Shoulder arthroplasty has witnessed continuous evolution over recent decades with continuous developments in techniques and instrumentation [1,2]. Different shoulder arthroplasty procedures have been established, all of which have provided pain relief and restoration of function for a substantial number of patients. As such, a dramatic increase in these procedures has been witnessed over the past decade [2]. Specifically, the reverse shoulder arthroplasty (RSA) has seen a significant growth recently, mainly due to its expanded indications, successful outcomes, and improved implant technology, making it favored over other shoulder procedures [2,3]. Wagner et al. [3] noted a 191.3% increase in the number of reverse shoulder arthroplasty-specific score (RSAS) performed in the United States from 2011 to 2017, indicating a prominent rise in the popularity and utility of this procedure in orthopedic surgery.

Approximately 56% of the total world population used the internet in 2022, compared to around 5% back in 2000 [4]. Seventy-five percent of patients reportedly base their health-related decisions on information acquired through the internet [5]. As such, it is of pivotal importance to have access to reliable online information regarding medical procedures so that patients can make well-informed decisions related to their health care. Among the different sources of information present on the internet, YouTube is one of the most popular with billions of reported users each month and one billion hours of video watching recorded each day [6]. Given that it provides content that can educate patients in an audiovisual format, it comes to no surprise that YouTube constitutes a favorable source of patient education regarding different medical procedures, including those relating to orthopedics like shoulder replacement surgeries [7,8].

As shared decision-making has become a central tenet in the healthcare field, patients play a major role in deciding to undergo an RSA, which is essentially an elective procedure design to reduce pain and restore function in the glenohumeral joint [9]. As such, evaluating the quality of online sources of information like YouTube videos can give insight into what content patients are basing their health care decisions on. Several studies have evaluated video content on YouTube regarding different orthopedic topics [7,8,10,11]. Nevertheless, and to our knowledge, none have explored the quality of content pertaining to RSA. Accordingly, and considering the high rise in utility and popularity of RSA in recent years, the purpose of our study was to evaluate the reliability and educational content of YouTube videos concerning the procedure.

The first 50 videos that appeared in our initial search were included in our analysis. Video duration ranged between 35 seconds and 62 minutes, 47 seconds, with a mean of 12 minutes and 15 seconds (±14 minutes, 56 seconds) (Table 4). The oldest video was uploaded 4,215 days prior to the search, and the most recent video was uploaded 34 days prior to the search. On average, the included videos were uploaded 1,526±1,079.6 days prior to our search (Table 4). The total collective number of views was 3,232,289 views, and total number of likes was 20,684 likes, leading to an average of 64,645.78±264,160.9 views and 414 likes per video (Table 4). The average view ratio was 32.96±127.7, and the average number of likes was 413±1,848.6 per video. There were significant between-group effects observed for the view ratio with the uploader source (P=0.025), with industry videos having the highest view ratio (149.2±335.9).

With regard to video sources, academic centers had the highest number of uploaded videos at sixteen videos (32%), whereas industry-produced videos had the lowest number at seven videos (14%). The most commonly encountered video content was that of patient education with 18 videos (36% each), whereas the least common video content was patient experience with eight videos (16%).

Our study found that the top 50 YouTube videos on RSA accumulated around 3.2 million views, with industry videos acquiring the highest number of views. The videos had mean JAMA, GQS, and RSAS scores of 2.32±0.64, 2.31±0.82, and 5.53±2.43, respectively. Academic centers were the video source with the highest number of videos uploaded, and surgical techniques/approach videos were the most common according to video content. Lecture videos showed and predicted higher JAMA scores, whereas industry videos predicted lower RSAS scores. Considering the prominent involvement of online resources in directing patient health care decisions, addressing the inaccurate content on online platforms is essential.

It is evident through our findings that RSA has been a popular topic among YouTube users, as shown by the large number of views accrued in our study. This falls in line with the rising popularity and prevalence of RSA in shoulder surgery and how it’s garnering much more interest from patients, surgeons, and industry personnel [2,3]. This is also expected given the established popularity of YouTube and the availability of numerous videos and content that convey information and insight regarding different surgical procedures and medical interventions [5]. The ease of the search, as well as the audiovisual presentation of different pathologies and their treatments, renders this tool a valuable resource for people who are planning on making health care decisions [5,22]. In addition, the upload sources with the highest number of views were medical/orthopedic industry sources, and this reflects the increasing commercial and financial interest in this procedure. Uploaded sources related to the medical industry were also found to be negative predictors for RSAS, which is alarming yet expected, given that the main interest of these sources resides in promotion and marketing rather than delivery of quality patient education [23].

In general, YouTube videos proved to be a poor online source for information regarding RSA, as shown by the poor quality scores attained. This falls in line with other YouTube-based studies in the literature that reported a low quality of information for orthopedic-related pathologies and procedures [7,16,20,21,24]. The unrestricted ability to upload videos and the lack of editorial evaluation on accuracy and comprehensiveness of content are potential contributors to the low scores exhibited in our study [8]. This raises concerns for the status of patient education in orthopedics and the ability to make well-informed health care decisions based on the available online video content. It also highlights the importance of proper patient education during clinic visits and appropriate counseling toward reliable and accurate sources of information.

The Kruskal-Wallis test in our study failed to demonstrate significant differences in quality scores between the different uploaded source types. That is surprising considering that academic and physician sources were expected to provide higher quality information than other sources, given the involved knowledge and expertise [8]. Videos with lecture content generally had higher quality scores than did other content types. Lecture videos often involve physicians and surgeons with high knowledge and expertise in their respective fields. These videos are usually thorough, comprehensive, and accurate in delivering information [25]. As such, it is not surprising that these had higher scores in our study. Nevertheless, the concerns with lecture videos are that they are often cater to medical personnel rather than patients, and this limits their appeal to patients, who might prefer shorter videos with simpler concepts and terminologies.

Our study demonstrates important findings regarding the educational value of YouTube videos related to RSA. Given the high number of views and likes accrued by these videos, it is evident that this informative video format is appealing to the RSA patient. Nevertheless, this low informative quality needs to be addressed as online sources play a huge role in patient education and, accordingly, patient-related health care decisions [5]. Introducing an editorial process that monitors medical videos on YouTube may be helpful in limiting the spread of inaccurate or harmful information. If that is not possible, introducing a new platform that publishes reliable expert-reviewed content may be the tool to provide proper education on orthopedic-related topics to patients. In addition, as lectures were shown to generally have better quality scores than other content categories, uploading lecture-based content that caters to patients rather than professionals can be helpful in disseminating credible educational content.

Several limitations exist for this study. While the query “reverse shoulder replacement” may not have provided a thorough representation of all videos targeting this topic, we decreased selection bias by systematically analyzing the first 50 videos in our search. Most internet users do not go beyond the first two pages populated by a search, and this is in accordance with the methodology implemented in our study. Moreover, our study involved the use of an unvalidated quality assessment tool, though several similar studies used similar tools to assess and evaluate online resources with acceptable inter-observer reliability for both the validated and unvalidated tools both in the literature and in our study [7,11,12,16,19-21]. This indicates that the findings in our study relating to low quality of information is, in fact, accurate.

Based on the number of views and likes, our study showed that YouTube videos focusing on RSA are popular and attractive to the prospective patient. Nevertheless, these videos provide a low quality of information on the surgical procedure and do not offer an appropriate educational value. More lectures, which generally had higher quality scores in our study, need to be published, and these need to cater to patients more than to medical professionals. Editorial reviewing of videos that showcase medical content may be required to ensure proper informative material is being disseminated. If that is not possible on YouTube, a new patient-friendly online video sharing platform, with expert peer review, should be developed to ensure accurate and reliable information is available to patients in need.