# Quality of Online Information on Patient-Specific Knee Arthroplasty and Its Impact on Personalized Care

## TL;DR

This study shows that online information about patient-specific knee surgery varies in quality, with academic sources being more accurate and transparent than non-academic ones.

## Contribution

The study evaluates the quality and readability of online information on patient-specific instrumentation in knee arthroplasty, highlighting disparities between academic and non-academic sources.

## Key findings

- Academic websites scored significantly higher in quality and accuracy than non-academic ones.
- Non-academic sites often omitted risks and made inaccurate claims about the procedure.
- Readability of all websites was poor, limiting patient understanding and engagement.

## Abstract

Background: Patient-specific instrumentation (PSI) in total knee arthroplasty represents an increasingly relevant component of personalized surgical planning. As nearly half of orthopedic patients search online for medical information before or after clinical consultation, the quality, accuracy, and readability of publicly available digital resources directly influence patient expectations, shared decision-making, and rehabilitation engagement. This study assessed the content, quality, and readability of online information about PSI in TKA. Methods: Google searches using four predefined PSI-related terms were conducted on 6 March 2025. After applying exclusion criteria, 71 websites were included for evaluation. Websites were categorized as academic or non-academic and analyzed for authorship, reporting of advantages and disadvantages, inaccurate assertions, use of peer-reviewed references, multimedia content, and mention of specific PSI platforms. Website quality was assessed using validated quality evaluation tools (QUEST and JAMA criteria), and readability was evaluated using established readability indices (SMOG, FKGL, and FRE). Results: Academic websites demonstrated significantly higher quality than non-academic sources based on QUEST (25.4 vs. 9.8; p < 0.001) and JAMA criteria (3.7 vs. 1.7; p < 0.001). Disadvantages of PSI were reported in 69.1% of academic sites versus 12.5% of non-academic sites (p < 0.001). Inaccurate claims occurred in 31.3% of non-academic sites but were absent in academic sources (p < 0.001). Peer-reviewed references were present in 81.8% of academic websites and only 12.5% of non-academic sites (p < 0.001). Readability was uniformly poor across all websites, with no significant group differences (mean SMOG 13.5; mean FKGL 11.8; mean FRE 32.4). Conclusions: Online information about PSI in total knee arthroplasty varies widely in transparency and accuracy, with non-academic websites frequently omitting risks or presenting misleading claims. Given the role of individualized implant planning, accessible and evidence-based digital content is essential to support personalized patient education and shared decision-making. Because limited readability restricts patient comprehension and informed participation in personalized orthopedic care, improving the clarity and accessibility of digital patient resources is essential.