Instagram videos provide limited information on complications and return to social life regarding total knee arthroplasty: A multilingual analysis

Abstract

Introduction

The purpose of this study was to examine the content quality and potential shortcomings of arthroplasty training videos on Instagram.

Materials and Methods

A search on Instagram was performed from November 1, 2023, to April 30, 2024. The hashtags Replacement, Total knee replacement and Knee arthroplasty were translated into 6 different languages and searched on Instagram by 6 observers who are native speakers of those languages. The videos were scored using the DISCERN score and Global Quality Score (GQS). The extent to which the videos addressed the processes about which patients need to be informed was also examined.

Result

A total of 126 videos were analyzed in this study. The median DISCERN and GQS scores were 3.0 [1.0–5.0] and 3.0 [2.0–5.0], respectively. The most frequently mentioned subheading was arthroplasty procedure and prosthesis technology (74%), followed by treatment options (66%). The least mentioned subheading was complications (19%), followed by return to social life (44%).

Conclusions

The main finding of this study was that knee arthroplasty videos posted on Instagram were lacking in data. Video content largely describes surgical techniques but is insufficient to inform patients about postoperative processes. The video content quality was found to be moderately good according to both video quality scores, and these quality scores were moderately correlated with the mention of subheadings.

Keywords

Arthritis total knee arthroplasty content quality Instagram Internet replacement

Introduction

The progressive increase in social media usage over the past two decades has encouraged users to produce video content across multiple platforms.¹ Social media, which encompasses various platforms accessible through applications on mobile devices, contains content from daily life. Numerous social media platforms (Facebook, YouTube, Instagram, Twitter, TikTok, LinkedIn, etc.) generate content on a daily basis, and their popularity continues to increase.^2,3 Instagram ranks as the third most popular social media platform globally, following Facebook and YouTube, and has a higher daily usage rate compared to other platforms. It appeals to users across all age demographics.¹ Users can efficiently navigate the Instagram interface. Through features such as the timeline, reels, and Instagram Direct Message, users can view content from their friends and followed accounts, and receive numerous content recommendations. Recommendations may be made in various domains, including education, entertainment, travel, and health. A primary advantage of Instagram is the accessibility of all tagged videos pertaining to a specific subject through the utilization of hashtags in the search function.

The proliferation of Instagram as a platform for advertising and health-related recommendations has prompted numerous physicians to utilize social media for promotional purposes and to produce educational video content.^4–6 On a daily basis, medical specialists from various disciplines utilize Instagram to disseminate patient outcomes within their respective fields and provide informative videos pertaining to the services they offer to patients.^7,8 Hair transplantation, dietary regimens formulated by nutritionists, esthetic dental procedures, rhinoplasty and mammoplasty, as well as various orthopedic surgical interventions are among these services.^9,10 Orthopedic surgeons present video demonstrations explaining surgical procedures and treatment modalities in specialized areas pertaining to specific joints, such as arthroplasty, sports medicine, spinal surgery, and interventions involving the knee, shoulder, and ankle, in accordance with their respective areas of expertise.^4,5,11 There has been seen to be an increasing trend for utilization of social media platforms by members of the American Association of Hip and Knee Surgeons.^6,12 Numerous videos have been produced in the field of knee arthroplasty, and it has been hypothesized that these videos enable patients to comprehend the process of arthroplasty procedures.

Research examining the adequacy of English language presentations regarding the content design and content quality of these videos is limited.^13,14 In contrast to YouTube, Instagram does not utilize a general search engine for content discovery.¹⁵ The IP address of the mobile device determines the geographical location and subsequently limits the video content to those in the immediate vicinity, as well as the posts and reels from accounts the user follows on Instagram, which are displayed on the Instagram timeline. Consequently, this mechanism results in the user viewing a higher proportion of videos in their native language.

Previous studies have shown that content producers surgeons focus on a specific topic and fail to cover all the topics necessary to inform patients.^5,15 The hypothesis of this study was that patients seeking information about knee arthroplasty surgery would have access to limited information in videos prepared by surgeons. The entire process is a whole and patients may lack appropriate information about the preoperative process, per-operative techniques and post-operative processes. The one-minute video format of Instagram is insufficient to adequately inform patients. Furthermore, users’ attention span during timeline browsing is notably brief.

The objective of this study was to evaluate the content adequacy of arthroplasty training videos in six languages (English, Turkish, Spanish, German, French, Italian) prevalent in Europe and North America. The research aimed to establish the essential information that patients should receive regarding arthroplasty as subtopics and to analyze the extent to which these subtopics are addressed in the videos.

Methods

A systematic search was conducted on Instagram (http://www.instagram.com) from November 1, 2023 to April 30, 2024. The study was designed in the native languages of selected Eastern-Central and Western European countries, as well as North America (Spain, Germany, France, Italy, Turkey, USA). The systematic search was conducted by six observers in six different languages. All the observers were orthopedic specialists or senior orthopedic residents. The systematic search locations were Hamburg, Zaragoza, Marseille, Rome, Istanbul, and New York.

Inclusion/search criteria

–

For this study, four hashtags were selected for the Instagram search (Replacement, Total knee replacement, Knee arthroplasty, Arthroplasty). These hashtags were searched in the authors’ native language using the Instagram search function.

–

The study included the personal Instagram accounts of physicians specializing in orthopedics and traumatology (surgeons only).

–

In cases where a surgeon had multiple videos on the topic, the video with the highest view count was analyzed.

–

A minimum of five videos were selected for each hashtag.

Exclusion criteria

–

Clinical advertising, physical therapy and rehabilitation doctors, and physiotherapist accounts were excluded from the study.

–

Office accounts of private hospitals and other private institutions were excluded.

–

Contents that were not an informational video (advertisement, entertainment, etc.) were excluded from the study.

A comprehensive review of the extant literature was conducted prior to the study, resulting in the identification of seven subheadings. The subsequent analysis of the videos examined which of these seven subheadings were addressed within the video content.¹⁶

Knee biology and/or biomechanics.

Knee arthrosis type and etiology.

Treatment modalities (pharmacological treatments, physiotherapy, intra-articular injections, surgical procedures, etc.).

Arthroplasty procedure and prosthesis technology (total or unicompartmental knee arthroplasty, approaches etc.).

Complications (infections, medical and surgical complications etc.).

Rehabilitation protocol.

Return to social life.

The subheadings above were examined in terms of whether they were included in the video content (plus or not). In a video, only one subheading can be address or 7 subheadings can be address. The subheadings in the video content were collected and scored. In addition, two video quality scores, namely the DISCERN Score and the Global Quality Scale (GQS) were assessed.^5,17,18 The DISCERN Score is scored from 0 to 5 points, with 5 points indicating high quality. The Global Quality Scale is scored between 1 and 5 points, with 5 points indicating high quality.^4,5

Statistical analysis

The data obtained in the study were analyzed statistically using IBM SPSS Statistics vn. 24.0 software (IBM Co., Armonk, NY, USA). Conformity of the data to normal distribution was assessed both visually and statistically. Categorical variables were stated as number (n) and percentage (%), and continuous variables as median [IQR] or mean ± standard deviation (SD) values according to normal distribution. Correlations between non-parametric variables were examined using the Spearman rho correlation coefficient. The correlations were accepted as weak, moderate, strong and very strong if the rho correlation coefficient was between 0.2–0.39, 0.4–0.59, 0.6–0.79 and >0.8, respectively. A value of p<0.05 (two-sided) was accepted as statistically significant.

Results

A total of 126 videos were analyzed in this study, and all videos were shorter than 1 min. The number of videos by language and the number of followers of Instagram accounts are presented in Table 1.

Table 1.

Surgeons and Instagram accounts basic data.

		Followers
	Number of Surgeons	Median (min-max)
French	20	4893 [746–13,500]
English	26	4955 [337–763,000]
German	20	1593 [417–15,600]
Italian	20	2093 [507–28,700]
Spanish	20	7450 [1039–87,200]
Turkish	20	6666 [568–51,100]
Total	126	3971 [337–763,000]

The median DISCERN score and GQS were 3.0 [1.0–5.0] and 3.0 [2.0–5.0], respectively. The DISCERN scores and GQS according to the languages analyzed are presented in Table 2. The analysis of the 126 videos showed the median frequency of subheading mentions to be 4.0 [0.0–7.0]. The most frequently mentioned subheading was the arthroplasty procedure and prosthesis technology (74%), followed by treatment options (66%). The least mentioned subheading was complications (19%), followed by return to social life (44%) (Table 3).

Table 2.

Numerical scores for discern and GQS.

	DISCERN	GQS	Subheading
	Median (Min-max)	Median (Min-max)	Median (Min-max)
French	3.0 [2.0–4.0]	3.0 [2.0–4.0]	4.0 [2.0–6.0]
English	3.0 [1.0–4.0]	3.0 [2.0–4.0]	4.0 [1.0–6.0]
German	2.5 [1.0–3.0]	3.0 [2.0–4.0]	4.0 [1.0–7.0]
Italian	1.0 [1.0–3.0]	3.0 [2.0–5.0]	3.0 [1.0–5.0]
Spanish	3.0 [1.0–5.0]	4.5 [2.0–5.0]	2.5 [0.0–6.0]
Turkish	3.0 [2.0–3.0]	3.5 [2.0–4.0]	4.0 [0.0–6.0]
Total	3.0 [1.0–5.0]	3.0 [2.0–5.0]	4.0 [0.0–7.0]

GQS: Global Quality Scale.

Table 3.

Percentage of mentions of subheadings by language.

	Turkish	German	Franch	Italian	Spanish	English	Total
Subheadings	(n=20)	(n=20)	(n=20)	(n=20)	(n=20)	(n=26)	(n=126)
Knee biology and/or biomechanics	13 (65.0%)	13 (65.0%)	10 (50.0%)	3 (15.0%)	13 (65.0%)	20 (76.9)	72 (57.1%)
Knee arthrosis type and etiology	8 (40.0%)	16 (80.0%)	8 (40.0%)	9 (45.0%)	7.0 (35.0%)	12 (46.2%)	60 (47.6%)
Treatment modalities	10 (50%)	16 (80.0%)	20 (100.0%)	11 (55.0)	12.0 (60.0%)	14 (53.8%)	83 (65.9%)
Arthroplasty procedure and prosthesis technology	12 (60%)	16 (80.0%)	19 (95.0%)	14 (70.0%)	13 (65.0%)	19 (73.1%)	93 (73.8%)
Complications	8 (40.0%)	8 (40.0%)	1 (5.0%)	2 (10.0%)	–	5 (19.2%)	24 (19.0%)
Rehabilitation protocol	9 (45.0%)	8 (40.0%)	10 (50.0%)	12 (60.0%)	8 (40.0%)	13 (50.0%)	60 (47.6%)
Return to Social Life	14 (70.0%)	8 (40.0%)	4 (20.0%)	8 (40.0%)	4 (20.0%)	17 (65.4)	55 (43.7)

Table 4.

Correlation between subheadings and video quality scores.

		DISCERN	GQS	Subheadings
DISCERN	Correlation coefficient	1.000	.516**	.493**
GQS	Correlation coefficient	.516**	1.000	.464**
Subheadings	Correlation coefficient	.493**	.464**	1.000

* Correlation is significant at the 0.01 level (2-tailed).

GQS: Global Quality Scale.

A significant moderately correlation was determined between the subheadings and the DISCERN score (rho: 0.493 and p=0.001). The subheadings and GQS were determined to be statistically sgnificantly positively correlated at a moderate level (rho: 0.464 and p=0.001) (Table 4).

Discussion

The main finding of this study was that knee arthroplasty videos posted on Instagram do not provide comprehensive data. The subheading of complications was mentioned in only 1 in 5 of the videos. The second least mentioned subheading was information about return to social life. However, surgeons mostly provide information about surgical techniques. Video content quality was determined to be moderately good according to both video quality scores, and these quality scores were moderately correlated with the mention of subheadings.

There are many potential reasons why surgeons specifically mention surgical techniques in their video content. These videos may serve educational purposes. However, numerous authors have emphasized that such videos are primarily produced for advertising purposes.^5,19 While demonstrating the surgical procedure to patients is undoubtedly crucial, total knee arthroplasty encompasses multiple stages, including preoperative preparation, hospitalization, the operative procedure, and postoperative recovery.²⁰ Informing the patient about all of these steps is of paramount importance both in terms of patient satisfaction and medicolegal considerations.²¹ From this perspective, it is imperative to inform patients about possible TKA complications. A previous study presented similar data to that of the current study, but in respect of cruciate ligament reconstruction and argued that surgeons inadequately address complications.⁵ Another subheading was the return to social life. Surgeons may offer a combination of physical therapy and a return to social life. However, how long and to what extent they can return to social life is a matter of curiosity for patients.²² Clearly explaining the possible complications of the postoperative process, the physiotherapy process and the return to social life and daily activities to patients will help the surgeon in terms of patient expectations. Our study will serve as a guide to identify missing information in patient education on the Instagram platform. The phrase “postoperative complications may occur” in the clinician's informational video would be too limited. We believe that producing a video explaining potential complications such as infection, aseptic loosening, and embolism along with how these complications can be managed will enhance patient trust in the physician.

Only orthopedics and traumatology surgeon accounts were analyzed in this study. Kolade O et al. stated that content created by doctors on Instagram provided more accurate information but received fewer interactions than content created by non-physicians.⁴ This is a potential negative effect of Instagram. Ramkumar et al. reported that most posts about shoulder and elbow surgery were created by patients, while some of the videos created by doctors barely touched on the disease and generally advertised a private clinic.¹⁹ Zhang D et al. found that Instagram is not a useful source of information in terms of hand surgery information and useful posts usually contain a clinical image.²³ In the light of these findings, it can be said that Instagram is not yet a reliable and valid information platform, and does not currently serve as an adequate substitute for in-person outpatient clinical consultations for patients.^5,15

Instagram is a free, valuable, and widely popular social media platform that attracts users of all age groups. It ranks among the most widely used platforms globally, alongside YouTube, Facebook, and TikTok.²⁴ Instagram allows social interaction, with people both sharing and receiving suggestions from the Instagram timeline, reels, and messages section. This application includes numerous topics such as health, travel and others (art, music, food etc). In the healthcare domain, individuals can access information from many specialists across multiple fields, including orthopedic surgery.^25–27 Healthcare professionals frequently utilize social media platforms for communication, marketing, and educational purposes.^6,19 Most orthopedic surgeons and journals maintain at least one social media account, including Instagram, with shoulder and knee surgeons representing the most active user groups.^6,9,26,28 This increasing utilization is evident as Instagram and other social media platforms are becoming more prevalent among surgeons for educational purposes, promotional activities, and professional communication. Throughout this evolution, there has remained a paucity of comprehensive data in the extant literature regarding the utilization of social media and the production of high-quality content.¹⁵ To date, there has been no comprehensive patient-feedback study examining the characteristics of high-quality content. It can be suggested that this research will provide guidance to content producers in the development of such material.

The power of social media is an undeniable reality of the twenty-first century.^6,7,10,12 This situation has escalated to such an extent that health authorities and ministries have issued directives to define patient privacy and doctor boundaries in this regard.²⁹ Social media is currently served through numerous platforms, but only some have specific features tailored for doctor-patient interactions.^27,30 Instagram and TikTok have taken the lead in this regard within the Fast Track group. YouTube primarily caters to longer content and does not include sponsored advertisements as found on Instagram.³¹ Instagram professional account users can create timeline advertisements targeting people living in specific regions by selecting specific features (age, gender) in exchange for a certain fee. Research has suggested that the average attention span has diminished due to constant exposure to short-form videos.³² These conditions urge the human brain to seek quicker satisfaction and novelty. The stop-scrolling time through Instagram timelines varies between 2 to 8 s.³³ This is a crucial point, to which surgeons or video creators should be aware and provide definite information about the content in the first few seconds of the video. In this context, the importance of an attention-grabbing title cannot be overstated. Given the limited attention span of approximately three seconds, the pursuit of attention-grabbing elements may result in a diminished focus on content organization and quality. To produce high-quality content effectively, surgeons should structure the video duration into distinct subheadings and utilize them within a specific framework. While orthopedic surgeons may consider examining different subheadings across multiple videos, patients may not be aware of the existence of these various subheadings.

Limitations and strengths

The inaccessibility of private accounts represents a potential limitation of this study. Another limitation was that a surgeon may be posting multiple videos on THA and answering a question in each one. Or the surgeon may be explaining a video about TKA and THA together. An additional limitation was that the research was conducted using only four hashtags, whereas medical professionals may have utilized specific hashtags related to their intended topics of discussion. This study represents the first examination of total knee arthroplasty video content quality and potential limitations on Instagram. Furthermore, the incorporation of multicentre and multilanguage analysis enhances the robustness of the data collected. Finally, this study is a cross-sectional study. Content quality is likely to improve over the years as social media use increases and health professionals receive training in content production. Therefore, we think that longitudinal follow-ups should be done in prospective studies.

Conclusion

Although Instagram is an easily accessible social media platform, the quality of total knee arthroplasty videos published by orthopedic and traumatology doctors is moderate. There is a lack of information on postoperative processes and complications about which the patient needs to be informed. Therefore, at present, it does not appear to be a suitable replacement for face-to-face patient-physician outpatient consultations.

Footnotes

Ethical approval

This article does not contain any experimental studies with human participants or animals performed by any of the authors.

Informed consent

This research in accordance with the principles of the Helsinki declaration.

Credit authorship contribution statement

Y.S.: Methodology, Writing - review & editing, Conceptualization; M.F.D.: Conceptualization; Formal analysis, Data curation; Visualization, Supervision; A.E.N.: Formal analysis, Writing - review & editing, Validation, Data curation; A.M.R.T.: Formal analysis, Writing - review & editing, Validation, Data curation; L.Z.: Formal analysis, Writing - review & editing, Validation, Data curation; A.H.: Formal analysis, Writing - review & editing, Validation, Data curation; S.S.: Formal analysis, Writing - review & editing, Validation, Data curation; M.C.: Writing - review & editing, Conceptualization, Supervision.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data availability

The data that supports the findings of this study are available on reasonable request from the corresponding author.

ORCID iDs

Yavuz Sahbat

Serkan Surucu

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