Total number of citations has been considered a proxy for a published study's importance within a given field. However, there are multiple pitfalls to correlating the total number of citations alone with the quality of a study. In this review, the authors aimed to identify the top 100 most-cited studies of hip and knee arthroplasty and then assess study design and quality of reporting. More than half of these studies were level IV evidence, unblinded, not randomized, and not controlled. This underscores the need for higher-quality study design to support practice.