last decade, evidenced by the increasing number of primary TAA surgeries being revised. Characterizing the most influential studies in total ankle replacement revision surgeries can clarify controversies regarding complications, identify core literature, and further collective knowledge for educational purposes. We conducted a comprehensive bibliometric analysis regarding revision total ankle arthroplasty to evaluate the significance and influence of these online sources. Methods: Using the search terms 'revision' AND 'total ankle replacement' OR 'TAR' OR 'total ankle arthroplasty,' we systematically searched through the top 45 most cited articles in The Science Citation Index Expanded subsection of the Web of Science Core Collection. Publication and study characteristics were extracted and reported using descriptive statistics for the total number of citations, citation rate, publication year, journal, implant type, and level of evidence. Spearman correlations were calculated to assess the relationship between citation data and the level of evidence. Results: 728 results were yielded from our initial search. 45 articles were published between 2004 and 2024, with 20% published in 2020. The top 45 cited papers had a mean of 11.35 citations (range: 0 to 68 citations), and the citation rate was 4.18 ± 7.6 citations per year. These articles were published across 16 different journals, mentioning 24 different implant types. The top three most frequently referenced implants were Agility (13 citations), STAR (13 citations), and Hintegra (12 citations). Most studies were level of evidence III (33, 73.3%), with the remaining articles classified as level of evidence IV. A significant positive correlation was found between the year of publication and citation rate (r=0.38, p=0.009). Conclusion: This study provides a current landscape of the most cited articles in TAA revision surgeries. With the increase in these procedures over the past two decades, this study serves as the first historical landmark in the literature and a launching point for future research. As TAA becomes a more common option for end-stage arthritis, we anticipate a corresponding increase in revisions. Therefore, bibliometric analyses will play an important role for surgeons and future researchers in identifying foundational papers and research trends regarding this emerging procedure.