Lost in Translation: Preoperative Orthopaedic Education Materials Significantly Exceed Recommended Reading Levels

National guidelines recommend that patient education materials are written at or below a 6th-grade reading level. Poor understanding of their care plan after orthopaedic surgery has been associated with worse outcomes, including lower surgical satisfaction and higher postoperative complications. This study evaluates the language availability and readability of orthopaedic patient education materials published by Elsevier and distributed via Epic, the most widely used electronic health record system in the United States.

In March 2025, orthopaedic patient education documents, as well as their easy-to-read versions when available, were extracted from Epic in English and Spanish. Documents were summarized by type, subspecialty, and revision date. Readability was assessed using 5 validated English scoring systems and 2 Spanish systems. Comparisons with recommended grade levels and with their easy-to-read versions were analyzed using t-test, whereas trends over time were assessed using linear regression.

Among 806 patient education documents, English and Spanish versions were available for all documents, but other languages were available for less than 30% of the documents. The mean readability grade level was 8.6 for English and 5.8 for Spanish documents, with 100% and 27% exceeding the recommended 6th-grade level, respectively. Preoperative documents consistently demonstrated the highest grade levels, whereas rehabilitation documents demonstrated lower grade levels across both English and Spanish documents (p < 0.05). Furthermore, musculoskeletal oncology documents consistently had the highest grade levels across document subspecialties (p < 0.05). Easy-to-read versions were only available for 11% of documents and reduced grade level to 7.4 for English and 5.5 for Spanish documents, although 94% and 4% still exceeded the recommended 6th-grade level, respectively. No significant changes in readability were observed over time.

Elsevier's orthopaedic patient education materials, specifically related to preoperative information, are frequently written above recommended reading levels. The scarcity of easy-to-read versions further restricts their availability accessibility. To improve patient comprehension and adherence, efforts should focus on increasing the availability of simplified materials and expanding translation efforts. Artificial intelligence driven solutions may offer a scalable approach to addressing these deficiencies.

Level III. See Instructions for Authors for a complete description of levels of evidence.