Increasing Public Interest in Stem Cell Injections for Osteoarthritis of the Hip and Knee: A Google Trends Analysis

Patient Interest in Quadriceps Autograft Anterior Cruciate Ligament Reconstruction Is Increasing Over Other Autograft Options: A 12-Year Google Trends Analysis

Purpose

To use Google trends to explore differences in public interest among types of anterior cruciate ligament (ACL) autografts, specifically quadriceps tendon, patellar tendon, and hamstring tendon autografts, between 2008 and 2019.

Methods

Data were obtained by querying Google Trends for key terms and phrases for online search data ranging from January 2008 to December 2019. Relative search volumes were created based on searches related to ACL reconstruction with comparative analysis generated for search terms related to quadriceps ACL, patellar tendon ACL, and hamstring ACL autografts. Statistical analysis included linear regression analysis, comparison of quarterly search volume trends over time, and comparison of cumulative annual search volumes for 2008 versus 2019.

Results

Linear models for respective search terms were statistically significant for the quadriceps (P < .001) and patellar (P = .007) tendon autograft groups but not the hamstring group (P = .129). The quadriceps autograft group demonstrated a 12-year search volume trend change of 0.56, which was significantly greater than the hamstring (0.07; P < .001) and patellar tendon (0.168; P < .001) groups. There was no significant difference in the trend change between hamstring and patellar tendon groups (P = .20). Percent change in cumulative relative annual search volumes between 2008 and 2019 was 112% for the quadriceps tendon group, 12.9% for the hamstring group, and 18.6% for the patellar tendon group.

Conclusions

This study indicates a consistently increasing public interest in quadriceps tendon autograft for ACL reconstruction. The quadriceps autograft group demonstrated a significantly greater 12-year online search volume, greater linear correlation, and larger percent change between 2008 and 2019 compared with patellar tendon or hamstring autograft groups.

Clinical Relevance

Awareness of patient perceptions has value in informing shared decision-making, aligning patient expectations, and guiding areas of future research. Each of these has an impact on patient care. Being aware of patient interest and expectations is particularly important in areas with controversial or emerging research.

Exploring Orthopedic Stem-Cell Approaches for Osteoarthritis Management: Current Trends and Future Horizons

PURPOSE OF REVIEW

Osteoarthritis (OA) is a prevalent and debilitating condition characterized by joint degeneration and pain. Current treatment options aim to alleviate symptoms and slow disease progression but lack curative potential. Stem cell therapies have emerged as a promising alternative. This article explores the epidemiology, pathophysiology, clinical manifestations of hip and knee OA, and the evolving role of stem cell therapies in their treatment.

RECENT FINDINGS

The global prevalence of OA, with knee OA being the most common form, has fueled the demand for stem cell therapies. Despite limited robust evidence supporting their efficacy, clinical trials investigating stem-cell treatments for OA have reported encouraging radiological and clinical improvements. Stem cell therapies offer potential disease-modifying benefits through immunomodulatory actions, growth factor secretion, and chondrogenic capabilities. Adipose-derived mesenchymal stem cells (ADMSCs) have shown promise in clinical trials for OA treatment, offering potential pain relief and functional improvement. ADMSCs possess advantages such as accessibility and a favorable safety profile, making them a viable option for OA management. Although other stem-cell types, including human embryonic stem cells (hESCs) and induced pluripotent stem cells (iPSCs), have been used in OA treatment, ADMSCs have demonstrated superior outcomes. By providing a comprehensive overview of the evolving landscape of stem cell therapies for hip and knee OA, this article highlights the potential of stem-cell treatments to address the limitations of current therapies. However, further research is required to establish their long-term efficacy, identify optimal stem-cell types, and develop standardized protocols.

Incidence of Rapidly Progressive Osteoarthritis Following Intra-articular Hip Corticosteroid Injection: A Systematic Review and Meta-Analysis

Background

The American Academy of Orthopedic Surgery recommends intra-articular corticosteroid injections (CSIs) for managing hip osteoarthritis (OA) based on short-term, prospective studies. Recent retrospective studies have raised concerns that CSIs may lead to rapidly progressive OA (RPOA). We sought to systematically review the literature of CSIs for hip OA to estimate the incidence of RPOA.

Methods

MEDLINE, Embase, and Cochrane Library were searched to identify original research of hip OA patients receiving CSIs. Overall, 27 articles involving 5831 patients published from 1988 to 2022 were included. Study design, patient characteristics, CSI details, follow-up, and cases of RPOA were recorded. Studies were classified by their ability to detect RPOA based on follow-up. Random effects meta-analysis was used to calculate the incidence of RPOA for studies able to detect RPOA.

Results

The meta-analytic estimate of RPOA incidence was 6% (95% confidence interval, 3%-9%) based on 10 articles classified as able to detect RPOA. RPOA definitions varied from progression of OA within 6 months to the presence of destructive changes. These studies were subject to bias from excluding patients with missing post-CSI radiographs. The remaining 17 articles were classified as unable to detect RPOA, including all of the studies cited in the American Academy of Orthopedic Surgery recommendation.

Conclusions

The incidence of RPOA after CSIs remains unknown due to variation in definitions and follow-up. While RPOA following CSIs may be 6%, many cases are not severe, and this may reflect selection bias. Further research is needed to understand whether clinically significant RPOA is incident enough to limit CSI use.

Analyzing Public Interest in Osteoarthritis and Its Minimally Invasive Treatments: A Google Trends Analysis

Introduction In recent years, online search engines have become a source of information about medical issues. We aimed to evaluate the public's interest in osteoarthritis and minimally invasive treatments of osteoarthritis in the last 10 years using Google Trends (GT). Methods Interventional physiatrist analyzed 14 selected terms (joint pain, joint pain treatment, joint cartilage damage, narrowing of the joint, osteoarthrosis, osteoarthritis, intra-articular injection, intra-articular steroid, intra-articular hyaluronic acid, intra-articular plasma rich platelet (PRP), essential oil for joint pain, joint pain supplements, home remedies for joint pain, and stem cell for joint) related with osteoarthritis and minimally invasive treatments of osteoarthritis in physical medicine and rehabilitation discipline. All keywords were searched in the GT application using the 'all categories,' 'web search,' and 'worldwide' filters. The last 10 years have been divided into two equal parts, each spanning five years (from January 1, 2013 to December 31, 2017, and January 1, 2018 to December 31, 2022). Public interest in the 14 keywords mentioned above was recorded for these two periods, and the GT for all 14 keywords were compared across the two five-year periods. Results Searching rates for the terms 'joint pain,' 'joint pain treatment,' 'joint cartilage damage,' 'narrowing of the joint,' 'osteoarthritis,' 'intra-articular injection,' 'intra-articular PRP,' and 'joint pain supplements' have increased significantly in the last five years (p= 0.001, p= 0.001, p= 0.005, p= 0.001, p= 0.001, p= 0.004, p= 0.001, and p= 0.001, respectively). The average Google Trends (GT) score for all terms was 40 between January 1, 2013, and December 31, 2017, and the average GT score for all terms was 48 between January 1, 2018, and December 31, 2022 (p= 0.001). Conclusion The present study stated that public interest in osteoarthritis and minimally invasive treatments for osteoarthritis has increased significantly in the last five years. Study outcomes demonstrated that public attention to 'joint pain,' 'joint treatment,' 'joint cartilage damage,' 'narrowing of the joint,' 'osteoarthritis,' 'intra-articular injection,' 'intra-articular PRP,' and 'joint pain supplements' has also significantly increased in the last five years.

Public Interest in Shoulder Platelet-Rich Plasma Injections Is Increasing: A 10-Year Google Trends Analysis

Purpose

To quantify and analyze public interest trends in platelet-rich plasma (PRP) therapy for shoulder pathology between 2011 and 2020 using Google Trends data.

Methods

Google Trends data were queried for online search data ranging from January 2011 to December 2020. Various combinations of terms related to PRP and shoulder pathology were queried. Terms related to corticosteroid therapy in association with shoulder pathology were also generated for comparative analysis. Analyses were performed regarding trends in online search volumes.

Results

Linear models were generated to evaluated trends in the volume of online searches for PRP and corticosteroid therapy for shoulder pathology. For both the PRP and steroid groups, linear models showed a statistically significant increase in search volume for the period studied (P < .001). The PRP group showed a significantly greater growth rate than the steroid group (P < .001). There were no statistically significant differences in online search volume when compared between different geographic and socioeconomic locations.

Conclusions

This study indicates consistently increasing public interest in PRP injections in the shoulder. The rate of online search volume growth of PRP is significantly greater than that of corticosteroid injections for the period studied.

Clinical Relevance

Awareness of patient perceptions has value in informing shared decision making, aligning patient expectations, and guiding areas of future research. Each of these has an impact on patient care. Being aware of patient interest and expectations is particularly important in areas with controversial or emerging research.

Impact of changes in clinical practice guidelines for intra-articular injection treatments for knee osteoarthritis on public interest and social media

OBJECTIVE

To summarize changes in recommendations for injection treatments for knee osteoarthritis (OA) in current clinical practice guidelines (CPGs) and to assess whether these changes have affected public interest according to Google data and content in YouTube videos.

DESIGN

A literature search to identify CPGs revised since 2019 that provide recommendations regarding the five intra-articular injection treatments for knee OA (corticosteroid [CS], hyaluronic acid [HA], stem cell [SC], platelet-rich plasma [PRP], and botulinum toxin [BT]) was conducted to assess perspective changes for each treatment. Data from Google Trends were examined to identify changes in search volume from 2004 to 2021 using a join-point regression model. Relevant YouTube videos were divided into those uploaded before and after changes in CPGs and compared according to degrees of recommendation for each treatment to identify the effect of changes in CPGs on video production.

RESULTS

All eight identified CPGs released after 2019 recommended HA and CS use. Most CPGs were the first to state a neutral or opposing stance concerning the use of SC, PRP, or BT. Interestingly, relative searches on Google for SC, PRP, and BT has increased greater than those for CS and HA. YouTube videos produced after CPGs changed continue to recommend SC, PRP, and BT as much as those produced before CPGs were revised.

CONCLUSIONS

Although knee OA CPGs have changed, public interest and healthcare information providers on YouTube have not reacted to this shift. Improved methods to propagate updates to CPGs warrant consideration.

Alternative and Adjunct Treatments for Scoliosis: A Google Trends Analysis of Public Popularity Compared With Scientific Literature

Purpose As Google searches have often been found to provide inaccurate information regarding various treatments for orthopedic conditions, it becomes important to analyze search trends to understand what treatments are most popularly considered and the quality of information available. We sought to compare the public interest in popular adjunct/alternative scoliosis treatments to the published literature on these topics and assess any temporal trends in the public interest in these treatments. Methods The study authors compiled the most common adjunct/alternative treatments for scoliosis on PubMed. Chiropractic manipulation, Schroth exercises, physical therapy, pilates, and yoga, along with "scoliosis," were each entered into Google Trends, collected from 2004 to 2021. A linear regression analysis of covariance (ANCOVA) was done to determine whether there was a linear relationship between Google Trends' popularity and PubMed publication data. The seasonal popularity of the terms was assessed using locally estimated scatterplot smoothing (LOESS) regression. Results Google Trends and publication frequency linear regression curves were different for chiropractic manipulation (p < 0.001), Schroth exercises (p < 0.001), physical therapy (p < 0.001), and pilates (p = 0.003). Chiropractic manipulation (p < 0.001), Schroth exercises (p = 0.003), and physical therapy (p < 0.001) had positive trends, and yoga (p < 0.001) had a negative trend. Chiropractic manipulation and yoga were more popular in the summer and winter months. Conclusion Google Trends can provide orthopedic surgeons and other healthcare professionals with valuable information on which treatments are gaining popularity with the public, so physicians may specifically inform themselves prior to patient encounters, leading to more productive shared decision-making.

The Relationship Between Public Interest and Surgical Demand During the COVID-19 Pandemic

INTRODUCTION

Surgical databases are useful for examining outcomes and case volume to improve care, while public interest data has the potential to track the supply and demand of medical services in specific communities. However, the relationship between public interest data and case volume from surgical databases, specifically during disruptive instances like the coronavirus pandemic, is unknown. Therefore, the purpose of this study is to determine how public interest data is related to the case volume of coronavirus and other surgical procedures performed during the coronavirus pandemic.

METHODS

This retrospective study included a review of appendectomy, total hip arthroplasty (THA), and total knee arthroplasty (TKA) cases from the National Surgery Quality Improvement Project and relative search volume (RSV) of hip replacement, knee replacement, appendicitis, and coronavirus from Google Trends from 2019 to 2020. T-tests were used to compare surgical caseload and RSV data before and after the COVID-19 surge in March 2020, while linear models were used to determine relationships between confirmed procedures and relative search volumes.

RESULTS

The RSV for knee replacement (p < 0.001, Cohen's D [d] = -5.01, 95% confidence interval [CI]: -7.64 to -2.34) and hip replacement (p < 0.001, d = -7.22, 95% CI: -10.85 to -3.57) had a large dip during the coronavirus pandemic, while the RSV for appendicitis had a smaller dip (p = 0.003, d = -2.37, 95% CI: -3.93 to -0.74). Linear models showed very strong linear relationships between surgical RSV and surgical volume for TKA (R² = 0.931) and THA (R² = 0.940).

CONCLUSIONS

There was a significant reduction in the number of elective surgeries, which correlated to drops in public interest during COVID-19. The strong correlations between RSV, surgical volume, and coronavirus cases indicate that public interest can be used to track and predict surgical case volume. Our findings allow for greater insight into the use of public interest data to gauge surgical demand.

Biologic Therapies for the Treatment of Knee Osteoarthritis: An Updated Systematic Review

BACKGROUND

Use of "orthobiologics" continues to expand for patients who have knee osteoarthritis (OA). We sought to perform a systemic review of biologic therapies relative to comparative groups, including the following: (1) platelet-rich plasma (PRP); (2) bone marrow-derived mesenchymal stem cells (BMSCs); (3) adipose-derived mesenchymal stem cells (ADSCs); and (4) amniotic-derived mesenchymal stem cells (AMSCs). We assessed the following: (1) study methodologies; (2) cell preparations and formulations; (3) patient-reported outcome scores (PROMs); and (4) structural changes.

METHODS

PubMed, Cochrane Library, and Embase databases were queried (2013-2021) to conduct a systematic review of biologic therapies for knee OA, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eighty-two studies were included: PRP (51); BMSC (15); ADSC (11); and AMSC (5). Study evaluations were made using the Modified Coleman Methodology Score. PROMs included the Western Ontario and McMaster Universities Arthritis Index and the Visual Analog Scale. Structural change evaluations included ultrasounds, radiographs, or magnetic resonance imaging.

RESULTS

PRP comprised a majority of the studies (n = 51), most with "fair" to "good" Modified Coleman Methodology Score. Studies had variable cell preparations and formulations, with comparison study results leading to inconsistent PROMs, and structural changes. A limited number of studies were included for BMSC, ADSC, and AMSC, all with similar findings to PRP.

CONCLUSION

Available literature evaluating "orthobiologics" for knee OA remain nonsuperior to comparison cohorts. Higher level studies with larger sample sizes and improved methodologies are warranted to suggest differences. Despite a growth of "orthobiologics" in clinics, this updated systematic review highlights the uncertain efficacy for use in knee OA.

Autologous Adipose-Derived Tissue Stromal Vascular Fraction (AD-tSVF) for Knee Osteoarthritis

Adipose tissue contains adult mesenchymal stem cells that may modulate the metabolism when applied to other tissues. Stromal vascular fraction (SVF) can be isolated from adipose tissue mechanically and/or enzymatically. SVF was recently used to decrease the pain and improve the function of knee osteoarthritis (OA) patients. Primary and/or secondary OA causes inflammation and degeneration in joints, and regenerative approaches that may modify the natural course of the disease are limited. SVF may modulate inflammation and initiate regeneration in joint tissues by initiating a paracrine effect. Chemokines released from SVF may slow down degeneration and stimulate regeneration in joints. In this review, we overviewed articular joint cartilage structures and functions, OA, and macro-, micro-, and nano-fat isolation techniques. Mechanic and enzymatic SVF processing techniques were summarized. Clinical outcomes of adipose tissue derived tissue SVF (AD-tSVF) were evaluated. Medical devices that can mechanically isolate AD-tSVF were listed, and publications referring to such devices were summarized. Recent review manuscripts were also systematically evaluated and included. Transferring adipose tissues and cells has its roots in plastic, reconstructive, and aesthetic surgery. Micro- and nano-fat is also transferred to other organs and tissues to stimulate regeneration as it contains regenerative cells. Minimal manipulation of the adipose tissue is recently preferred to isolate the regenerative cells without disrupting them from their natural environment. The number of patients in the follow-up studies are recently increasing. The duration of follow up is also increasing with favorable outcomes from the short- to mid-term. There are however variations for mean age and the severity of knee OA patients between studies. Positive outcomes are related to the higher number of cells in the AD-tSVF. Repetition of injections and concomitant treatments such as combining the AD-tSVF with platelet rich plasma or hyaluronan are not solidified. Good results were obtained when combined with arthroscopic debridement and micro- or nano-fracture techniques for small-sized cartilage defects. The optimum pressure applied to the tissues and cells during filtration and purification of the AD-tSVF is not specified yet. Quantitative monitoring of articular joint cartilage regeneration by ultrasound, MR, and synovial fluid analysis as well as with second-look arthroscopy could improve our current knowledge on AD-tSVF treatment in knee OA. AD-tSVF isolation techniques and technologies have the potential to improve knee OA treatment. The duration of centrifugation, filtration, washing, and purification should however be standardized. Using gravity-only for isolation and filtration could be a reasonable approach to avoid possible complications of other methodologies.

Public Interest in Hyaluronic Acid Injections for Knee Osteoarthritis in the United States and Europe: An International Google Trends Analysis

Background

Hyaluronic acid injections remain a common nonsurgical alternative for the treatment of knee osteoarthritis despite limited clinical evidence and varying global recommendations regarding its use. We used the Google Trends tool to provide a quantitative analysis of public interest in hyaluronic acid injections for knee osteoarthritis in the United States and Europe.

Methods

We customized Google Trends parameters to obtain search data from January 2009 to December 2019 in both the United States and Europe. Combinations of "arthritis", "osteoarthritis", "hyaluronic acid", "knee arthritis", "knee osteoarthritis", and "knee injection" were entered into the Google Trends tool, and trend analyses were performed.

Results

The models generated to describe public interest in hyaluronic acid for knee injections in both the United States and Europe showed increased Google queries as time progressed (P < .001). The United States growth model displayed linear growth (r² = 0.90) while the European growth model displayed exponential growth (r² = 0.90).

Conclusions

Our results indicate a significant increase in Google queries related to hyaluronic acid injections for knee osteoarthritis since 2009 in both the United States and Europe. Our models suggest that despite mixed evidence supporting its use, orthopedic surgeons should expect continued public interest in hyaluronic acid for knee osteoarthritis. The results of our study may help to prepare surgeons for patient inquiries, inform the creation of evidence-based shared decision-making tools, and direct future research.

An Investigation of Google Searches for Knee Osteoarthritis and Stem Cell Therapy: What are Patients Searching Online?

Background

Stem cell therapies have emerged as a potential treatment for osteoarthritis (OA), but their role remains controversial. Their growing popularity may lead patients to search for information online, but search queries and sources are unknown.

Purpose

We sought to (1) identify the most frequently asked questions on Google related to knee OA and stem cell therapy, (2) assess the types of websites accessed through these searches, and (3) evaluate the transparency of these websites.

Methods

The search terms "knee," "osteoarthritis," and "stem cell" were entered into Google. Frequently asked questions suggested by Google, and their corresponding websites were extracted. Questions and websites were classified by type. Journal of the American Medical Association (JAMA) benchmark criteria were used as a measure of website transparency (range: 0-4). Analysis of variance tests were performed to compare JAMA benchmark criteria between website types.

Results

Of the 145 questions and website extracted, the most common question subtype pertained to non-stem cell treatments (41.4%) for knee OA; the most common website types were medical publishers (24.8%) and nonacademic medical practices (22.8%). JAMA scores were highest for medical publishers (mean: 3.81) and lowest for nonacademic medical practices (mean: 1.55). Nonacademic medical practices had significantly worse JAMA scores compared with commercial, academic, and medical publishers.

Conclusion

The most frequent questions pertained to non-stem cell treatments, although questions related to stem cell efficacy were most common among the 10 most frequent questions. Google searches on knee OA and stem cell therapies often directed the user to websites lacking transparency and verifiable information. Further research is warranted.

The Efficacy of Platelet-Rich Plasma for the Treatment of Knee Osteoarthritis Symptoms and Structural Changes: A Systematic Review and Meta-Analysis

BACKGROUND

Platelet-rich plasma (PRP) usage in orthopedics continues to rise, despite guidelines suggesting non-superiority to comparative cohorts. Therefore, we performed a systematic review and meta-analysis on PRP efficacy using two clinical assessments: (1) Visual Analog Scale and (2) Western Ontario and McMaster Universities Osteoarthritis Index. We assessed consistency and clinical relevancy by determining study heterogeneity (eg, sample sizes, ages, body mass index, arthritic severities, etc.). Comparative cohorts were: (A) hyaluronic acid (HA); (B) corticosteroid (CS); (C) normal saline (NS); and (D) exercise therapy. We performed sub-analyses of structural changes assessed on ultrasound, radiograph, or magnetic resonance imaging .

METHODS

We utilized PubMed, Cochrane Library, and Embase databases up to December 1, 2021, according to Preferred Reporting Items for Systematic-Reviews and Meta-Analyses guidelines. Twenty-four studies met criteria, with comparisons to: HA (n = 11); CS (n = 6); NS (n = 5); and exercise therapy (n = 3). Seven studies assessed structural changes. Evaluations utilized a methodological scoring system. I² statistics and forest plots pooled analyses and delineated study results.

RESULTS

PRP led to Visual Analog Scale and Western Ontario and McMaster Universities Osteoarthritis Index improvements in most studies when compared to HA, CS, and NS (P ≤ .05). Comparison to exercise therapy resulted in inconclusive findings (P ≥ .05). However, substantial heterogeneity (I² ≥ 76%) was reported due to study variability. No differences were found when assessing structural changes or cartilage thickness by magnetic resonance imaging (standardized mean difference -0.01 [-0.19, 0.18], P = .91).

CONCLUSIONS

PRP may be associated with pain and functional improvements but was not clinically relevant (inconsistent study- and patient-metrics). In addition, PRP did not confer superiority when assessing knee-related structural changes.

Patients are Most Interested in Which Hip Arthroplasty Approach? A 15-year Google Trends Analysis

Background

Methods

Results

Conclusions

Differences of Search Engine Digital Footprints Between Podiatrists and Foot and Ankle Orthopaedic Surgeons: A Need to Join the Digital Era

BACKGROUND

Search engines generate lists of the most relevant websites using a keyword or phrase query and are integral in guiding consumer preferences. Digital information is important in the field of medicine, influencing what patients learn about their conditions and who they choose as providers. When two types of healthcare providers, such as podiatry and foot and ankle orthopaedic surgeons (FAOSs), share an overlapping consumer market, whichever group has a larger digital footprint receives increased digital engagement.

METHODS

The Google search engine was used to query nine common foot and ankle-associated terms using a "search term + zip code" format for 150 zip codes divided into urban, suburban, and rural population densities. The first 10 results of each search were classified into one of five categories. Site content was classified as podiatry-oriented, other MD/DO-oriented, or FAOS-oriented. Separately, a ratio between podiatrists and FAOSs was calculated for each population density group. Data were then normalized using this ratio and reanalyzed with the Wilcoxon signed-rank test with significance at P < 0.05.

RESULTS

Of 13,500 total search results, 4,992 (36.9%) were podiatry-oriented, 2,109 (15.6%) were other MD/DO-oriented, and 436 (3.2%) were FAOS-oriented. All geographic areas featured a higher number of podiatry than FAOS-oriented sites. FAOSs have more results per provider in urban areas (P < 0.001), although podiatrists had more in suburban and rural areas (P < 0.001, P < 0.001). Podiatrists have greater digital engagement in descriptive search terms. "Ankle replacement" has greater FAOS engagement in all three geographic areas.

DISCUSSION

Foot and ankle-related Internet search terms results are overwhelmingly composed of podiatry-oriented sites. Per provider, regional differences are demonstrated, with FAOS having more sites in urban areas only. FAOS scope-of-practice terms such as "ankle replacement" still retain greater engagement by FAOSs. Search engine optimization and saturation strategies should be considered.

LEVEL OF EVIDENCE

Level 3 (observational study).

Patient Interest in Robotic Total Joint Arthroplasty Is Exponential: A 10-Year Google Trends Analysis

Background

The use of robotics in arthroplasty continues to increase. Patient demand, patient expectations, and patient-directed marketing by industry and care providers each likely contributes to its increasing popularity. Trends in patient interest have not been well described. We used the online Google Trends tool to analyze trends in national public interest toward robotic and nonrobotic arthroplasty between 2011 and 2021.

Material and methods

Google Trends online was queried for search terms related to nonrobotic hip and knee arthroplasty in addition to robotic hip, robotic knee, and general robotic arthroplasty between January 1, 2011, and December 31, 2021.

Results

Google Trends Data demonstrated a significant linear increase in online searches related to nonrobotic total knee and hip arthroplasty. Online search volume for robotic hip arthroplasty was significant and linear, while that of robotic knee arthroplasty was significant and exponential. When combined, robotic joint arthroplasty demonstrated an exponential trend over the 10-year period. This increase was noted to be statistically significant when compared with nonrobotic arthroplasty search volume.

Conclusion

Our study demonstrates that public interest in robotic total joint arthroplasty has increased significantly from 2011 through 2020. When compared with online search volume for conventional arthroplasty, this increasing growth is statistically significant. Public interest in robotic arthroplasty is anticipated to continue to increase, and care providers should be aware of this trend that impacts patient perceptions and expectations. Despite significant growth in interest for robotic arthroplasty, there is incomplete evidence supporting its use over nonrobotic arthroplasty. Additional high-quality studies are needed to inform provider decision-making and appropriately guide public interest in robot-assisted arthroplasty.

Publication Frequency and Google Trends Analysis of Popular Alternative Treatments to Arthritis

Background

Public interest in alternative, nonoperative treatments for the management of arthritis has increased. Few have been approved by the Food and Drug Administration. The present study aimed to evaluate trends in public and scientific interest in 4 such treatments by assessing Google Trends and publication frequency data, respectively.

Material and methods

Turmeric, stem cell therapy, platelet-rich plasma (PRP) therapy, and cannabidiol (CBD) were studied. For 2010-2019, Google Trends data and publication frequency data on PubMed were collected by year for arthritis and each of the 4 therapies. Linear, quadratic, and exponential regressions were applied, and the best model of growth was identified.

Results

From 2010 to 2019, Google Trends annual scores for arthritis and turmeric (exponential; R²: 90.5%, P < .001), CBD (exponential; R²: 99.3%, P < .001), stem cell therapy (exponential; R²: 86.7%, P < .001), and PRP therapy (linear; R²: 80.6%, P < .001) increased significantly. Search term frequencies for arthritis and CBD exhibited the highest increase (12,929%). Publications in arthritis and turmeric (linear; R²: 74%, P = .001), stem cell therapy (linear; R²: 94.8%, P < .0001), and PRP therapy (linear; R²: 97.1%, P < .0001) increased from 2010 to 2019. However, publications relating to arthritis and CBD have not increased (P = .122).

Conclusion

Regression analysis indicates that public interest in alternative therapies have had a marked increase. The rise in public interest for CBD, and to a lesser extent, turmeric, stem cell therapy, and PRP, has dramatically outstripped scientific evidence on these therapies. Rigorously designed, clinical studies may be beneficial to keep up with the growing popularity of these treatments, especially CBD.

The Role of Mesenchymal Stromal Cells in the Management of Knee Chondral Defects

➤

Mesenchymal stromal cells (MSCs) are a subset of progenitor cells that help to promote tissue healing and regeneration through the secretion of various cytokines and growth factors. Although technically pluripotent, MSCs in vivo rarely repair damaged tissue through direct differentiation and engraftment.

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Augmentation of traditional marrow stimulation techniques with MSCs has been theorized to improve repair tissue quality and defect fill. Clinical trials evaluating this technique are limited but have shown modest improvements compared with isolated marrow stimulation.

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Various scaffolds also have been utilized in combination with MSCs to treat focal chondral defects. Although the techniques described are heterogeneous, many have shown promising early clinical outcomes.

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Newer techniques involving 3-dimensional bioprinted scaffolds seeded with MSCs allow for the recreation of complex architecture, more closely resembling articular cartilage. These techniques are evolving and have not yet been studied in human clinical trials.

Evolution of Nutritional Habits Behaviour of Spanish Population Confined Through Social Media

Introduction: In Spain, on 14 March 2020, a state of alarm is declared to face the health emergency situation caused by the COVID-19 coronavirus, limiting the freedom of movement of people. The Spanish population is confined. Objective: With this situation, "NUTRITIONAL HEALTH IS NOT CONFINED" arises a research project that seeks to promote nutritional education based on the pattern of the Mediterranean diet (MD) using new computer technologies. It is about providing the population with the information of general interest about the promotion of a healthy diet through social networks and analysing the impact of its dissemination, in the form of a longitudinal intervention study of the Spanish nutritional evolution during confinement, with a daily survey format, and it is intended to assess food consumption during the period of confinement. Materials and methods: In total, 936 participants were asked every day. Short publications were published every day based on the scientific evidence (FAO, WHO, AECOSAN) through social media such as Instagram, accompanied by a questionnaire of 11 questions (yes/no) where it was intended to assess the evolution of daily consumption. Results and Discussion: The diffusion through social media has allowed to have a greater reach of the population. We observed that mood throughout confinement generally improves. There are certain eating habits from the MD that are well established in the daily diet of our population, such as the consumption of fruits, vegetables, legumes, dairy products, and eggs. It seems that enjoying good health is a growing concern in pandemic situations, which is why inappropriate behaviours such as "snacking" between meals or the consumption of processed foods such as snacks, industrial pastries, soft drinks, and sweets are avoided, increasing the amount of healthy food such as meat and fish. This study opens up future avenues of research promoting MD and implements new cohort nutritional databases, especially about young adult people, who are adept at navigating digital spaces and therefore using social media.

Trends and Seasonality of Information Searches Carried Out through Google on Nutrition and Healthy Diet in Relation to Occupational Health: Infodemiological Study

This study aimed to analyze and relate the population interest through information search trends on Nutrition and Healthy Diet (HD) with the Occupational Health (OH). Ecological and correlational study of the Relative Search Volume (RSV) obtained from Google Trends query, segmented in two searched periods concerning antiquity; date of query: 20 April 2021. The RSV trends for the analyzed three Topics were: Nutrition (R² = 0.02), HD (R² = 0.07) and OH (R² = -0.72). There was a good positive correlation between Nutrition and OH (R = 0.56, p < 0.001) and a moderate one between HD and OH (R = 0.32, p < 0.001). According to seasons, differences were verified between RSV means in the Topics HD (p < 0.01) and OH (p < 0.001). Temporal dependence was demonstrated on Nutrition searches (Augmented Dickey-Fuller = -2.35, p > 0.05). There was only a significant relationship between the RSV Topic HD (p < 0.05) for the Developing and Least Developed countries. The data on the analyzed RSV demonstrated diminishing interest in the search information on HD and OH as well as a clearly positive trend change in recent years for Nutrition. A good positive correlation was observed between the RSV of nutrition and OH whereas the correlation between HD and OH was moderate. There were no milestones found that may report a punctual event leading to the improvement of information searches. Temporal dependence was corroborated in the RSV on Nutrition, but not in the other two Topics. Strangely, only an association was found on HD searches between the Developing and Least Developed Countries. The study of information search trends may provide useful information on the population's interest in the disease data, as well as would gradually allow the analysis of differences in popularity, or interest even between different countries. Thus, this information might be used as a guide for public health approaches regarding nutrition and a healthy diet at work.

Google Trends Analysis Shows Increasing Public Interest in Platelet-Rich Plasma Injections for Hip and Knee Osteoarthritis

BACKGROUND

Osteoarthritis is a chronic musculoskeletal condition that frequently affects the hip and knee joints. Given the burden associated with surgical intervention for hip and knee osteoarthritis, patients continue to search for potential nonoperative treatments. One biologic therapy with mixed clinical and basic science evidence for treating osteoarthritis is platelet-rich plasma injections into the affected joint. We used the Google Trends tool to provide a quantitative analysis of national interest in platelet-rich plasma injections for hip and knee osteoarthritis.

METHODS

Google Trends parameters were selected to obtain search data from January 2009 to December 2019. Various combinations of "arthritis," "osteoarthritis," "PRP," "platelet-rich plasma," "knee," and "hip" were entered into the Google Trends tool and trend analyses were performed.

RESULTS

Three linear models were generated to display search volume trends in the United States for platelet-rich plasma and osteoarthritis, hip osteoarthritis, and knee osteoarthritis, respectively. All models showed increased Google queries as time progressed (P < .001), with R² ranging from 0.837 to 0.940. Seasonal, income-related, and geographic variations in public interest in platelet-rich plasma for osteoarthritis were noted.

CONCLUSION

Our results demonstrate a significant rise in Google queries related to platelet-rich plasma injections for osteoarthritis of the hip and knee since 2009. Surgeons treating hip and knee osteoarthritis patients can expect continued interest in platelet-rich plasma, despite inconclusive clinical and basic science data. Trends in public interest may inform patient counseling, shared decision-making, and directions for future clinical research.

Utilizing Google Trends to Track Online Interest in Elective Hand Surgery During the COVID-19 Pandemic

Introduction

Elective hand surgery encompasses a large volume of orthopaedic cases annually. Carpal tunnel syndrome, ganglion cysts, and trigger digits are some of the most common pathologies treated by hand surgeons. In the midst of the COVID-19 pandemic, patient's interest in elective hand surgery for these conditions is uncertain. The objective of this study is to use Google Trends to track online interest in elective hand surgery in the United States during the COVID-19 pandemic.

Methods

Online search trends regarding elective orthopaedic hand surgery were obtained via Google Trends from November 2019 to November 2020. Three common hand pathologies in lay terms ("carpal tunnel," "‘ganglion cyst’ + ‘wrist cyst,’" and "trigger finger") and three hand surgery-specific keywords ("hand surgery," "carpal tunnel surgery," and "trigger finger surgery") were used as search terms. The search volume index (SVI) graphs for the United States for both sets of search terms were then generated from the Google Trends data and compared to the seven-day average of new COVID-19 cases per day as reported by the CDC. A separate SVI graph was then created for the search term "coronavirus” and was compared against both sets of search terms as above.

Results

Search trends for all elective hand pathologies and surgery-specific keywords remained constant from November 2019 to the beginning of March 2020 and then decreased significantly within a one-month period following the peak in COVID-19 cases the week of March 15, 2020. Search trends for these keywords increased to baseline levels over the next few months. The search trend for "coronavirus" demonstrated a small search volume index peak of 13 during January 2020 followed by the maximum peak of 100 during the week of March 15, 2020, corresponding to the decrease in search trends of elective hand surgery at that time.

Conclusions

Online interest in elective hand surgery remained constant prior to the COVID-19 pandemic; however, there was a marked decrease in search trends of elective hand surgery with the rise in daily reported COVID-19 cases, suggesting that patient's interest in elective hand surgery decreased with the onset of the pandemic.

Using Google Trends to Identify Seasonal Variation in Foot and Ankle Pathology

BACKGROUND

Google Trends proves to be a novel tool to ascertain the level of public interest in pathology and treatments. From anticipating nascent epidemics with data-driven prevention campaigns to identifying interest in cosmetic or bariatric surgery, Google Trends provides physicians real-time insight into the latest consumer trends.

METHODS

We used Google Trends to identify temporal trends and variation in the search volume index of four groups of keywords that assessed practitioner-nomenclature inquiries, in addition to podiatric-specific searches for pain, traumatic injury, and common podiatric pathology over a 10-year period. The Mann-Kendall trend test was used to determine a trend in the series, and the Wilcoxon signed-rank test was used to determine whether there was a significant difference between summer and winter season inquiries. Significance was set at P ≤ .05.

RESULTS

The terms "podiatrist" and "foot doctor" experienced increasing Search Volume Index (SVI) and seasonal variation, whereas the terms "foot surgeon" and "podiatric surgeon" experienced no such increase. "Foot pain," "heel pain," "toe pain," and "ankle pain" experienced a significant increase in SVI, with "foot pain" maintaining the highest SVI at all times. Similar results were seen with the terms "foot fractures," "bunion," "ingrown toenail," and "heel spur." These terms all experienced statistically significant increasing trends; moreover, the SVI was significantly higher in the summer than in the winter for each of these terms.

CONCLUSIONS

The results of this study show the utility in illustrating seasonal variation in Internet interest of pathologies today's podiatrist commonly encounters. By identifying the popularity and seasonal variation of practitioner- and pathology-specific search inquiries, resources can be allocated to effectively address current public inquiries. With this knowledge, providers can learn what podiatric-specific interests are trending in their local communities and market their practice accordingly throughout the year.

Efficacy and safety of mesenchymal stem cell injections for patients with osteoarthritis: a meta-analysis and review of RCTs

INTRODUCTION

Osteoarthritis (OA), which has a high incidence in the elderly, brings a huge economic burden to society. MSCs (Mesenchymal Stem Cells) have shown great multidirectional differentiation potential which are expected to treat OA, and numerous clinical trials have been conducted. However, the efficacy and safety of the MSCs still need to be further integrated and analyzed.

MATERIALS AND METHODS

We searched several databases (PubMed, EMBASE, Scopus, Web of Science, Cochrane Library, Ovid, and ScienceDirect) for assessing eligible trials that randomized controlled trials, hyaluronic acid as control, and MSCs injection to treat OA. Vitro studies and animal studies were excluded. Search terms were: "cartilage," "clinical trial," "mesenchymal," "stromal" and "stem cell", "osteoarthritis". The preliminary guidelines and study protocol were published online at PROSPERO.

RESULTS

Many assessment scales could not be improved significantly after 6 months. However, most of the scales were significantly improved after 12 months, indicating that compared with hyaluronic acid, stem cells could relieve OA symptoms significantly. No serious adverse effect was found.

CONCLUSION

There are significant therapeutic effects on joint function, symptoms, and no permanent adverse effect has been found after stem cell treatment. It is promising to apply intro-articular injection of stem cells for OA to clinical application. More researches are needed to supplement present deficiencies.

Regenerative Injectable Therapies: Current Evidence

Regenerative medicine is a growing field of musculoskeletal treatments that focuses on amplifying the body's natural healing properties to improve function and pain after injury. Regenerative treatments are applied locally at the site of injury and work though different mechanisms, some of which are unexplained at this time. Current evidence demonstrates benefit for certain regenerative treatments, but further standardization of treatments and additional studies are required to provide additional data to support specific regenerative treatments. This review seeks to explore the evidence and discuss appropriate use of the most common regenerative treatments including platelet-rich plasma, prolotherapy, autologous mesenchymal stem cells, human-derived allograft products, and saline.

Public Interest in Knee Replacement Fell During the Onset of the COVID-19 Pandemic: A Google Trends Analysis

BACKGROUND

The COVID-19 pandemic significantly altered medical practice and public behavior in the USA. In spring of 2020, elective surgery including most joint replacement was suspended and much of the public asked to stay at home. As elective surgery resumes, it is unknown how the public will respond.

QUESTIONS/PURPOSES

We sought to describe public interest in knee replacement during the onset of the COVID-19 pandemic.

METHODS

Google Trends was used to obtain the daily number of searches for "knee replacement," "coronavirus," and "knee pain" from December 19, 2019, to May 14, 2020. The number is on a term-specific scale weighted to the highest number of daily searches for that term. Seven-day weighted averages were used to smooth the data.

RESULTS

The number of daily searches for "knee replacement" was stable until around March 8, 2020, after which it decreased through late March, plateauing at less than half the number of searches. At the same time, searches for "coronavirus" spiked. By early May, searches for "knee replacement" had not meaningfully increased, though at the end of the search period the slope turned positive and coronavirus searches decreased. Searches for "knee pain" initially followed a similar pattern to "knee replacement," though the decline was not as steep, and by late April searches for "knee pain" had meaningfully increased.

CONCLUSION

Public interest in knee replacement, assessed through internet search queries, decreased during the onset of the COVID-19 pandemic. While interest in pain has returned, the continued decreased level of interest in surgery may represent a fear of surgery among the general public in the setting of COVID-19. Surgeons may wish to focus outreach and education efforts on the safety and efficacy of knee replacement.

Rapid Decline in Online Search Queries for Hip and Knee Arthroplasties Concurrent With the COVID-19 Pandemic

BACKGROUND

In response to the coronavirus disease 2019 (COVID-19) pandemic, US hospitals have canceled elective surgeries. This decline in total joint arthroplasty (TJA) revenue may place financial strain on hospitals. Our goal was to quantify the impact of COVID-19 on the public interest in elective TJA.

METHODS

The Google Search Volume Index (GSVI) identified the terms "knee replacement," "hip replacement," and "orthopedic surgeon" as the most common to describe TJA. The term "elective surgery cancellation" was also analyzed. Weekly GSVI data were extracted between 04-01-2015 and 04-04-2020. Time series analysis was conducted and state GSVI values were compared with COVID-19 prevalence and unemployment claims.

RESULTS

The relative public interest in elective TJA has sharply declined since the WHO declaration of COVID-19 as a global pandemic. Between 03-01-2020 and 03-29-2020, the popularity of searches for "knee replacement", "hip replacement," and "orthopedic surgeon" dropped by 62.1%, 52.1%, and 44.3%, respectively. A concurrent spike was observed for the term "elective surgery cancellation." California, New Hampshire, Maine, and Nevada showed a low relative rate for TJA searches, and the highest increase in unemployment claims.

CONCLUSION

The onset of COVID-19 correlates with declining relative popularity of searches related to elective TJA. Higher volume of COVID-19 cases in certain states may correspond with lower relative search popularity, although this correlation remains unclear. These results portend the possibility of a decline in elective TJA case volume, further straining hospitals. Further research is required to inform stakeholders how best to proceed and determine any sustained effects from the current diminished relative interest in TJA.

LEVEL OF EVIDENCE

Level III.

Public Interest in Sports Medicine and Surgery (Anterior Cruciate Ligament, Meniscus, Rotator Cuff) Topics Declined Following the COVID-19 Outbreak

Purpose

To quantify the coronavirus disease 2019 (COVID-19) pandemic's impact on public interest in sports medicine and surgery topics.

Methods

The Google Trends analysis tool (Google Search Volume Indices [GSVI]) was used to collect search information regarding orthopaedic sports medicine terms ("ACL," "meniscus," "rotator cuff") and sports surgery terms ("ACL surgery," "meniscus surgery," "rotator cuff surgery") from May 2015 to May 2020. A time series analysis was performed for these GSVIs and compared to the timing of the pandemic.

Results

Interest in both sports medicine and surgery declined following the COVID-19 outbreak. Following the World Health Organization's statement on COVID-19's pandemic status on March 11, 2020, searches for "ACL," "meniscus" and "rotator cuff" declined by 34.78%, 43.95%, and 31.37%, and search for "ACL surgery," "meniscus surgery" and "rotator cuff surgery" declined by 42.70%, 51.88%, and 53.32%, respectively.

Conclusion

The COVID-19 outbreak correlated with a decline in public interest in sports medicine and sports surgery topics, as measured by Google searches.

Clinical relevance

Orthopaedic sports medicine and arthroscopy patient and surgical case volumes were negatively affected by various factors after the onset of the pandemic. One factor associated with the volume decrease is a decline in public interest.

Minimally Invasive Therapies for Osteoarthritic Hip Pain: a Comprehensive Review

PURPOSE OF REVIEW

Osteoarthritis (OA) is a highly prevalent cause of chronic hip pain, affecting 27% of adults aged over 45 years and 42% of adults aged over 75 years. Though OA has traditionally been described as a disorder of "wear-and-tear," recent studies have expanded on this understanding to include a possible inflammatory etiology as well, damage to articular cartilage produces debris in the joint that is phagocytosed by synovial cells which leads to inflammation.

RECENT FINDINGS

Patients with OA of the hip frequently have decreased quality of life due to pain and limited mobility though additional comorbidities of diabetes, cardiovascular disease, poor sleep quality, and obesity have been correlated. Initial treatment with conservative medical management can provide effective symptomatic relief. Physical therapy and exercise are important components of a multimodal approach to osteoarthritic hip pain. Patients with persistent pain may benefit from minimally invasive therapeutic approaches prior to consideration of undergoing total hip arthroplasty. The objective of this review is to provide an update of current minimally invasive therapies for the treatment of pain stemming from hip osteoarthritis; these include intra-articular injection of medication, regenerative therapies, and radiofrequency ablation.

Analysis of Readability, Quality, and Content of Online Information Available for "Stem Cell" Injections for Knee Osteoarthritis

BACKGROUND

An increasing number of patients use the Internet to obtain health information, although online information is unregulated and highly variable. We aimed to assess the readability, quality, and content of online information available for "stem cell" injections for knee osteoarthritis.

METHODS

A cross-sectional analysis was performed on March 2019, inputting the search term "stem cells osteoarthritis" into the 3 most popular global search engines: Google, Bing, and Yahoo. The first 50 search results of each engine were evaluated/categorized. Readability was assessed using Flesch-Kincaid Ease/Grade Level. Quality/content was assessed through DISCERN score and a stem cell content score created for this study.

RESULTS

Eighty-two websites were analyzed (18 academic websites, 21 commercial, 13 government/non-profit, 30 physician). Among all websites, mean Flesch-Kincaid readability was 35.9 with a grade level of 13.6. The average DISCERN score was 49.5/80 with statistically significant differences between academic vs physician websites (64.6 vs 38.1, P < .001), and commercial vs physician websites (52.3 vs 38.1, P = .001). Mean stem cell content score was 6.5/19 with a statistically significant difference between academic vs physician websites (8.5 vs 5.1, P = .007).

CONCLUSION

Readability of online materials available for patients regarding "stem cell" treatment for knee osteoarthritis is significantly higher than the grade 6-8 recommended by the National Institutes of Health. The quality and content of websites is highly variable, with physician websites scoring especially low. Improving quality and readability of online materials that discuss risks/benefits of stem cell injections may potentially enhance the physician-patient therapeutic alliance and indirectly lead to better patient outcomes.