WASHINGTON, DC – When researchers typed the phrase "minimally invasive hip replacement surgery" into several Internet search engines, they were bombarded with information that tended to exaggerate the benefits of the procedure and often minimized its risks. In fact, many of the Web sites they found made specific claims about arthroscopic hip replacement surgery that were not supported by the existing peer-reviewed medical literature, according to new research presented at the 72nd Annual Meeting of the American Academy of Orthopaedic Surgeons in Washington, DC.

Considering the number of patients seeking information on joint replacement surgery, "this is actually a very big problem," lead study author Ryan S. Labovitch, MD, orthopaedic surgery resident at the University of California at San Francisco, tells CIAOMed, adding that misleading information "may contribute to unrealistic patient expectations and suboptimal clinical results."

The findings resulted from an examination of the top 50 hits from three popular search engines (excluding identical sites found by more then one engine). Overall, 52% of the Web sites were hospital or university sites and 32% were physician-authored. Of the latter, 58% allowed the user to contact the surgeon or make an appointment online. Slightly more than 30% described eligibility criteria and 68% described the technique. While almost 90% made claims about the benefits of minimally invasive surgery (MIS), only 11% described the potential risks. Less than 10% provided references to peer-reviewed publications.

"Minimally invasive total hip arthroplasty has not been validated in the orthopaedic literature, yet the majority of information available on the Internet infers such confirmation," Dr. Labovitch points out.

The onus falls on surgeons

"The doctors certainly have an ethical responsibility to make sure that the information their patients are getting through consultations and what they are reading is well backed by data," he says. "Sometimes that means telling them that we don't know what the risks are, because this is a new procedure."

"It's unfortunate that we don't have a regulatory counsel or group that oversees Internet information," Dr. Labovitch tells CIAOMed. "Each individual practitioner needs to have his or her own Web site with links to other sites that they feel are comprehensive and accurate. Or, they can list that information on their own Web site and cite different studies with benefits and risks," he says. Specifically, he suggests that surgeons may want to point patients toward reputable Web sites such as that of the American Academy of Orthopaedic Surgeons at www.aaos.org or the National Institutes of Health at www.nih.gov.

"I am not one to preach that direct-to-consumer marketing is unethical, but I think it is our responsibility not to disseminate information that is not well supported by the literature," he emphasizes. "Providing information and making claims that are not substantiated is not what we signed up for when we took the Hippocratic Oath."

Misinformation about MIS for hip replacement "is really the tip of the iceberg," says Aaron G, Rosenberg, MD, professor of surgery at Rush University Medical Center in Chicago, Illinois. "There is a long history of quackery involving treatment of arthritis and, in this day and age, every consumer has to be savvy and cautious on the Internet."

Despite the apparent abundance of misleading information, Dr. Rosenberg disagrees that tight restrictions should be placed on direct-to-consumer (DTC) Internet publishers. "DTC on the part of industry is a trend that will not abate unless evolutionary forces eliminate it. I believe, in general, in allowing [publishers of web sites] to say whatever they like even if it's completely ludicrous…and that patients should have the right to say ‘that's ridiculous.'"

References

Labovitch RS, Bozic K. The quality of information on the internet regarding minimally invasive hip replacement. Presented at: the 72nd Annual Meeting of the American Academy of Orthopaedic Surgeons; February 23–27, 2005; Washington, DC. Paper No. 136.