Global Research Status and Trends in Orthopaedic Surgical Robotics: a Bibliometric and Visualization Analysis Study

doi:10.21203/rs.3.rs-2615817/v1

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Research Article

Global Research Status and Trends in Orthopaedic Surgical Robotics: a Bibliometric and Visualization Analysis Study

https://doi.org/10.21203/rs.3.rs-2615817/v1

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Journal Publication

published 05 Apr, 2023

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Purpose

This study aimed to investigate and summarise the current state of research and trends in orthopaedic surgical robots.

Methods

Data on publicly available publications related to orthopaedic surgical robots were extracted by abstract searches of the Web of Science Core Collection database. A bibliometric analysis and detailed reading of the publications were then carried out and the information was visualised using co-authorship analysis, coupling analysis, co-citation analysis and co-occurrence analysis in VOSviewer.

Results

With 436 publications included in the study from 1993 to 2022, the overall contribution of publications to the world showed an increasing trend year by year, with a particularly pronounced after 2017, and a geographical trend of predominantly East Asia, North America, and Western Europe. Of these, China was the largest contributor (n = 128). Overall the UK affiliates and their scholars were leaders in the field, with a high number of publications, total citations, average citations per article and H-index. The most published institutions and authors were Imperial College London(n = 21) and Professor Fares Sahi Haddad of University College London(n = 12), respectively. Journals with a high overall impact on robotic orthopaedic surgery were the Journal of Arthroplasty, Bone Joint Journal, International Journal of Medical Robotics and Computer Assisted Surgery. Keyword co-occurrence network analysis revealed four main clusters: robot-assisted knee, hip arthroplasty, spine surgery, and robotic technology research and development. The top three most common sites for robot-assisted surgery use were the knee, hip and spine. The most used robot types were the knee and spine, with Mako and Arobot being the most used robots for the knee and TiRobot for the spine.

Conclusion

This study comprehensively reveals the current status and trends of global research on orthopaedic surgical robots, covering countries, institutions, authors, journals, research hotspots, robot types and surgical sites, providing directional guidance and research ideas for further research on the technological development and clinical evaluation of orthopaedic surgical robots.

Bibliometrics

information visualisation

orthopaedics

surgical robot

The emergence of digital orthopaedics [1], a new cross-discipline, has driven the birth and evolution of new orthopaedics in a new era, including orthopaedic finite element analysis[2], orthopaedic digital anatomy[3], computer-aided orthopaedic navigation surgery[4], orthopaedic remote surgery and orthopaedic robotic surgery[5, 6], etc. These new technologies have gradually been widely applied in various subspecialties of orthopaedics. Among them, the continuous development of precision medicine has made orthopaedic surgery robots attract the widespread attention of personnel in the industry, which was also among the first surgical robots to achieve clinical application, dating back to the 1990s[7]. With technical features such as improved surgical precision[8], reduced surgical trauma[9], improved surgical prognosis[10], decreased surgical complications[11], reduced intraoperative exposure to radiation and lessened surgeon intensity[12], it has been demonstrated good clinical utility, significantly changing the situation of traditional orthopaedic surgery relying on the expertise and experience of surgeons and achieving minimised invasiveness, precision and superior effects in surgical procedures. At present, the orthopaedic surgery robot has been widely used in the spine[13], knee arthroplasty and hip arthroplasty procedures[14, 15].

However, the clinical need for continuous updating of orthopaedic surgical robot technology and the huge financial burden of purchasing and maintaining orthopaedic surgical robots in underdeveloped and developing countries make understanding the state of art and application of these robots a must for technological innovation and research and development[16]. Therefore, understanding the current situation of its technology and applications is an essential part of the process to innovate the technology and carry out research and development.

Bibliometric analysis is a research method that uses mathematical and statistical methods to quantitatively and qualitatively study the distribution, structure, quantity, relationships, patterns and scientific management of literature information, taking the literature system and literature-related media as the object of study[17]. It is often combined with information visualisation techniques to intuitively display the history of research, the current status of research, research hotspots and the relationships between authors, institutions, countries and journals through co-authorship, co-occurrence and co-citation analysis, and has been widely used in various medical research fields[18–21]. However, as far as we know, there are relatively few reports on the current status of orthopaedic surgical robots using this method.

This study aimed to investigate the current status and trends of research on orthopaedic surgical robots in terms of countries, institutions, authors, journals, keywords and robot types through bibliometric analysis, and to complete data visualisation using information visualisation techniques to provide directional guidance and research ideas for further research on technology development and clinical evaluation of orthopaedic surgical robots.

Data source and search strategy

The Web of Science (WoS) Core Collection database was searched by computer with unlimited publication dates and no language restrictions and extracted open publication data. The database covers a comprehensive multidisciplinary academic information resource and contains a wide range of the most influential core academic journals in various research fields such as natural science, engineering technology and biomedicine, making it the best database for quantitative bibliometric analysis[22]. The search strategy was based on the Mesh word list and abstract search, with the following search formula: (AB=(Robotic Surgical Procedure* OR Procedure*, Robotic Surgical OR Surgical Procedure, Robotic OR Robot Surger* OR Surgery, Robot OR Robot-Assisted Surger* OR Surgery, Robot* Assisted OR Procedure, Robot-Enhanced OR Robot-Enhanced Procedure* OR Surgical Procedure*, Robotic OR Robotic-Assisted Surger* OR Robot Enhanced Surger* OR Surgery, Robot-Enhanced)) AND AB=(orthopedic* OR orthopeadic* OR orthopaedic* OR knee OR hip OR vertebral OR fracture*).

Inclusion And Exclusion Criteria

Inclusion criteria were articles, reviews, and online publications including clinical studies, reviews, meta-analyses, clinical trials, guidelines, animal studies, cadaveric trials and technical studies of the surgical robotic system itself for the application of robotic surgery in orthopaedics. Conference proceedings papers, book chapters and editorial material were excluded.

Data Extraction, Cleaning And Visualization

Basic information such as the number of publications, publication title, year of publication, author, institutions, country, journal, impact factor, total citations, average citations per article, H-index, etc. were obtained using the eigenanalysis function of WoS and further summarised and analysed using Microsoft Office. The H-index is a hybrid quantitative assessment of a researcher's scholarly output in terms of quantity and level of scholarly output, proposed in 2005 by George Hirsch, a physicist at the University of California, San Diego, U.S.A[23]. The H-index is calculated based on the number of papers a researcher has published and the number of times its papers have been cited[24]. According to Hirsch, an individual who has N papers cited at least N times each in all his scholarly articles has an H-index of N[25]. Compared to the impact factor and the total citations, the H-index aims to better describe the scientific productivity and impact of an author, institution, country or journal from both quantitative and qualitative perspectives[26].

The full records and cited reference files from the WoS Core Collection database were exported in plain text format and further imported into VOSviewer (version 1.6.18; Leiden University) for analysis. Data cleansing was required before importing data. This function relies heavily on the thesaurus file and supports both bibliographic and textual data, but does not support user-defined network data. This study built a network based on bibliographic data. The thesaurus files can be used to merge titles, author names, institution names, country names, cited documents, synonyms of keywords, different spelling forms of words, abbreviated forms, etc. each line of the thesaurus file contains a label (e.g. person name, country name, etc.) and an alternative label, if the alternative label is empty, the original label is ignored for display, which can be used as a pause word for the corpus, or to ignore nonsense words.

VOSviewer enables the mapping of scientific knowledge through the relational construction and visual analysis of "network data" (mainly bibliographic knowledge units), showing the structure, evolution, cooperation and other relationships in the knowledge domain, and is distinguished by its graphical presentation capability and suitability for large-scale data[27]. Common methods of co-authorship analysis, coupling analysis, co-citation analysis and co-occurrence analysis were used in this study. The co-authorship analysis analyses the cooperation situation of authors based on co-authored articles from the three perspectives of country, organisation and authorship. Coupling analysis measures the similarity of the literature by the number of identical references cited in the literature, reflecting the relationship between literature, which is a static form. Co-citation analysis measures the similarity between literature by the number of times literature are cited together, reflecting the relationship between the two cited references, and is a dynamic form of analysis that complements coupling analysis[28]. The first three methods were used to demonstrate the relationship between different authors, institutions, countries, and journals. Keyword co-occurrence analysis is calculated based on the number of occurrences of all keywords to identify high-frequency subject terms and current research directions and to predict future research directions in the field. VOSviewer offers three visualisation views: network visualization, overlay visualization and density visualization. The first two views were used in this study. In network visualization, circles and labels form an element, the size of which depends on the degree of the node, the strength of the connection, the number of citations, etc. The colour of the element represents the cluster to which it belongs, with different clusters represented by different colours. Overlay visualization by default takes the score value by the average year of the keyword for colour mapping, which can show the trend of the elements over time.

As of November 2022, of the 587 initial publications, 436 publications were finalized for bibliometric analysis through a review of titles, abstracts and full texts, of which nine were in German, one in French, one in Spanish and the remaining 425 all in English.

Countries

From 1993 to 2022, the overall contribution of publications to the global effort showed an increasing trend year by year, particularly after 2017 (Fig. 1). 436 publications came from 31 countries, with China being the largest contributor (n = 128), followed by the United States(US) (n = 114), the United Kingdom(UK) (n = 68), Germany (n = 44), and Australia (n = 22, Table 1). From a global perspective, research related to orthopaedic surgical robots showed a geographical trend, with East Asia, North America, Western Europe and Oceania predominating (Fig. 2). The statistics of the top 11 countries in terms of annual contribution were shown in Fig. 3, where the UK, the US and Germany started conducting orthopaedic robotics-related research earlier, while China started later, around 2012, and the growth of China conducting orthopaedic surgical robotics research after 2018 was relatively obvious, far exceeding other countries, which was in line with China's policy of supporting robotics development released in 2018 corresponds to this. In the last two years, China and the US have continued to show a growth trend in this area of research, while the UK has shown a declining trend.

Table 1

The top 11 countries with the most publications related to orthopaedic surgical robots
	Country	Publications	Total Citations	Average Citations	H-index
1	Peoples R China	128	915	7.15	16
2	United States	114	2353	20.64	27
3	United Kingdom	68	1630	23.97	24
4	Germany	44	756	17.18	14
5	Australia	22	154	7	5
6	France	20	317	15.85	9
7	Belgium	14	319	22.79	8
8	South Korea	14	551	39.36	10
9	Switzerland	11	110	10	6
10	Italy	10	62	6.2	4
11	Japan	10	120	12	6

The table (Table 1) of information about the top 11 countries worldwide in terms of the number of publications published on orthopaedic robotics research showed that although China was the top country in terms of the number of publications published, its total citations and average citations per article were much lower than those of the UK and the US, and its H-index was also lower than those of the UK and the US. In terms of average citations per article, Germany, France, Belgium and Korea were also much higher than China, indicating that the quality of publications published in these countries was higher. The highest number of total citations was in the US (2353), followed by the UK (1630) and China (915). The most citations per article were in South Korea (39.36), followed by the UK (23.97) and Belgium (22.79). The country co-occurrence analysis in the co-authorship analysis showed (setting a minimum number of publications for a country at 2, with 27 countries meeting the criteria, some of which were not connected, and the maximum ensemble of connected terms consisting of 22 countries) that the top five countries with the highest total link strength (TLS) were the US (35), France (29), China (23), Germany (22) and the UK (21, Fig. 4), with the US, France, Germany, the UK and Switzerland collaborating more with other countries, while the countries collaborating more with China were the US, Germany and Singapore.

Institutions

The 436 publications came from a total of 601 institutions, with the highest number of publications coming from Imperial College London (n = 21), followed by the University of London (n = 21), Hospital for Special Surgery (n = 20), University College London (n = 19) and Beijing Jishuitan Hospital (n = 15, Table 2). In general, the UK affiliates were in the lead, with a higher number of publications, total citations and H-index, while the Chinese affiliates still have a significant gap with the UK in terms of citations, despite a significant number of publications.

Table 2

The top 11 institutions with the most publications related to orthopaedic surgical robots
	Institutions	Publications	Country	Total Citations	Average Citations	H-index
1	Imperial College London	21	England	429	20.43	10
2	University Of London	21	England	539	25.67	12
3	Hosp Special Surg	20	USA	408	20.4	12
4	University College London	19	England	500	26.32	11
5	Beijing Jishuitan Hosp	15	China	204	13.6	6
6	Beihang University	14	China	120	8.57	5
7	Chinese People S Liberation Army General Hospital	14	China	76	5.43	4
8	Hannover Medical School	14	Germany	163	11.64	7
9	Nyu Langone Medical Center	10	USA	25	2.5	3
10	Peking University	10	China	54	5.4	4
11	Udice French Research Universities	10	France	182	18.2	6

The analysis of institutional co-occurrence in the co-authorship analysis showed (setting a minimum number of publications for an institution at 3, with 69 institutions meeting the criteria, some of which were not connected, and the maximum ensemble of connected terms consisting of 46 institutions) that the top five institutions with the highest TLS were the Chinese People's Liberation Army General Hospital (15), Hospital for Special Surgery (15), Beihang University (14) University of Chinese Academy of Sciences (13) and the Chinese University of Hong Kong (12, Fig. 5), it could be observed that there were international collaborations, for example, the Chinese People's Liberation Army General Hospital had a collaboration with Hospital for Special Surgery and the University College London Hospital had a collaboration with the Mayo Clinic, but institutions between the same country collaborate more closely, for example, the Chinese People's Liberation Army General Hospital collaborates worked most closely with the Beihang University, and the University College London Hospital had the closest cooperation with Princess Grace Hospital.

Authors

The 436 publications were from a total of 1764 authors, with the most prolific author being Professor Fares Sahi Haddad of University College London with 12 publications, followed by Academician Tian Wei of Beijing Jishuitan Hospital (n = 11), Researcher Hu Lei of Beihang University (n = 10), and Dr Konan Sujith (n = 10) and Dr Babar Kayani (n = 10) of University College London (Table 3). The table of information related to the top 14 authors of global publications on orthopaedic surgical robotics research revealed that most of these scholars with high total citations, average citations per article and H-index were from European and American countries, especially the UK, where the strength of scholars from University College London and Imperial College was more prominent, and Chinese scholars still show some gaps in other indicators, although they have shown some advantages in the number of publications.

Table 3

The top 14 authors with the most publications related to orthopaedic surgical robots
	Authors	Publications	Total Citations	Average Citations	H-index	Institution
1	Haddad FS	12	404	33.67	9	University College London
2	Tian W	11	144	13.09	5	Beijing Jishuitan Hospital
3	Hu L	10	68	6.8	4	Beihang University
4	Kayani B	10	316	31.6	7	University College London
5	Konan S	10	314	31.4	7	University College London
6	Harris SJ	9	278	30.89	7	Imperial College London
7	Tang PF	9	81	9	5	Chinese People's Liberation Army General Hospital
8	Zhang LH	9	50	5.56	4	Chinese People's Liberation Army General Hospital
9	Batailler C	8	102	12.75	3	University of Lyon
10	Cobb J	8	215	26.88	7	Imperial College London
11	Davies BL	8	242	30.25	7	Imperial College London
12	Jakopec M	8	238	29.75	7	Acrobot Company, Ltd
13	Pearle AD	8	283	35.38	8	Hosp Special Surg
14	Schwarzkopf R	8	22	2.75	3	New York University

Analysis of author co-occurrence in the co-authorship analysis showed (setting the minimum number of publications for an author at 3, with 111 authors meeting the criteria, some of whom were not connected, and the maximum ensemble of connected terms consisting of 15 authors) that the top six authors with the highest TLS were Researcher Lei Hu of Beihang University (29), Director Lihai Zhang of the Chinese People's Liberation Army General Hospital (27), Professor Brian Davies of the Imperial College London (23), Research Fellow Simon Harris of the Imperial College London (23), Acrobot Company, Ltd's Project Manager Matjaz Jakopec (23) and Professor Tang Peifu of the Chinese People's Liberation Army General Hospital (23). The author co-occurrence network for the co-authorship analysis (Fig. 6) showed that there was a collaboration between authors from different institutions, but a closer collaboration between authors from the same institution.

Journals

The 436 publications were published in a total of 150 journals, the journal with the highest number of articles was the International Journal of Medical Robotics and Computer Assisted Surgery with 39 publications, followed by the Journal of Arthroplasty (n = 21), the Archives of Orthopaedic and Trauma Surgery (n = 19) and the Orthopaedic Surgery (n = 19, Table 4). Among them, the Journal of Arthroplasty and the Bone Joint Journal had higher total citations, average citations per article, H-index and impact factor for 2021–2022.

Table 4

The top 10 journals with the most publications related to orthopaedic surgical robots
	Publication journal	IF (2021–2022)	Publications	Total Citations	Average Citations	H-index
1	International Journal of Medical Robotics and Computer Assisted Surgery	2.547	39	431	11.05	13
2	Journal of Arthroplasty	4.757	21	722	34.38	13
3	Archives of Orthopaedic and Trauma Surgery	3.067	19	78	4.11	5
4	Orthopaedic Surgery	2.071	19	118	6.21	8
5	Bone Joint Journal	5.082	16	523	32.69	12
6	Journal of Knee Surgery	2.757	16	138	8.63	6
7	Knee Surgery Sports Traumatology Arthroscopy	4.342	11	178	16.18	7
8	Journal of Robotic Surgery	1.996	10	68	6.8	3
9	Lecture Notes In Computer Science	1.363	10	66	6.6	6
10	Proceedings of The Institution of Mechanical Engineers Part H Journal of Engineering In Medicine	1.617	10	135	13.5	5

Setting the minimum number of journal publications to at least 3, a coupling analysis was conducted for 32 journals (Fig. 7) and the coupling network found that the Journal of Arthroplasty had the greatest TLS(3817), followed by the Bone Joint Journal (2973) and the Archives of Orthopaedic and Trauma Surgery (2824). Setting the minimum number of citations for journals to a minimum of 50 citations, an analysis of co-citations to 43 journals showed that the Journal of Arthroplasty (35689), the Clinical Orthopaedics and Related Research (29559) and the Journal of Bone and Joint Surgery American Volume (19695) had the greatest TLS(Fig. 8).

Hotspot And Research Trends

From the 1598 keywords derived from the included studies, the three most frequently occurring keywords were replacement (106), accuracy (95) and total knee arthroplasty (81, Fig. 9). Setting the minimum number of occurrences of a keyword to 8, four clusters were identified from the 74 keywords (Fig. 10), with the group in red relating to robot-assisted knee arthroplasty, with the keywords replacement (106), total knee arthroplasty (81), alignment (49), outcomes (40) and arthroplasty (38) appearing most frequently; the green group was associated with robot-assisted spine surgery, with the keywords accuracy (95), navigation (57), robotics (35), placement (28), complications (19) and fixation (19) appearing most frequently; the blue group was related to surgical robotic technology, with surgery (55), system (38) and robotic surgery (35) being the most frequent keywords; the yellow group was related to robotic-assisted total hip arthroplasty, with total hip arthroplasty (33), implantation (15) and dislocation (10) were the most frequent keywords. The overlay visualisation was used to show the development of the keywords over time (Fig. 11), with the overall trend gradually transitioning over time from the study of surgical robotic technology to the study of the application of robot-assisted surgery and patient outcomes, from the knee arthroplasty and hip arthroplasty to spinal surgery.

Type Of Robots And Surgical Site

Read publications published by six of the leading institutions in the three more leading countries of the US, the UK and China, including University College London, Imperial College London, Hospital for Special Surgery, Beijing Jishuitan Hospital, Chinese People's Liberation Army General Hospital and Beihang University, with a total of 44 publications describing the types of robots and surgical sites used. Seven types of robots were used in seven sites, and the top three most common sites used for robot-assisted surgery were the knee, hip and spine, with total arthroplasty being the most common in the knee and hip, and pedicle screw implantation being the most common procedure in the spine. The most used robot types were in the knee and spine, with four and three types respectively, with the more used robots in the knee being the Mako and Arobot and TiRobot for the spine. The TiRobot was the most used in different surgical sites (4 sites), followed by the Acrobot (3 sites, Table 5). In addition, it could also be noted that the Mako robot was preferred by both UK and US scholars compared to China.

Table 5

Types of robots in orthopaedic surgery and corresponding surgical sites in 6 institutions
Surgical site	Types of robots used	Quantity
Spine	Mazor	1
	TiRobot	4
	ZOEZEN	1
Knee Joint	Mako	13
	Navio	2
	ROBODOC	1
	Acrobot	10
Hip joint	Mako	6
Ankle	Acrobot	1
Pelvis	TiRobot	3
Femur	TiRobot	1
Wrist joint	TiRobot	1

Bibliometrics originated with the British scholar Hulme, who introduced the term “statistical bibliography" in 1923 and was formally introduced in 1969 when the British scholar Pritchard proposed replacing statistical bibliography with bibliometrics[29, 30]. We have used software to visualise the extensive publication data to provide a visual, comprehensive and objective display of research developments, research hotspots and research trends in orthopaedic robotic surgery from 1993 to November 2022. For patients, an in-depth understanding of the pros and cons of orthopaedic surgery robots allows them to consider whether or not to choose a robot to assist with their surgery based on their actual condition and doctor's recommendations. For the surgeon, the technology and operational skills of the orthopaedic surgery robot can be fully mastered to enhance intraoperative techniques. For hospitals, a detailed analysis of the technology, advantages and disadvantages of each brand of the robot will help to introduce and purchase a more cost-effective machine orthopaedic surgery robot. For robotics companies, a grasp of the state of the art in robotics can help them develop new technologies and open up new areas. In addition, having a clear understanding of trends and developments in orthopaedic surgical robots can help the country to introduce relevant policies to support and promote the flourishing development of the related field.

Research related to orthopaedic surgical robots has shown a year-on-year increase over 29 years, with an emergent trend in 1997 and a particularly marked increase after 2017, and will continue to increase in the future. Research related to orthopaedic surgical robots showed a geographic trend, with East Asia, North America, Western Europe, and Oceania predominating. Among the top four countries in terms of the number of publications, the US, the UK and Germany started their research much earlier than China. In the last five years, China has seen a surge in the number of publications, while the other countries have remained relatively stable. At present, most of the countries, institutions, authors and journals that are currently focusing on and leading research in orthopaedic surgical robots are concentrated in developed Western countries, mainly due to the early start of research and rapid technological development in this field in the developed West. The current focus of research in developed Western countries is on the applied part of robotics, including clinical outcomes and application costs, while the focus of research in developing countries is still at the technology development stage, which is closely related to the late start of orthopaedic surgical robots in these countries. Bibliometric analysis showed that the UK was a key area of research in this area with strong strength, particularly at University College London and Imperial College London, with Professor Fares Sahi Haddad's team at University College London and Professor Brian Davies’team at Imperial College London being particularly prominent. Journal of Arthroplasty, Bone Joint Journal, International Journal of Medical Robotics and Computer Assisted Surgery and Knee Surgery Sports Traumatology Arthroscopy remained in an impeccable position for orthopaedic surgical robots, and breakthroughs and discoveries in this field were more likely to be published in these journals. To identify research trends, a comprehensive analysis of the most used keywords and a co-occurrence analysis were carried out. The hotspots of research worldwide were robot-assisted total knee, unicompartmental knee, hip arthroplasty, spinal surgery robots and robotic technology research and development. The overlay visualization co-occurrence time diagram showed that research in orthopaedic surgical robots has generally shown an upward trend over time, with early research focusing on surgical robotic technology and gradually transitioning to studying the application of robot-assisted surgery, with a slight trend from the knee arthroplasty and hip arthroplasty to spine surgery. In recent years, more and more studies have set out to look at patient outcomes, particularly patient prognosis, survival and comparison of robot-assisted surgery with conventional hands[31–34].

The US and the UK are the major countries producing orthopaedic surgery robots, for example, Mako, Mazor and ROBODOC are produced in the US, Acrobot and Navio are produced in the UK, while China has been working in this direction in recent years, and TiRobot is a better proof of this. In terms of the sites of robot-assisted surgery, the clinical applications of orthopaedic robots are currently focused on the lower limb joints and the spine, and more types of robots are used in both, while MAKO and Acrobot are the more popular orthopaedic robots in the lower limb joints. Arthroplasty, including total knee arthroplasty, unicompartmental knee arthroplasty, total hip arthroplasty and robot-assisted pedicle screw implantation, is already relatively mature and has the advantages of less trauma[35], has fewer complications and a better prognosis[36, 37], with the potential to completely replace traditional surgical approaches in the future. In addition, in recent years, the clinical application of trauma surgery robots has also been developing in an increasing direction, especially for robotic-assisted surgery of pelvic fractures[34, 38].

Although this study provided a more comprehensive overview of the current status and research trends in orthopaedic surgical robots using co-authorship analysis, coupling analysis, co-citation analysis, co-occurrence analysis and detailed reading of the publications, there were still some shortcomings. Firstly, the publications on research on orthopaedic surgical robots in this study were all from the WoS Core Collection database, which may have missed valuable articles from commonly used databases like Pubmed and Scopus, resulting in database bias[39]. Secondly, the study excluded conference proceedings papers, and although this went some way to avoid their being published twice as conference abstracts and journal papers, it still may have missed some high-quality articles[28]. Thirdly, the analysis of the types of orthopaedic surgical robots and the surgical sites only covered six of the more forwarded institutions, which was not extensive enough in scope and was not comprehensive enough in the content. Finally, this study did not analyse clinical trial-related content and the information could have been mined more deeply.

This study used bibliometrics, information visualization and detailed publications reading methods to reveal a more comprehensive display of the current status and trends of global research on orthopaedic surgical robots. Research on robot-assisted surgical technology in orthopaedics has shown a year-on-year increase over 29 years, with a particularly marked increase after 2017, and a geographic trend, with a predominance in East Asia, North America, Western Europe, and Oceania. Scholars and institutions in the US, the UK, China and Germany have played an important role in research in this field, with the UK being particularly prominent, especially University College London and Imperial College London, while international collaboration is becoming closer. Journal of Arthroplasty, Bone Joint Journal, International Journal of Medical Robotics and Computer Assisted Surgery and Knee Surgery Sports Traumatology Arthroscopy were journals with a strong overall impact on orthopaedic surgery robots. Robot-assisted knee (including total knee, unicompartmental knee and hip) arthroplasty and pedicle screw implantation in spinal surgery with robotic technology development are current research hotspots worldwide, and trauma surgery robots have broad application prospects in the future, especially for application in pelvic fracture surgery. In addition, the study of patient outcomes in robot-assisted surgery, especially patient prognosis, survival and the comparison of robot-assisted surgery with conventional hands may be a future research trend.

WoS: Web of Science

US: United States

UK: United Kingdom

TLS: Total Link Strength

Acknowledgements

Not applicable.

Funding

The special fund of the National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation.

Competing interests

The authors have no relevant financial or non-financial interests to disclose.

Author contributions

All authors contributed to the study conception and design. Material preparation and data collection were performed by Xinmeng Guo and Daofeng Wang. Methodological evaluations were conducted by Daofeng Wang, Jiantao Li and Hao Zhang. Data analysis was performed by Xinmeng Guo. The first draft of the manuscript was written by Xinmeng Guo and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Ethics approval

Not applicable.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Consent to publish

All authors read the final manuscript and approved it for publication.

Availability of data and materials

All data generated or analyzed during this study are included in this published article.

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published 05 Apr, 2023

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Global Research Status and Trends in Orthopaedic Surgical Robotics: a Bibliometric and Visualization Analysis Study

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Data Extraction, Cleaning And Visualization

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Hotspot And Research Trends

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