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Orthopedics. 2011 Jul 7;34(7):e245-50. doi: 10.3928/01477447-20110526-03.

Research in THA and TKA from the United States has declined over the past decade relative to other countries.

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  • 1Department of Orthopedic Surgery, Indiana University Health Physicians, Indiana University School of Medicine, Indianapolis, Indiana, USA.


Decreasing reimbursement, increasing surgical volumes, and prohibitive institutional review board polices potentially deter residents from entering the subspecialty of joint replacement, while also inhibiting research production by existing surgeons. Our hypothesis is that there has been a decline in total hip arthroplasty (THA) and total knee arthroplasty (TKA) research in the United States relative to other countries over the past decade.All original research involving THA and TKA published in The Journal of Bone and Joint Surgery, American Volume, Journal of Arthroplasty, and Clinical Orthopaedics and Related Research over the past decade was queried. Country of origin and level of evidence of each publication were documented. From January 1999 to December 2008, 1724 original peer-reviewed research studies involving THA and TKA were identified. The percentage of publications from US institutions steadily declined from 65.8% in 1999 to 46.9% in 2008. The percentage of Level I and II studies from the United States increased from 9.7% in 1999 to 23.3% in 2008, which parallels the increase seen from all countries from 7.8% to 24.8% during the same decade.Despite the improving levels of evidence, the relative percentage of publications from the United States on THA and TKA has declined over the past 10 years. In contrast to the relatively constant number from the United States, publications on THA and TKA from non-US institutions have increased over the past decade. These trends may have significant implications for future THA and TKA research in the United States.

Copyright 2011, SLACK Incorporated.

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