Ekhtiari S, Gazendam A, Nucci N, et al. - A systematic search was conducted to evaluate the fragility index (FI) in arthroplasty randomized controlled trials (RCTs). Researchers carried out to search MEDLINE, Embase, and Web of Science for RCTs related to primary total joint arthroplasty (TJA) from 2010 to 2020. Using Fischer’s exact test, the FI was computed to ascertain how many events would need to be reversed to change a study from statistically significant to non-significant. The study included a sum of 34 RCTs. In the analysis,103 patients (range 24-791) was the median sample size. The data exhibited that in TJA, Hip and knee arthroplasty RCTs with statistically significant dichotomous outcomes are fragile. In TJA, the median FI is lower than the FI in any of the other previously reported orthopedic subspecialties. The outcomes of this study indicated that the fragility is another reason to be cautious when conducting or interpreting small trials and to continue to strive towards large trials to answer important questions in TJA.