Do Citations Reflect Online Influence? A Bibliometric and Altmetric Analysis of Randomised Controlled Trials in Total Hip Arthroplasty

Abstract Purpose This study aimed to identify the most influential randomised controlled trials (RCTs) in total hip arthroplasty (THA) from the past decade and examine the relationship between bibliometric and altmetrics. Methods Web of Science was searched between January 2016 to January 2026. Bibliometric and altmetric data were analysed. Citations and AAS were compared across journal impact factors (IF) quartiles. RCTs were analysed by country of origin and journal to identify the leading geographical contributors and journals. Results There were 285 RCTs across 104 journals. Median citation count was 10 (IQR 4–23). Median AAS was one (IQR 0–4). No online attention was recorded for 115 RCTs (40.4%). Citations moderately correlated with AAS (ρ = 0.483, P < 0.001). Only six RCTs appeared in both top 20 lists. The most cited were older (median 2017 vs. 2020). Journal IF correlated positively with AAS (ρ = 0.351) and citations (ρ = 0.311). China (17.0%) and the United States (9.9%) occurred the most. The Journal of Arthroplasty published the most (n = 37). Conclusion Among RCTs in THA published over the past decade, citations and online attention were moderately correlated. The top 20 contained largely different sets of RCTs. Online attention was mostly driven by activity on X and was greater for RCTs which were published in high impact journals. Altmetrics can be used as a complementary measure of broader dissemination and public engagement of THA research. However, the score itself may need updating to incorporate modern drivers of online attention.