Research integrity in orthopedics: a bibliometric analysis of retracted articles, and the role of publication incentives.

BACKGROUND: Article retractions are increasing across scientific literature, raising concerns about research integrity. In orthopedics, the distribution of retracted publications across study designs and their relationship with bibliometric indicators remains poorly characterized. This study aimed to: (1) analyze study designs and publication characteristics of retracted orthopedic articles; (2) assess the reasons for retractions across different study designs; and (3) explore factors contributing to increasing retraction rates and implications for research integrity. HYPOTHESIS: We hypothesized that clinical studies would account for the greatest proportion of retractions. METHODS: We analyzed 134 English-language orthopedic journals and identified retracted publications issued between January 2000 and January 2026 using PubMed, Scopus, and Retraction Watch Database. Data extracted included study design, reasons for retraction, journal impact factor, SIGAPS rank, country of origin, citation count, and time to retraction. RESULTS: A total of 184 retracted articles from 58 journals were included. Clinical studies represent the largest proportion (118/184, 64.1%), followed by basic science (33/184, 17.9%) and secondary research (31/184, 16.8%). Cohort studies were most frequently retracted (44/184, 24.0%), while randomized controlled trials and systematic reviews with meta-analyses accounted together for 20.7% (38/184). Most retractions occurred in SIGAPS B-ranking journals (63/184, 34.2%). Misconduct was the leading cause of retraction. The most cited article was also associated with the longest retraction delay (22 years) and had been retracted for misconduct. CONCLUSION: Orthopedic research retractions are increasing and predominantly involve clinical studies. The retraction of randomized controlled trials and systematic reviews with meta-analyses is particularly concerning given their high level of evidence. Misconduct remains the leading cause of retraction. Improved detection methods and increasing publication pressure may contribute to these trends, underscoring the need to prioritize research quality and integrity over publication output. LEVEL OF EVIDENCE: III; retrospective study.