Characteristics of the Top 50 Most Cited Orthopaedic Surgery Articles on Malpractice and Litigation: A Bibliometric Analysis of the Literature

Background: Malpractice litigation shapes orthopaedic practice and has notable financial implications. Orthopaedic surgeons face disproportionately high claim exposure. The primary aim was to identify and characterize the 50 most-cited articles on orthopaedic malpractice and describe trends in topic, geographical region, institution, and impact. Methods: A bibliometric analysis was done for the most-cited orthopaedic malpractice or litigation articles using all Web of Science databases. Articles were included if their primary focus was orthopaedic malpractice. Articles addressing informed consent, defensive medicine, or orthopaedic-related procedures without explicit reference to malpractice or litigation were excluded. Results: The top 50 articles on orthopaedic malpractice accrued 1967 citations (mean 39 ± 24, range 18 to 127) with mean citations per year (CPY) of 3.4 ± 1.8. Publications peaked in 2018 (n = 9). Annual citations generally increased over time, while citation density declined. The most common malpractice articles clustered into total joint arthroplasty (26%), spine (22%), and general orthopaedic malpractice (22%). Most papers originated in the United States (64%); among US articles, the Northeast produced the largest share (47%). Articles with a J.D. author (18%) had higher mean citations compared with those without (55.9 ± 38.4 vs 35.7 ± 17.7), though not statistically significant ( P = 0.294). Conclusion: Influential orthopaedic malpractice or litigation scholarship concentrates in arthroplasty and spine, increasingly leverages database-driven methods, and is geographically centered in the US Northeast region. Rising citation activity alongside decreasing citation density indicates a maturing yet expanding field of orthopaedic malpractice literature. Malpractice articles can inform clinical risk mitigation and may shape future insurance policy changes.