Characteristics and Quality of Online Searches for Direct Anterior Versus Posterior Approach for Total Hip Arthroplasty

Renee Ren; Rodnell Busigó Torres; Graham C Sabo; Juan Sebastian Arroyave; Brocha Z Stern; Darwin D Chen; Brett L Hayden; Jashvant Poeran; Calin S Moucha

doi:10.1016/j.arth.2024.03.048

Characteristics and Quality of Online Searches for Direct Anterior Versus Posterior Approach for Total Hip Arthroplasty

J Arthroplasty. 2024 Apr 4:S0883-5403(24)00264-X. doi: 10.1016/j.arth.2024.03.048. Online ahead of print.

Authors

Renee Ren¹, Rodnell Busigó Torres¹, Graham C Sabo¹, Juan Sebastian Arroyave¹, Brocha Z Stern², Darwin D Chen¹, Brett L Hayden¹, Jashvant Poeran², Calin S Moucha¹

Affiliations

¹ Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York.
² Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Population Health Science and Policy, Institute for Health Care Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York.

PMID: 38582372
DOI: 10.1016/j.arth.2024.03.048

Abstract

Background: Online resources are important for patient self-education and reflect public interest. We described commonly asked questions regarding the direct anterior versus posterior approach (DAA, PA) to total hip arthroplasty (THA) and the quality of associated websites.

Methods: We extracted the top 200 questions and websites in Google's "People Also Ask" section for 8 queries on January 8, 2023, and grouped websites and questions into DAA, PA, or comparison. Questions were categorized using Rothwell's classification (fact, policy, value) and THA-relevant subtopics. Websites were evaluated by information source, Journal of the American Medical Association Benchmark Criteria (credibility), DISCERN survey (information quality), and readability.

Results: We included 429 question/website combinations (questions: 52.2% DAA, 21.2% PA, 26.6% comparison; websites: 39.0% DAA, 11.0% PA, 9.6% comparison). Per Rothwell's classification, 56.2% of questions were fact, 31.7% value, 10.0% policy, and 2.1% unrelated. The THA-specific question subtopics differed between DAA and PA (P < .001), specifically for recovery timeline (DAA 20.5%, PA 37.4%), indications/management (DAA 13.4%, PA 1.1%), and technical details (DAA 13.8%, PA 5.5%). Information sources differed between DAA (61.7% medical practice/surgeon) and PA websites (44.7% government; P < .001). The median Journal of the American Medical Association Benchmark score was 1 (limited credibility, interquartile range 1 to 2), with the lowest scores for DAA websites (P < .001). The median DISCERN score was 55 ("good" quality, interquartile range 43 to 65), with the highest scores for comparison websites (P < .001). Median Flesch-Kincaid Grade Level scores were 12th grade level for both DAA and PA (P = .94).

Conclusions: Patients' informational interests can guide counseling. Internet searches that explicitly compare THA approaches yielded websites that provide higher-quality information. Providers may also advise patients that physician websites and websites only describing the DAA may have less balanced perspectives, and limited information regarding surgical approaches is available from social media resources.

Keywords: direct anterior approach; online health information; patient counseling; posterior approach; total hip replacement.