An evaluation of information available on the internet regarding minimally invasive hip arthroplasty

Evaluation of the Quality of Delirium Website Content for Patient and Family Education: Cross-Sectional Study

BACKGROUND

Patients and families who have experienced delirium may seek information about delirium online, but the quality and reliability of online delirium-related websites are unknown.

OBJECTIVE

This study aimed to identify and evaluate online delirium-related websites that could be used for patient and family education.

METHODS

We searched Microsoft Bing, Google, and Yahoo using the keywords "delirium" and the misspelled "delerium" to identify delirium-related websites created to inform patients, families, and members of the public about delirium. The quality of identified delirium-related website content was evaluated by 2 authors using the validated DISCERN tool and the JAMA (Journal of the American Medical Association) benchmark criteria. Readability was assessed with the Simple Measure of Gobbledygook, the Flesch Reading Ease score, and the Flesch Kincaid grade level. Each piece of website content was assessed for its delirium-related information using a checklist of items co-designed by a working group, which included patients, families, researchers, and clinicians.

RESULTS

We identified 106 websites targeted toward patients and families, with most hospital-affiliated (21/106, 20%) from commercial websites (20/106, 19%), government-affiliated organizations (19/106, 18%), or from a foundation or advocacy group (16/106, 15%). The median time since the last content update was 3 (IQR 2-5) years. Most websites' content (101/106, 95%) was written at a reading level higher than the recommended grade 6 level. The median DISCERN total score was 42 (IQR 33-50), with scores ranging from 20 (very poor quality) to 78 (excellent quality). The median delirium-related content score was 8 (IQR 6-9), with scores ranging from 1 to 12. Many websites lacked information on the short- and long-term outcomes of delirium as well as how common it is. The median JAMA benchmark score was 1 (IQR 1-3), indicating the quality of the websites' content had poor transparency.

CONCLUSIONS

We identified high-quality websites that could be used to educate patients, families, or the public about delirium. While most delirium-related website content generally meets quality standards based on DISCERN and JAMA benchmark criteria, high scores do not always ensure patient and family-friendliness. Many of the top-rated delirium content were text-heavy and complex in layout, which could be overwhelming for users seeking clear, concise information. Future efforts should prioritize the development of websites with patients and families, considering usability, accessibility, and cultural relevance to ensure they are truly effective for delirium education.

Platelet-Rich Plasma for Knee Osteoarthritis: Internet Marketing and Patient Education-An Appraisal of Content for Websites with the Greatest Search Engine Visibility

OBJECTIVE

The internet is increasingly being used as a resource for health-related information by the general public. We sought to establish the authorship, content, and accuracy of the information available online regarding platelet-rich plasma (PRP) therapy for knee osteoarthritis.

DESIGN

Top 200 search results from each of the 3 leading search engines available online (Google, Yahoo!, Bing) were screened, and 181 websites were finally reviewed for content with emphasis on specific claims, comparing between websites authored by private physicians/groups and other authorship types.

RESULTS

Nearly 80% of the websites claimed that PRP injections for osteoarthritis of the knee improve patients' pain. A total of 42.8% of the private websites and 27.6% of nonprivate websites have stated that the procedure can delay or eliminate the need for future surgery. Costs were only mentioned by few (11.6%), and mainly by the nonprivate websites. Both website groups were unlikely to mention that PRP therapy is not the treatment of choice for end-stage knee osteoarthritis (7.9% of private and 17.2% of the nonprivate sites), or to state that patients with less advanced disease may benefit more from the treatment (11.8% and 20.6%, respectively). Private websites were less likely to refer to peer-reviewed literature (18.4% vs. 41.4%) and were more than 3 times less likely to mention lack of adequate evidence (13.2% vs. 48.2%).

CONCLUSIONS

Patients seeking online information regarding PRP therapy are vulnerable to websites presenting a narrow viewpoint of this treatment modality, putting emphasis on unsubstantiated benefits while disregarding potential drawbacks and concerns.

Robotic-Assisted Total Knee Arthroplasty: An Assessment of Content, Quality, and Readability of Available Internet Resources

BACKGROUND

The use of robotic-assisted total knee arthroplasty (TKA) has significantly increased over the past decade. Internet content is largely unregulated and may contain inaccurate and/or misleading information about robotic TKA. Our goal was to assess the content, quality, and readability of online material regarding robotic-assisted TKA.

METHODS

We conducted an internet search for the top 50 web sites from each of the 3 most popular search engines (Google, Yahoo, and Bing) using the search term robotic total knee replacement. Each web site was assessed for content, quality, and readability. Web site quality was assessed utilizing the QUality Evaluation Scoring Tool (QUEST). Readability was assessed utilizing the Simple Measure of Gobbledygook, Flesch-Kincaid Grade Level, and Flesch Reading Ease Formula scores.

RESULTS

General risks of TKA were discussed in 47.2%, while benefits were discussed in 98.6% of all web sites. Inaccurate claims occurred at a significantly higher rate in physician/community hospital sources compared to university/academic web sites (59% vs 28%, P = .045). Web sites from university/academic web sites had the highest QUEST scores, while physician/community hospital sources scored the lowest (16.1 vs 10.6, P = .01). Most web sites were written at a college reading level or higher.

CONCLUSION

Patients should be counseled on the largely unregulated nature of online information regarding robotic-assisted TKA. Physicians and hospitals should consider revising the readability of their online information to a more appropriate level in order to provide accurate, evidence-based information to allow the patient to make an informed consent decision.

Osteotomy around the knee: Assessment of quality, content and readability of online information

BACKGROUND

As knee osteotomy surgery becomes increasingly accessible, more patients may turn to the Internet for information. This study examined the source, quality, content and readability of online information regarding osteotomy around the knee.

METHODS

The first 70 websites returned by the top four search engines were identified using the key words: "knee osteotomy" and "high tibial osteotomy." The websites were categorised by type and assessed using the DISCERN score, Journal of the American Medical Association (JAMA) benchmark criteria and a novel Knee Osteotomy-Specific Score (KOSS). The presence of the Health On the Net (HON) code accreditation seal was noted. Readability of each website was assessed using eight readability formulae. The mean reading grade level (RGL) was compared to the 6th and 8th grade reading levels. The mean RGL of each category was also compared.

RESULTS

Of the 45 unique websites analysed, the majority were Physician (33%) and Journal websites (31%). The mean DISCERN score was 36.7 (±8.9) which is classified as 'poor.' The mean JAMA benchmark criteria score was 2.04 (±1.5) and Physician websites were most likely to be scored zero. The mean KOSS was 15.4 (±5.7). The highest scoring website was a Commercial site but, overall, Journal category sites provided the best quality information. Websites that bore the HONcode seal obtained higher DISCERN, JAMA benchmark criteria and Knee Osteotomy - Specific Scores. The cumulative mean RGL was 13.2 (±2.2) which exceeded the 6th grade level by an average of 7.2 grade levels and the 8th grade level by an average of 5.2 grade levels. No website (0%) was written at or below either the 6th or the 8th grade reading levels. The mean Flesch Reading Ease Score of all websites was 41.13 (±14.7) which is classified as 'difficult.' Journal websites had the highest RGL.

CONCLUSION

The information available online regarding osteotomy around the knee varies tremendously in quality and completeness. Physician sites predominate, but these were among the lowest scoring of all websites. Even where high quality information is available, it is set at too high a level to be easily understood.

LEVEL OF EVIDENCE

Survey of materials - Internet.

Modern Internet Search Analytics and Total Joint Arthroplasty: What Are Patients Asking and Reading Online?

BACKGROUND

Patients considering total joint arthroplasty often search for information online regarding surgery; however, little is known about the specific topics that patients search for and the nature of the information provided. Google compiles frequently asked questions associated with a search term using machine learning and natural language processing. Links to individual websites are provided to answer each question. Analysis of this data may help improve understanding of patient concerns and inform more effective counseling.

METHODS

Search terms were entered into Google for total hip and total knee arthroplasty. Frequently asked questions and associated websites were extracted to a database using customized software. Questions were categorized by topic; websites were categorized by type. JAMA Benchmark Criteria were used to assess website quality. Pearson's chi-squared and Student's t-tests were performed as appropriate.

RESULTS

A total of 620 questions (305 total knee arthroplasties, 315 total hip arthroplasties) were extracted with 602 associated websites. The most popular question topics were Specific Activities (23.5%), Indications/Management (15.6%), and Restrictions (13.4%). Questions related to Pain were more common in the TKA group (23.0% vs 2.5%, P < .001) compared to THA. The most common website types were Academic (31.1%), Commercial (29.2%), and Social Media (17.1%). JAMA scores (0-4) were highest for Government websites (mean 3.92, P = .005).

CONCLUSION

The most frequently asked questions on Google related to total joint arthroplasty are related to arthritis management, rehabilitation, and ability to perform specific tasks. A sizable proportion of health information provided originate from non-academic, non-government sources (64.4%), with 17.1% from social media websites.

Transoral robotic surgery: Differences between online information and academic literature

OBJECTIVES

Evaluate the authorship, content, quality, and readability of information on Transoral Robotic Surgery (TORS) available to patients online.

METHODS

The technical search term "TORS Surgery" and layperson's term "robotic surgery of the mouth" were utilized to conduct a search of the top 50 websites on Google, Bing, and Yahoo. Websites were evaluated according to the HONcode evaluation of content and quality, and readability was assessed using the Flesch Reading Ease Formula, Flesch-Kincaid Grade Level Formula, SMOG readability formula, Coleman Liau Index formula, and Gunning Fog Index. Statistical analysis was conducted using the Fisher Freeman- Halton test to compare differences in authorship, quality, and content between the three search engines and the Fisher exact test was used to determine if there was a difference in these variables between the two search terms.

RESULTS

Overall, websites were predominantly from academic institutions with 97% mentioning benefits of TORS with 24% mentioning risks. 45% of TORS websites had no description of the TORS procedure, while 62% allowed individuals to make appointments. There was a significant difference in authorship with the layperson's terms yielding more news sources, but there were no significant differences in quality and content of information elicited through the technical and layperson search terms. The mean readability scores were Flesch Kincaid Grade Level 13.81(±3.32), Gunning-Fog Index 16.51(±3.39), SMOG 12.53(±2.40), and Automated Readability Index 14.05 (±4.17).

CONCLUSIONS

Current online information on TORS surgery may not provide balanced information for patients to make informed healthcare decisions. The current readability of online information regarding TORS far exceeds the average literacy level of average American adults.

Minimally Invasive Spine Surgery: Analyzing Internet-based Education Material

STUDY DESIGN

This is a cross-sectional study.

OBJECTIVE

The purpose of this study is to evaluate the content of information available on the Internet regarding minimally invasive spine surgery (MISS).

SUMMARY OF BACKGROUND DATA

Patients look to the Internet for quick and accessible information on orthopedic procedures to help guide their personal decision making process regarding the care they receive. However, the quality of internet-based orthopedic education material varies significantly with respect to accuracy and readability.

MATERIALS AND METHODS

The top 50 results were generated from each of 3 search engines (Google, Yahoo!, and Bing) using the search term "minimally invasive spine surgery." Results were categorized by authorship type and evaluated for their description of key factors such as procedural benefits, risks, and techniques. Comparisons between search engines and between authorship types were done using the Freeman-Halton extension for the Fisher exact test. The content of websites certified by Health on the Net Foundation (HONcode) was compared with those not HONcode certified.

RESULTS

Of the 150 websites and videos, only 26% were authored by a hospital or university, whereas 50% were by a private physician or clinic. Most resources presented some benefits of MISS (84%, 126/150), but only 17% presented risks of the procedure (26/150). Almost half of all resources described the technique of MISS, but only 27% had thorough descriptions that included visual representations while 26% failed to describe the procedure. Only 12 results were HONcode certified, and 10 (83%) of these were authored by a medical industry company.

CONCLUSIONS

Internet-based resources on MISS provide inconsistent content and tend to emphasize benefits of MISS over risks.

Minimal Incision Total Hip Arthroplasty: A Concise Follow-up Report on Functional and Radiographic Outcomes at 10 Years

In 2005, we conducted a prospective randomized controlled trial that demonstrated that, compared with a standard incision, a minimal incision technique did not improve early outcomes of total hip arthroplasty (THA). There was concern that reduced exposure could compromise long-term outcome. For the current study, all surviving participants were invited to return for 10-year radiographic and clinical evaluation. Outcome scores were available for 152 patients (69.4%) from the original cohort, and radiographs were available for 126 (57.5%). The median duration of follow-up was 124 months. We did not find significant differences in functional status or radiographic outcome between the minimal and standard incision groups at 10 years. The 10-year implant survival rate was 99.1% (95% confidence interval [CI] = 97.3% to 100%) in the standard incision group and 97.9% (95% CI = 95.1% to 100%) in the minimal incision group (p = 0.57). We concluded that minimal incision THA performed by a high-volume surgeon does not compromise long-term results but offers no benefit over a standard incision.

LEVEL OF EVIDENCE

Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Patient Perceptions of the Direct Anterior Hip Arthroplasty

BACKGROUND

The quest for less invasive surgical approaches for total hip arthroplasty (THA) has garnered much attention recently in the community, as well as media outlets. There are very little data demonstrating the actual differences in these approaches. We are unaware of any information documenting patients' perceptions of the direct anterior approach (DAA) for THA. The purpose of this study was to collect information regarding patients' perceptions of the DAA THA.

METHODS

We surveyed 166 consecutive new patients being evaluated for hip osteoarthritis in our outpatient clinic. Demographic data and their knowledge of the DAA were collected, as well as a number of questions on a 5-item Likert scale.

RESULTS

Forty-six (28%) responded that they were aware of the DAA. Respondents primarily learned about the DAA from friends and family (58%), and healthcare professionals (38%). Respondents agreed or strongly agreed that the DAA is less painful (70%), reduces the amount of time spent on a cane after surgery (70%), damages tissues less (68%), allows patients to more quickly return to work (64%), and allows for shorter hospital stays (62%), compared to other procedures. In addition, 30% felt there is a consensus among surgeons that the DAA is the safest and most effective procedure for THA.

CONCLUSION

Many people are unaware of the DAA, with a majority of healthcare information being transmitted by friends and family members. The patients' perceptions are inconsistent with published data about the DAA and are likely influenced by marketing and individuals surrounding them.

Metal-on-Metal Total Hip Arthroplasty: Quality of Online Patient Information

Metal-on-metal total hip arthroplasty (THA) has generated much attention in the media because of early failure of certain implant systems. This study assessed the quality, accuracy, and readability of online information on metal-on-metal THA. The search terms "metal-on-metal hip replacement" and "metal hip replacement" were entered into the 3 most popular search engines. Information quality was assessed with the DISCERN score and a specific metal-on-metal THA content score. Accuracy of information was assessed with a customized score. Readability of the websites was assessed with the Flesch-Kincaid grade level score. A total of 61 unique websites were assessed. For 56% of websites, the target audience was patients. Media or medicolegal sources accounted for 44% of websites. As assessed by DISCERN (range, 16-80) and metal-on-metal THA (range, 0-25) scores, quality of the websites was moderate at best (47.1 and 9.6, respectively). Accuracy (range, 0-8) of the information presented also was moderate, with a mean score of 6.6. Media and medicolegal websites had the lowest scores for both quality and accuracy, despite making up the greatest proportion of sites assessed. Only 1 website (2%) had a Flesch-Kincaid grade level at or less than the recommended level of 8th grade. This study found that online information on metal-on-metal THA was of poor quality, often was inaccurate, and was presented at an inappropriately high reading level, particularly for media and medicolegal websites. Health care providers should counsel patients on the quality of information available and recommend appropriate online resources. [Orthopedics. 2017; 40(2):e262-e268.].

Partial Tonsillectomy

OBJECTIVES

Evaluate the content and readability of health information regarding partial tonsillectomy.

METHODS

A web search was performed using the term partial tonsillectomy in Google, Yahoo!, and Bing. The first 50 websites from each search were evaluated using HONcode standards for quality and content. Readability was assessed using the Flesch-Kincaid Grade Level (FKGL), Flesch Reading Ease, Gunning-Fog Index, Coleman-Liau Index, Automated Readability Index, and SMOG score. The Freeman-Halton extension of Fisher's exact test was used to compare categorical differences between engines.

RESULTS

Less than half of the websites mentioned patient eligibility criteria (43.3%), referenced peer-reviewed literature (43.3%), or provided a procedure description (46.7%). Twenty-two websites (14.7%) were unrelated to partial tonsillectomy, and over half contained advertisements (52%). These finding were consistent across search engines and search terms. The mean FKGL was 11.6 ± 0.11, Gunning-Fog Index was 15.1 ± 0.13, Coleman-Liau Index was 14.6 ± 0.11, ARI was 12.9 ± 0.13, and SMOG grade was 14.0 ± 0.1. All readability levels exceeded the abilities of the average American adult.

CONCLUSIONS

Current online information regarding partial tonsillectomy may not provide adequate information and may be written at a level too difficult for the average adult reader.

Analysis of Internet Information on Lateral Lumbar Interbody Fusion

Lateral lumbar interbody fusion (LLIF) is a surgical technique that is being increasingly used. The authors' objective was to examine information on the Internet pertaining to the LLIF technique. An analysis was conducted of publicly accessible websites pertaining to LLIF. The following search engines were used: Google (www.google.com), Bing (www.bing.com), and Yahoo (www.yahoo.com). DuckDuckGo (www.duckduckgo.com) was an additional search engine used due to its emphasis on generating accurate and consistent results while protecting searchers' privacy and reducing advertisements. The top 35 websites providing information on LLIF from the 4 search engines were identified. A total of 140 websites were evaluated. Each web-site was categorized based on authorship (academic, private, medical industry, insurance company, other) and content of information. Using the search term lateral lumbar interbody fusion, 174,000 Google results, 112,000 Yahoo results, and 112,000 Bing results were obtained. DuckDuckGo does not display the number of results found for a search. From the top 140 websites collected from each website, 78 unique websites were identified. Websites were authored by a private medical group in 46.2% of the cases, an academic medical group in 26.9% of the cases, and the biomedical industry in 5.1% of the cases. Sixty-eight percent of websites reported indications, and 24.4% reported contraindications. Benefits of LLIF were reported by 69.2% of websites. Thirty-six percent of websites reported complications of LLIF. Overall, the quality of information regarding LLIF on the Internet is poor. Spine surgeons and spine societies can assist in improving the quality of the information on the Internet regarding LLIF. [Orthopedics. 2016; 39(4):e701-e707.].

Assessment of the Accuracy of Online Information Regarding Trigger Finger

Background: Review of the recent literature suggests substantial use of the Internet by patients seeking health care information despite questionable accuracy and readability of information presented on some websites. The purpose of our study was to assess the accuracy, quality, and readability of online information regarding trigger finger.

Methods: Three terms (“trigger finger”, “stenosing tenosynovitis”, and “finger locking”) were used to query three Internet search engines to evaluate websites regarding information about trigger finger. Three hand surgery fellows independently assessed website accuracy and quality using standardized scoring criteria. The Fleisch-Kincaid reading grade level score was used to assess website readability. Website authorship and commercial association were also noted.

Results: Sixty-nine unique websites were assessed. Internet information obtained using the search term “stenosing tenosynovitis” was written at a significantly higher reading level than information found using “finger locking” or “trigger finger”. Website quality and accuracy were both significantly better in websites authored by physicians compared to websites authored by non-physicians. However, website accuracy was significantly poorer in websites featuring commercial association. Additionally, websites presenting information written below the 8th grade reading level demonstrated poorer accuracy.

Conclusions: Search term has a significant effect on the readability of online information regarding trigger finger. Despite the terminology used in searches, most websites are largely inaccurate and may not be easily understandable by the general population. This demonstrates a substantial barrier to accessing accurate health care information and may impact patient outcomes. Hand surgeons should direct patients towards websites presenting accurate information with easily readable content.

Computer-assisted total knee arthroplasty marketing and patient education: an evaluation of quality, content and accuracy of related websites

BACKGROUND

The internet is increasingly being used as a resource for health-related information by the general public. We sought to establish the authorship, content and accuracy of the information available online regarding computer-assisted total knee arthroplasty (CA-TKA).

METHODS

One hundred fifty search results from three leading search engines available online (Google, Yahoo!, Bing) from ten different countries worldwide were reviewed.

RESULTS

While private physicians/groups authored 50.7 % of the websites, only 17.3 % were authored by a hospital/university. As compared to traditional TKA, 59.3 % of the websites claimed that navigated TKA offers better longevity, 46.6 % claimed accelerated recovery and 26 % claimed fewer complications. Only 11.3 % mentioned the prolonged operating room time required, and only 15.3 % noted the current lack of long-term evidence in support of this technology.

CONCLUSIONS

Patients seeking information regarding CA-TKA through the major search engines are likely to encounter websites presenting a narrow, unscientific, viewpoint of the present technology, putting emphasis on unsubstantiated benefits while disregarding potential drawbacks.

LEVEL OF EVIDENCE

Survey of Materials-Internet.

Orthopaedic Patient Information on the World Wide Web: An Essential Review

BACKGROUND

Patients increasingly use the Internet to research health-related issues. Internet content, unlike other forms of media, is not regulated. Although information accessed online can impact patients' opinions and expectations, there is limited information about the quality or readability of online orthopaedic information.

METHODS

PubMed, MEDLINE, and Google Scholar were searched using anatomic descriptors and three title keywords ("Internet," "web," and "online"). Articles examining online orthopaedic information from January 1, 2000, until April 1, 2015, were recorded. Articles were assessed for the number of reviewers evaluating the online material, whether the article examined for a link between authorship and quality, and the use of recognized quality and readability assessment tools. To facilitate a contemporary discussion, only publications since January 1, 2010, were considered for analysis.

RESULTS

A total of thirty-eight peer-reviewed articles published since 2010 examining the quality and/or readability of online orthopaedic information were reviewed. For information quality, there was marked variation in the quality assessment methods utilized, the number of reviewers, and the manner of reporting. To date, the majority of examined information is of poor quality. Studies examining readability have focused on pages produced by professional orthopaedic societies.

CONCLUSIONS

The quality and readability of online orthopaedic information are generally poor.

CLINICAL RELEVANCE

For modern practices to adapt to the Internet and to prevent misinformation, the orthopaedic community should develop high-quality, readable online patient information.

Evaluating patient education material regarding unicompartmental knee arthroplasty

BACKGROUND

Variability in quality and accuracy of information has been well documented in other orthopedic procedures. Given the growing role of the Internet in patient education, it is important to assess the quality of material provided. The purpose of this study was to evaluate online patient education materials regarding unicompartmental knee arthroplasty (UKA).

METHOD

The first 50 websites generated from a search of the term, partial knee replacement, using three search engines, Google, Yahoo!, and Bing, were analyzed for quality, content, and authorship. Categorical data between the three search engines were compared using the Freeman-Halton extension for the Fisher's exact test. Fisher's exact test was used to compare categorical data between the search terms partial knee replacement and unicompartmental knee arthroplasty.

RESULTS

Most websites mentioned benefits of UKA (69%) but only a minority (39%) mentioned risks. A more technical search term, unicompartmental knee arthroplasty, yielded fewer websites authored by manufacturers/industry and miscellaneous sources (p=0.018 and p=0.039, respectively), more mentions of risks (p=0.0014), and more references to peer-reviewed literature (p=0.0026).

CONCLUSIONS

Overall, online information related to UKA is of questionable quality and may be geared more towards attracting patients than providing high-quality information.

Evaluating online information regarding the direct anterior approach for total hip arthroplasty

We evaluated the quality of information available on the Internet regarding the direct anterior approach (DAA). The top 50 Web sites from three major search engines (Google, Yahoo!, and Bing) were tabulated utilizing the search term direct anterior hip replacement. Of these, only 22% were authored by a hospital/university, while 60% were by a private physician/clinic. Most Web sites presented the DAA as "better" than other surgical approaches describing benefits, such as accelerated recovery though only 35% described risks of the approach. While only 39% of sites presented patient eligibility criteria, greater than 75% had the ability to make an appointment. Web sites regarding the DAA provide patients with a limited perspective and may be focused on attracting new patients, as opposed to accurately educating them.

Analysis of Internet information on the controversial X-Stop device

BACKGROUND CONTEXT

The Internet is frequently used by patients to aid in medical decision making. Multiple studies display the Internet's ineffectiveness in presenting high-quality information regarding surgical procedures and devices. With recent reports of unacceptably high complication rates and poor outcomes with the X-Stop device, it is important that online information is comprehensive and accurate. This study is the first to examine Internet information on the controversial X-Stop.

PURPOSE

To determine how accurately public information over the Internet portrays the existing primary literature on the X-Stop, how extensively the X-Stop is characterized online, and how patient decision making could foreseeably be affected.

STUDY DESIGN

This cross-sectional study analyzed publicly available Internet information, including videos on the web site YouTube regarding the X-Stop device.

PATIENT SAMPLE

No patients were involved in this study.

OUTCOME MEASURES

No specific outcome measures were used.

METHODS

Search engines Google, Yahoo, and Bing were used to identify 105 web sites providing information on the X-Stop. Videos on the web site YouTube were included. Web sites were categorized based on the authorship. Each site was analyzed for the provision of appropriate patient inclusion and exclusion criteria, surgical and nonsurgical treatment alternatives, purported benefits, common complications, peer-reviewed literature citations, and descriptions/diagrams of the procedure. Data were evaluated for each authorship subgroup and the entire group of sites.

RESULTS

Forty-three percent of sites were authored by a private medical group, 4% by an academic medical group, 16% by an insurance company, 9% by a biomedical industry, 10% by news sources, and 19% by other. Thirty-one percent of web sites and 11% of sites authored by private medical groups contained references to peer-reviewed literature. Fifty-six percent of web sites reported patient inclusion criteria, whereas 33% reported exclusion criteria. Benefits and complications were reported within 91% and 23% of sites, respectively. Surgical and nonsurgical treatment options were mentioned within 59% and 61% of web sites, respectively.

CONCLUSIONS

Our study demonstrates the Internet's ineffectiveness in reporting quality information on the X-Stop. Information was often incomplete and potentially misleading. Significant controversy exists within primary literature regarding the safety and efficacy of the X-Stop. Yet, publicly available Internet information largely provided misinformation and did not reflect any such controversy. This raises the concern that such information lends itself more toward patient recruitment than patient education. Medical professionals need to know how this may affect their patients' decision making.

Surfing for hip replacements: has the "internet tidal wave" led to better quality information

This study aimed to determine the quality of information available on the internet regarding Total Hip Replacement (THR). The unique websites identified were categorised by type and assessed using the DISCERN score, the Journal of the American Medical Association (JAMA) benchmark criteria, and a novel (THR)-specific content score. The presence of the Health On the Net (HON) code, a reported quality assurance marker, was noted. Commercial websites predominate. Governmental & Non-Profit Organizations websites attained the highest DISCERN score. Sites that bore the HONcode seal obtained significantly higher DISCERN and THR content scores than those without the certification. Physicians should recommend the HONcode seal to their patients as a reliable indicator of website quality or, better yet, refer patients to sites they have personally reviewed.

Web-based information on minimally invasive total knee arthroplasty

PURPOSE

To evaluate information available on the internet regarding minimally invasive total knee arthroplasty (TKA).

METHODS

The 3 most popular search engines (Google, Yahoo, and MSN) were used to search the keyword 'minimally invasive knee replacement'. The top 50 websites from each search engine were evaluated for authorship and contents; duplicate websites were not double-counted.

RESULTS

Of the 150 websites, 51% were authored by a hospital/university, 26% by private medical groups, 14% were news stories, and 9% were from orthopaedic industry sources. 73% offered the opportunity to make an appointment. 18% described the surgical technique, whereas only 9% explained patient eligibility. 25% described the risks, whereas only 3% made reference to peer-reviewed publications. >82% made specific claims regarding the advantages of minimally invasive surgery.

CONCLUSION

Most websites providing minimally invasive TKA information were insufficient in terms of explaining surgical technique, patient eligibility, and assoicated risks.

Minimally invasive total hip arthroplasty: a systematic review

The purpose of this study was to compare the operative outcome between mini and standard incisions in total hip arthroplasty (THA). We identified 12 randomised or quasi-randomised control trials (RCT or qRCT) published between 1996 and 2008. Subgroup and sensitivity analyses were performed to evaluate the differences in results for surgical approach, trial quality, and follow-up duration. Operative time and blood loss were significantly reduced in the mini-incision group for studies with the posterior or posterolateral approach. Concerning postoperative complications, there were no significant differences between the two groups with no significant heterogeneity. No differences were observed between the two groups for Harris hip score and radiographic results except for cup anterversion. Although mini-incision appeared to have similar outcomes compared to standard incision, the follow-up is short-term according to current standards in THA. High-quality studies are required to compare the outcomes of these two procedures.

Analysis of published evidence on minimally invasive total hip arthroplasty

Minimally invasive surgery has become a popular method of total hip arthroplasty. This study reviewed the literature to determine the number and quality of scientific publications analyzing different types of minimally invasive surgery approaches. The miniposterior approach has been studied the most and to our knowledge is the only approach with good quality randomized control study evidence. The overall length of follow-up and quality of reports for minimally invasive total hip arthroplasty is low.

An evaluation of sepsis Web sites for patient and family education

More and more consumers are using the Internet to find answers to questions about healthcare. Unfortunately, information at health Web sites may be incorrect, biased, and outdated. The purpose of our project was to identify Web sites on sepsis that could be used for patient and family education. We evaluated 30 sites on the basis of the Health on the Net criteria for medical and health Web sites, key content areas that patients and families should know in relation to sepsis, and readability. This article shares the process we used to evaluate the Web sites and identify the top sites for patient education.

Outcomes-based evaluations supporting computer-assisted surgery and minimally invasive surgery for total hip arthroplasty

Minimally invasive surgeries, as well as computer-assisted surgery for total hip replacement have gained popularity over recent years. This article provides an overview of state-of-the-art minimally invasive surgery (MIS) and computer-assisted surgery for total hip arthroplasty. A comprehensive review of the literature for scientific evidence supporting the use of these technologies was undertaken. This review evaluates whether commonly asked questions concerning these topics have been addressed. Controversy remains as to whether there are significant benefits of MIS or computer-assisted surgery for total hip arthroplasty. Fortunately, most studies report similar outcomes for both technologies. Minimally invasive techniques have been developed that do not significantly increase operative time or immediate postoperative complications. Computer-assisted navigation has shown improved radiographic alignment for total hip arthroplasty and may allow MIS to be performed more optimally. The authors believe that both of these technologies are likely to have a place in the future for hip arthroplasty with expectations of increased successful outcomes with these techniques while lowering complications and costs. Long-term outcomes of both techniques will need to be investigated.

Economic considerations in minimally invasive total joint arthroplasty

Minimally invasive techniques for hip and knee arthroplasty have been gaining popularity in recent years. Despite the apparent widespread enthusiasm for these procedures, there is little published evidence demonstrating superior quality of life outcomes directly attributable to the surgical technique. The current debate regarding the value of minimally invasive surgery extends beyond the demonstrated or potential clinical benefits of these procedures. Economic considerations of patients, surgeons, hospitals, and payers are prominent factors in this debate and will continue to influence the adoption of minimally invasive surgical procedures. Developing an understanding of the barriers posed by our healthcare delivery system to minimally invasive surgical procedures and how these barriers impact each of the stakeholders in the healthcare system will foster a rational deployment of these promising new approaches to hip and knee arthroplasty in the future.

The science of minimally invasive total hip arthroplasty

Minimally invasive hip surgery has stimulated a new process in hip arthroplasty. There is consensus among surgeons about the benefits of anesthesia, pain management, and rapid recovery protocols. The benefits of the surgical technique for small incision surgery remain controversial. Some patients influence this controversy because they prefer minimally invasive hip surgery: they associate less body violation and better cosmesis with smaller incisions. Small incision surgery is associated with a learning curve and requires specialized instruments for favorable outcomes. Despite being a more difficult operation to perform, in skilled hands it is a safe procedure that does not increase complication rates as shown by recent prospective, randomized studies. Correct component positioning has been achieved consistently with these procedures and short-term results of small incision surgery are the same as with long incisions. New anesthesia and pain management techniques have led to remarkable early functional results, making same-day surgery possible. With improved instrumentation such as computer navigation, minimally invasive total hip arthroplasty will become more prevalent.

The ugly underbelly of the MIS movement: in the affirmative

Minimally invasive surgery (MIS) for hip or knee arthroplasty has been a recent rage in orthopedics. However, there are no substantial data supporting the use of these techniques, and multiple articles document increased risk of complications with MIS technique. Unfortunately, a huge marketing effort on the part of the implant industry and many surgeons is creating pressure on surgeons to sacrifice the quality of outcome for purported improved cosmesis or shorter length of hospital stay. This review examines the data from prospective studies evaluating the outcomes of MIS techniques and implores the surgeon to place quality before decreased incisional quantity!

The 2007 ABJS Marshall Urist Award: The impact of direct-to-consumer advertising in orthopaedics

Direct-to-consumer advertising (DTCA) has become an influential factor in healthcare delivery in the United States. We evaluated the influence of DTCA on surgeon and patient opinions and behavior in orthopaedics by surveying orthopaedic surgeons who perform hip and knee arthroplasties and patients who were scheduled to have hip or knee arthro-plasty. Respondents were asked for their opinions of and experiences with DTCA, including the influence of DTCA on surgeon and patient decision making. Greater than 98% of surgeon respondents had experience with patients who were exposed to DTCA. The majority of surgeon respondents reported DTCA had an overall negative impact on their practice and their interaction with patients (74%), and their patients often were confused or misinformed about the appropriate treatment for their condition based on an advertisement (77%). Fifty-two percent of patient respondents recalled seeing or hearing advertisements related to hip or knee arthroplasty. These patients were more likely to request a specific type of surgery or brand of implant from their surgeon and to see more than one surgeon before deciding to have surgery. Direct-to-consumer advertising seems to play a substantial role in surgeon and patient decision making in orthopaedics. Future efforts should be aimed at improving the quality and accuracy of information contained in consumer-directed advertisements related to orthopaedic implants and procedures.

Direct to consumer advertising in healthcare: history, benefits, and concerns

Physicians, health plans, hospitals, pharmaceutical companies, and medical device manufacturers have all recognized the benefits of marketing their products and services directly to the end user. As a result, there has been tremendous growth of direct-to-consumer advertising (DTCA), illustrated by the increase in spending on DTCA related to prescription drugs from an estimated $55 million in 1991 to $3.2 billion in 2003. This increase in DTCA has sparked vigorous debate among the major stakeholders in healthcare over the benefits and drawbacks of advertising directly to the healthcare consumer. Issues with DTCA include its impact on the doctor-patient relationship, patient education, inappropriate resource utilization, healthcare costs, healthcare quality, and overall patient wellbeing. Orthopaedic surgery is no longer insulated from this expanding trend in DTCA, as orthopaedic surgeons and hospitals are responsible for a substantial portion of DTCA related to orthopaedic devices and procedures. The Food and Drug Administration has a limited regulatory role and limited power related to DTCA due to considerable inefficiencies in its review and disciplinary processes. Therefore, physicians, including orthopaedic surgeons, must take a leadership role on this issue to ensure the integrity of information provided to patients and to protect the sanctity of the doctor-patient relationship.

The quality of web-based information on hip resurfacing arthroplasty: a cross-sectional survey

The Internet has become an important source of information for patients. Websites offering medical information are not subject to peer-review. The aim of this study was to evaluate the quality of information available on the web regarding hip resurfacing arthroplasty. The search term hip resurfacing was entered into five commonly used general search engines. The 20 highest-ranked websites from each engine were reviewed, after eliminating duplicate and non-relevant sites. Each site was then given a quality score (maximum of 20) according to predefined general and specific criteria. Our search identified 40 unique websites. Commercial websites were the most common (n=17). Quality scores ranged from 8 to 18, indicating that the quality of information on the web varied widely. The mean score for all sites was 11.7, SD 2.6, and only four websites scored >15. Fifteen sites did not mention the disadvantages or complications specific to hip resurfacing. The quality of information on the Internet regarding hip resurfacing is variable. Only four sites out of 40 were deemed to be of high quality. Orthopaedic surgeons need to be aware of these limitations, and take the lead in educating and counselling their patients.;