International Orthopaedics

, Volume 43, Issue 8, pp 1865–1871 | Cite as

Robotic-assisted versus standard unicompartmental knee arthroplasty—evaluation of manuscript conflict of interests, funding, scientific quality and bibliometrics

  • Leonardo CavinattoEmail author
  • Michael J. Bronson
  • Darwin D. Chen
  • Calin S. Moucha
Original Paper



Robotic-assisted unicompartmental knee arthroplasty (UKA) has gained popularity over the last decade claiming enhanced surgical precision and better joint kinematics, with peer-reviewed publications about this new technology also increasing over the past few years. The purpose of our study was to compare manuscripts about robotic-assisted UKA to those about standard UKA in terms of industry funding, author conflict of interest, scientific quality, and bibliometrics.


A systematic search using PRISMA guidelines on PubMed and Google Scholar from 2012 to 2016 resulted in 45 papers where robotic technology was performed for UKA and 167 papers that UKA were performed without the assistance of a robot. Between the two groups, we compared (1) rate of manuscripts with reported conflict of interest or industry funding, (2) journal impact factor, (3) level of evidence, and (4) relative citation ratio.


Fifty-one percent (23/45) of robotic UKA manuscripts were industry-funded or had authors with financial conflict of interest, compared to 29% ([49/167], p < 0.01) of non-robotic UKA papers. Significantly more robotic UKA papers (24% [11/45] vs 9% [16/167), p < 0.01) were published in journals that were not assigned an impact factor by the Journal Citations Report. There was no difference in regard to bibliometrics or level of evidence.


Manuscripts in which UKA was performed with the assistance of a robot were more likely to be industry funded or be written by authors with financial conflicts of interest and published in less prestigious journals. There were no differences in scientific quality or influence between the two groups. Readers analyzing published data should be aware of the potential conflicts of interests in order to more accurately interpret manuscripts data and conclusions.


Conflict of interest Funding Financial disclosure Unicompartmental knee arthroplasty Robotics Level of evidence Medical ethics, bibliometrics 


Compliance with ethical standards

Conflict of interest

Dr. Cavinatto has nothing to disclose.

Dr. Bronson reports being member of the editorial board of the Journal of Arthroplasty and board member of the Arthritis Foundation.

Dr. Chen reports personal fees from Monogram Orthopedics, outside the submitted work.

Dr. Moucha reports personal fees from 3 M, personal fees from Biocomposites, outside the submitted work.


  1. 1.
    Jacofsky DJ, Allen M (2016) Robotics in arthroplasty: a comprehensive review. J Arthroplast 31:2353–2363. CrossRefGoogle Scholar
  2. 2.
    Lonner JH, Moretti VM (2016) The evolution of image-free robotic assistance in unicompartmental knee arthroplasty. Am J Orthop 45:249–254PubMedGoogle Scholar
  3. 3.
    Herry Y, Batailler C, Lording T et al (2017) Improved joint-line restitution in unicompartmental knee arthroplasty using a robotic-assisted surgical technique. Int Orthop 41:2265–2271. CrossRefGoogle Scholar
  4. 4.
    Bell SW, Anthony I, Jones B et al (2016) Improved accuracy of component positioning with robotic-assisted unicompartmental knee arthroplasty: data from a prospective, randomized controlled study. J Bone Joint Surg Am 98:627–635. CrossRefGoogle Scholar
  5. 5.
    Goldberg BA, Scarlat MM (2017) No free lunch in orthopedics. Int Orthop 41:1963–1964. CrossRefPubMedGoogle Scholar
  6. 6.
    Foughty Z, Antalis MS, Ringenberg J, Hall AD (2017) Funding sources and financial disclosures, and their relationship to study outcomes and level of evidence in the journal of shoulder and elbow surgery. J Shoulder Elb Surg 26:e193–e197. CrossRefGoogle Scholar
  7. 7.
    Moher D, Liberati A, Tetzlaff J et al (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6:e1000097. CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Marx RG, Wilson SM, Swiontkowski MF (2014) Updating the assignment of levels of evidence. J Bone Joint Surg Am 97:1–2. CrossRefGoogle Scholar
  9. 9.
    Okike K, Kocher MS, Mehlman CT, Bhandari M (2007) Conflict of interest in orthopaedic research. An association between findings and funding in scientific presentations. J Bone Joint Surg Am 89:608–613. CrossRefPubMedGoogle Scholar
  10. 10.
    Friedman LS, Richter ED (2004) Relationship between conflicts of interest and research results. J Gen Intern Med 19:51–56CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Fischgrund JS (2012) Conflict of interest in orthopaedic journals. J Am Acad Orthop Surg 20:263–264. CrossRefPubMedGoogle Scholar
  12. 12.
    Wright JG, Swiontkowski MF, Heckman JD (2003) Introducing levels of evidence to the journal. J Bone Joint Surg Am 85-A:1–3CrossRefGoogle Scholar
  13. 13.
    Scheschuk JP, Mostello AJ, Lombardi NJ et al (2016) Levels of evidence in orthopaedic trauma literature. J Orthop Trauma 30:362–366. CrossRefPubMedGoogle Scholar
  14. 14.
    Zaidi R, Abbassian A, Cro S et al (2012) Levels of evidence in foot and ankle surgery literature: progress from 2000 to 2010? J Bone Joint Surg Am e112(1–10):94. CrossRefGoogle Scholar
  15. 15.
    Stringer MJ, Sales-Pardo M, Nunes Amaral LA (2008) Effectiveness of journal ranking schemes as a tool for locating information. PLoS One 3:e1683. CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Hutchins BI, Yuan X, Anderson JM, Santangelo GM (2016) Relative citation ratio (RCR): a new metric that uses citation rates to measure influence at the article level. PLoS Biol 14:e1002541. CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Greenwood DC (2007) Reliability of journal impact factor rankings. BMC Med Res Methodol 7:48–53. CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Lavoie F, Al-Shakfa F, Moore JR et al (2018) Postoperative stiffening after bicruciate-retaining total knee arthroplasty. J Knee Surg 31:453–458. CrossRefPubMedGoogle Scholar
  19. 19.
    Turktas U, Piskin A, Poehling GG (2016) Short-term outcomes of robotically assisted patello-femoral arthroplasty. Int Orthop 40:919–924. CrossRefPubMedGoogle Scholar
  20. 20.
    Lee H-J, Park Y-B, Song M-K et al (2018) Comparison of the outcomes of navigation-assisted revision of unicompartmental knee arthroplasty to total knee arthroplasty versus navigation-assisted primary TKA. Int Orthop 25:799–798. CrossRefGoogle Scholar
  21. 21.
    Matta JM, Shahrdar C, Ferguson T (2005) Single-incision anterior approach for Total hip Arthroplasty on an Orthopaedic table. Clin Orthop Relat Res 441:115–124. CrossRefPubMedGoogle Scholar

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  1. 1.Jefferson Health System/3B Orthopaedic ClinicPhiladelphiaUSA
  2. 2.Mount Sinai Health SystemNew YorkUSA

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