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origin. Table 3 Journal of origin. No. of articles Journal of Arthroplasty 15 Clinical Orthopaedics and Related Research 13 Orthopedic Clinics of North America 6 Journal of Bone and Joint Surgery 5 Clinical Biomechanics 2 Journal of the American Academy of Orthopaedic Surgeons 1 International Orthopaedics 1 Canadian Journal of Surgery 1 Journal of Orthopaedic Surgery and Research 1 Presse Medicale 1 Yale Journal of Biology and Medicine 1 Acta Orthopaedica Belgica 1 Archive of orthopaedic and trauma surgery 1 Surgical and Radiologic Anatomy 1 194 C.M. Mikhail et al. / Arthroplasty Today 6 (2020) 190e195 studies on the topic of citation analysis to look into the relationship between the breadth of the topic and levels of evidence found in the most cited studies. This citation analysis is subject to several limitations. Some of these are inherent to the study design. Using citation analysis as a proxy for impact is limited by the “snowball effect”, which states scientific authors are likely to cite an article due to its previous citations rather than the merit of the article itself [24,31]. In addition, citation count is limited as a proxy for influence in a field because responding to a controversial article requires a citation [17]. This may inflate citation counts for articles that do not positively influence a field of study and reduce the strength of citation count as a metric for influence. Other limitations are specific to this study. First, the analysis herein did not account for self-cited works, which may inflate representation of high-volume authors. Second, we did not account for bias that may arise from authors citing from the journals where they are attempting to publish. Third, there may be limitations inherent to the Web of Knowledge database that led to the exclusion of highly influential publications from this analysis. This work also excluded presentations, textbooks, and lectures that may be highly influential in DAA hip arthroplasty. Finally, this is a cross-sectional study, which limits the results of this study to describing a single point in time. Despite these limitations, this study still successfully spotlights influential papers on the topic of DAA hip arthroplasty. Conclusion This analysis provides insight into factors that characterize highly cited articles on the specific topic of DAA hip arthroplasty. These factors include higher levels of evidence, recent publication, and origin in the United States. Citations of DAA hip arthroplasty papers appear to be on the rise. The curation and analysis of this set of 50 articles will provide orthopaedic providers, researchers, and residency program directors a guide for quickly isolating influential articles on the topic of DAA hip arthroplasty. This may serve as a quick reference for clinical decision-making, foundation for further research, and curriculum on DAA hip arthroplasty. Conflict of interest The authors declare there are no conflicts of interest. Projections of Primary and Revision Hip and Knee Arthroplasty in the United States from 2005 to 2030 By Steven Kurtz, PhD, Kevin Ong, PhD, Edmund Lau, MS, Fionna Mowat, PhD, and Michael Halpern, MPH, MD, PhD Investigation performed at Exponent Inc., Philadelphia, Pennsylvania Background: Over the past decade, there has been an increase in the number of revision total hip and knee arthroplasties performed in the United States. The purpose of this study was to formulate projections for the number of primary and revision total hip and knee arthroplasties that will be performed in the United States through 2030. Methods: The Nationwide Inpatient Sample (1990 to 2003) was used in conjunction with United States Census Bureau data to quantify primary and revision arthroplasty rates as a function of age, gender, race and/or ethnicity, and census region. Projections were performed with use of Poisson regression on historical procedure rates in combination with population projections from 2005 to 2030. Results: By 2030, the demand for primary total hip arthroplasties is estimated to grow by 174% to 572,000. The demand for primary total knee arthroplasties is projected to grow by 673% to 3.48 million procedures. The demand for hip revision procedures is projected to double by the year 2026, while the demand for knee revisions is expected to double by 2015. Although hip revisions are currently more frequently performed than knee revisions, the demand for knee revisions is expected to surpass the demand for hip revisions after 2007. Overall, total hip and total knee revisions are projected to grow by 137% and 601%, respectively, between 2005 and 2030. Conclusions: These large projected increases in demand for total hip and knee arthroplasties provide a quantitative basis for future policy decisions related to the numbers of orthopaedic surgeons needed to perform these procedures and the deployment of appropriate resources to serve this need. ver the past thirteen years, there has been an increase in the number of revision total hip arthroplasties and total knee arthroplasties performed in the United States1 , while the revision burden—defined as the ratio of revision arthroplasties to the total number of arthroplasties— has remained relatively constant. Previous analyses of nationwide data on the procedures have indicated that the revision burden for total hip arthroplasty was approximately 17.5% between 1990 and 2002, whereas the revision burden for total knee
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