A Bibliometric Analysis and Visualisation of Research Trends in Allergy of knee Implants

Several metals are used for Knee implants. The allergy of metals used for knee implants is an important issue to be addressed. The bibliometric analysis had been conducted to understand the active authors, organizations, journals, and countries involved in the research domain of “Allergy of knee implants”. All published articles related to “Allergy of knee implants” from “Scopus”, were analyzed using the VOS viewer to develop analysis tables and visualization maps. This article had set the objective to consolidate the scientific literature regarding “Allergy of knee implants” and also to find out the trends related to the same. The most active journals in this research domain were the Contact Dermatitis. The most active countries were Germany and Italy. The leading organization engaged in research regarding knee implants was the Ludwig Maximilian University of Germany. The most active authors were Thomas P.; Arkansan J.N, and Drancourt M.


Introduction
An engineered medical device to replace a missing or damaged biological structure is known as an implant. Human knee joints are facing numerous problems including wear, damage, and accidents. Total knee replacement surgery can improve quality of life in cases where repair of the knee is impossible. A knee implant is placed in the knee joint in cases of total knee replacement. knee implants are often used subjected to wear and corrosion and ultimately lead to poor performance, pain, and wastage of money. Material engineering and surface engineering can play a significant role in the development of new types of knee implants; and in enhancing the performance of knee implants [1]- [4].
One of the main challenges associated with knee implants is the wear and friction of knee implants. Hypersensitivity to Nickel is a serious issue associated with Nickel based knee implants, which can even lead to failure of Nickel knee implants [5]- [11]. Similarly, high metal concentration on the body had also been reported as an adverse effect of Nickel-based knee implants [12] [13]; wear debris from knee replacements may cause chromosomal damages in human cells [14]. Other metals can be good alternatives for knee implants, where patients having hypersensitivity to Nickel. allergic skin disease is another issue associated with patients who underwent chromium-based implants. This happens due to corrosion and the release of wear debris and high levels of metal ions in the blood [15]. Similarly, dermatitis associated with Chromium following total knee arthroplasty [16] Sensitivity to Chromium and wear may also lead to the loosening of a component of the prosthesis after total joint replacement [17] serious adverse health issues had been reported on chromium implants [18]. In short, the allergy of knee implants is the allergy of metal on which the implant was based.
This bibliometric analysis will be a useful platform for future researchers by realizing the top researchers, organizations, and countries involved in research regarding allergy of knee implants. This article is arranged into four sections. The first section is the introduction, followed by the discussion of the methodology by which the research was conducted. The third section deals with results and discussion. The fourth section deals with the conclusion. The following research objectives and research questions were framed for conducting bibliometric analysis systematically.

Research Objectives
a) To consolidate the literature regarding allergy of knee implants b) To find out the trends related to research in allergy of knee implants 1.2 Research Questions a) Who are the active researchers working on the allergy of knee implants? b) Which are the main organizations and countries working on the allergy of knee implants? c) Which are the main journals related to the allergy of knee implants?

Research Methodology
Scopus files had been used for this article. For the article selection, the Boolean used was TITLE (knee implant) on 25/02/2021. All the tables in this paper were created by using Microsoft Excel and VOS Viewer. Grammarly was used for spelling and grammar checks. Mendeley was used for article review and citation. This paper had been inspired by bibliometric analysis in its presentation style, analysis, and methodology from the works [19]-[25].

Results and discussion 3.1 Results
This first round of search produced an outcome of 130 documents, in five languages, out of which 103 documents were in English. The classification of document categories is shown in Figure 1. For improving the quality of the analysis, we had selected only the peer-reviewed articles and all other documents had not been considered. Thus after using filters "Article" and "English" the second round search produced an outcome of 72 English articles (both open access and others). This paper had used all English articles to conduct bibliometric analysis and visualization using VOS Viewer. The English research articles in this domain since 1976 had been shown in Figure 2.    In Co-occurrence analysis, we had used all keyword analyses, by keeping the minimum number of occurrences of a keyword as 20. This combination plotted the map of 27 thresholds, in two clusters. The overlay visualization of co-occurrence analysis of keywords has been shown in Figure 4.  Co-authorship analysis of the countries engaged in the research on "Allergy of knee implants" had been shown in Figure 5. The overlay visualization map of co-authorship analysis plotted in Figure 5, points out the main countries with their strong co-authorship linkages and clusters involved.  Link analysis and citation analysis were used to identify the most active journal in this research domain. We have taken the parameters of the minimum number of documents of a journal as one and the minimum number of citations of a journal as one for the link analysis and citation analysis. Highlights of the most active and relevant journals related to "Allergy of knee implants" are shown in table 4. Table 4 shows the journal activity of this research domain through parameters of publication volume, citations, and co-authorship linkages. From the above discussion regarding the bibliometric patterns in the research regarding allergy of knee implants, this research had observed a gradual increase in research interest regarding allergy of knee implants from the starting of the millennium and the momentum is going on positively. This points out the relevance and potential of this research domain (Refer to Figure 2). The most active authors in this research domain were Thomas P.; Argenson J.N, and Drancourt M. with the highest publication, co-authorship links; and citations respectively (Refer to table  1). The overlay analysis of top countries researching allergy on knee implants indicates that Germany and Italy were the leading countries relating to the highest number of publications citations, co-authorship links (Refer to figure 5).
The top journals of this research domain were identified as the Contact Dermatitis with the highest number of publications, citations, and links. From these wide sources of information, researchers can focus on top journals where they can identify the most relevant and highly cited articles regarding allergy of knee implants.

Conclusion
The knee implant was an interesting research domain and the most active journals related to this research domain were the Contact Dermatitis. The most active countries were Germany and Italy. The leading organization engaged in research regarding knee implants was the Ludwig Maximilian University of Germany. The most active authors who had made valuable contributions related to dental implants were Thomas P.; Argenson J.N, and Drancourt M.