Journal of Orthopaedic Surgery最新文献

{"title":"Arthroscopic additional biceps augmentation and biceps superior capsular reconstruction yield similar clinical and radiological outcomes for patients with medium to large rotator cuff tears.","authors":"Meng Huan Tsai, Poyu Chen, Alexandre Lädermann, Cheng-Pang Yang, You-Hung Cheng, Chen-Heng Hsu, Joe Chih-Hao Chiu","doi":"10.1177/10225536251345183","DOIUrl":"https://doi.org/10.1177/10225536251345183","url":null,"abstract":"<p><p><b>Purpose:</b> To compare the outcomes of additional biceps augmentation (ABA) and biceps superior capsule reconstruction (BSCR) in arthroscopic medium to large rotator cuff tear (RCT) repair. <b>Hypothesis:</b> Both ABA and BSCR yielded comparable clinical and radiological outcomes and retear rates at the 2-year follow-up in patients with medium to large RCTs. <b>Methods:</b> Patients undergoing ABA or BSCR for RCT repairs were included retrospectively between January 2019 and May 2020. The preoperative and postoperative Constant-Murley score (CMS), American Shoulder and Elbow Surgeons (ASES) score, subjective shoulder value (SSV), visual analog scale (VAS), and range of motion (ROM) were recorded, as well as the radiographic evaluation. <b>Results:</b> 67 patients (41 with ABA, 26 with BSCR) were included. There were no significant differences regarding preoperative patient demographics between groups unless forward flexion. In the ABA group, CMS, ASES, SSV, and VAS improved significantly from 33.9 ± 6.0, 37.3 ± 8.7, 24.9 ± 12.3, and 5.1 ± 1.1 to 79.3 ± 8.4, 82.7 ± 8.4, 77.5 ± 10.9, and 2.4 ± 0.6, at 2-year follow-up (all <i>p</i> < .001). In the BSCR group, the CMS, ASES, SSV, and VAS significantly improved from 33.9 ± 5.5, 33.5 ± 11.6, 20.8 ± 9.8, and 5.3 ± 1.5 to 72.8 ± 12.9, 79.6 ± 12.1, 73.1 ± 10.2, and 2.7 ± 0.8, at follow-up (all <i>p</i> < .001). All ROM improved at follow-up in both groups (all <i>p</i> < .001). No significant differences were found between the two groups regarding the postoperative clinical and radiological results. All patients reached minimal clinically important differences for CMS, ASES, SSV, and VAS at the final follow-up. The retear rates in the ABA and BSCR groups were 0% and 7.7%, respectively (<i>p</i> = .001). <b>Conclusions:</b> Both ABA and BSCR provided similar clinical and radiological outcomes in patients with medium to large RCTs. The BSCR group had a higher retear rate than the ABA group. <b>Level of Evidence:</b> Level III, Retrospective comparative therapeutic trial. <b>Clinical Relevance:</b> Both ABA and BSCR provided comparable clinical and radiological outcomes in patients with medium to large RCTs.</p>","PeriodicalId":16608,"journal":{"name":"Journal of Orthopaedic Surgery","volume":"33 2","pages":"10225536251345183"},"PeriodicalIF":1.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraosseous endoscopic-assisted lesion debridement combined with free fibular vascularized transplantation for non-traumatic femoral head necrosis: A comparative study with core decompression.","authors":"Yalong Yang, Zhao Zhang, Yuanyuan Wei, Yang Li, Junliang Liu, Bo Wang, Shouhu Mi, Jintong Liu, Yongqiang Zhang, Yongming Guo, Meng Wu","doi":"10.1177/10225536251348726","DOIUrl":"https://doi.org/10.1177/10225536251348726","url":null,"abstract":"<p><p>BackgroundNon-traumatic femoral head necrosis results from insufficient blood supply to the femoral head, causing hip pain, restricted movement, and eventual collapse. This study compares the efficacy of endoscopy-assisted lesion debridement with free vascularized fibular grafting versus core decompression (CD) to identify a more effective surgical approach for treating osteonecrosis of the femoral head (ONFH).MethodsThis retrospective study included 83 patients with femoral head necrosis who were treated between January 2010 and December 2020. The patients were divided into Group A (intraosseous endoscopic-assisted lesion debridement combined with free fibular grafting, <i>n</i> = 45) and Group B (CD, <i>n</i> = 38) based on their treatment approach. Preoperative general data, intraoperative variables such as operation time and blood loss, and postoperative assessments of Harris Hip Score, Visual Analog Scale (VAS), as well as imaging evaluations through X-ray and MRI for femoral head shape restoration and healing, were conducted at 1 week, 4 weeks, 3 months, 6 months, and 12 months post-surgery.ResultsA follow-up of more than 2 years was conducted for both groups of patients. Preoperative general data, such as age, showed no significant difference between the two groups (<i>p</i> > 0.05). Group A patients had significantly better Harris Hip Scores at 3, 6, and 12 months postoperatively, as well as significantly lower VAS scores at 4 weeks, 3 months, 6 months, and 12 months post-surgery compared to Group B (<i>p</i> < 0.05). In Group A, 3 patients experienced elevated body temperature (maximum 38.6°C), which was considered to be postoperative absorption heat; their temperatures returned to normal within 2-3 days following symptomatic treatment. All surgical incisions in both groups healed well, with no vascular or nerve injuries or other related complications. Additionally, imaging results showed that 4 hips in Group A developed femoral head collapse, compared to 10 hips in Group B. In Group A, 4 patients (4/45, 8.9%) with collapse were in ARCO stage II, while in Group B, 6 patients (6/38, 15.7%) were in ARCO stage I and 4 patients (4/38, 10.5%) were in ARCO stage II. Overall, Group A had a non-collapse rate of 91.1% (41/45) in early-stage femoral head necrosis, which was significantly higher than Group B's 73.7% (28/38) (<i>p</i> < 0.05).ConclusionIntraosseous Endoscopic-assisted lesion debridement combined with free fibular grafting shows superior clinical efficacy compared to CD in the treatment of femoral head necrosis. It effectively improves femoral head morphology, alleviates pain, restores joint function, and has a lower complication rate, making it a promising approach for further clinical application and promotion.</p>","PeriodicalId":16608,"journal":{"name":"Journal of Orthopaedic Surgery","volume":"33 2","pages":"10225536251348726"},"PeriodicalIF":1.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ensemble learning guided survival prediction and chemotherapy benefit analysis in high-grade chondrosarcoma: A study based on the surveillance, epidemiology, and end results (SEER) database.","authors":"Xu Zheng, Longqiang Shu, Shanyi Lin, Hanqiang Jin, Xiaoyu Wang, Ting Yuan","doi":"10.1177/10225536251340113","DOIUrl":"https://doi.org/10.1177/10225536251340113","url":null,"abstract":"<p><p><b>Purpose:</b> The chemotherapy benefit for high-grade chondrosarcoma remains controversial. Ensemble learning has better overall performance than single computational approaches for clinical decision. The primary objective was to select prognostic variables and develop optimal ensemble learning algorithms for survival prediction and analyzing chemotherapy benefit in high-grade chondrosarcoma. The secondary objective included identifying specific patient groups with estimated survival benefit for guidance in chemotherapy strategies. <b>Methods:</b> The data of 1931 patients with chondrosarcoma from 2000 to 2019 were obtained from the Surveillance, Epidemiology, and End Results database to conduct the retrospective analysis. Among 468 patients with high-grade chondrosarcoma, cox proportional hazards models and random survival forests were used for feature selection. Ensemble learning and survival support vector machine with different kernel methods were developed and compared for their prognostic performance. <b>Results:</b> Ensemble learning outperformed the single models, with the concordance index reaching 0.764 (based on inverse probability of censoring weights) and the mean area under time-dependent receiver operating characteristic curve of 0.851. According to the ensemble model, overall survival generally improved in younger patients after chemotherapy. Age-stratified analysis revealed differential chemotherapy benefits across various clinical subgroups. Survival benefits were observed in: Age ≤ 10 with dedifferentiated chondrosarcoma, amputation, local surgical treatment, absence of distant metastasis, or grade III tumor; Age ≤ 20 who were male with clear cell chondrosarcoma, non-axial primary sites, or no radiotherapy; Age ≤ 30 who were female with primary site at pelvis/limb, received radiotherapy, extension beyond periosteum, further extension, or distant metastasis; Age≤40 with chondrosarcoma NOS (including mesenchymal, juxtacortical and classical chondrosarcoma); Age ≤ 50 with grade IV tumor or no surgery received. <b>Conclusion:</b> Ensemble learning algorithms demonstrate outstanding overall performance in prognostic assessment of high-grade chondrosarcoma and identification of age-specific factors associated with chemotherapy benefit for tailored chemotherapy strategy.</p>","PeriodicalId":16608,"journal":{"name":"Journal of Orthopaedic Surgery","volume":"33 2","pages":"10225536251340113"},"PeriodicalIF":1.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144002955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alteration of foot loading pattern in patients with lower limb endoprothesis surgery and functional outcome: A pilot study.","authors":"Vivek Ajit Singh, Hartharanjeet Singh Phinder, Amber Haseeb, Rupini Devi Santharalinggam, Nor Faissal Yasin","doi":"10.1177/10225536251326059","DOIUrl":"10.1177/10225536251326059","url":null,"abstract":"<p><p>IntroductionEndoprosthetic reconstruction is a widely used technique; however, it is associated with various postoperative complications. One often overlooked complication is the alteration of foot loading patterns. This pilot study evaluated functional outcomes with postoperative static foot loading patterns in patients undergoing endoprosthesis replacements compared to the contralateral limb.ObjectiveThis study evaluates static foot loading patterns in patients undergoing endoprosthetic replacements. It explores the relationship between the functional outcomes of the operated limb and foot loading patterns in a standing position. Additionally, the study considers factors such as the anatomical location of the endoprosthetic reconstruction, limb length discrepancy, age, gender, and body mass index (BMI).Materials and MethodsThis prospective cross-sectional study included 100 patients over 15 years who had undergone lower limb endoprosthetic reconstruction at least 1 year prior and could walk unaided. Data collection encompassed patient demographics, diagnosis, anthropometric measurements, postoperative functional status (evaluated using AOFAS-Hindfoot, MSTS, and TESS scores), and postoperatively analysis of foot loading patterns.ResultsThe patient group has a significantly higher prevalence of abnormal foot arches compared to the expected population proportion. Notably, 10% of patients transitioned from a normal arch to flatfoot, while 40% developed a high arch post-surgery. Asymmetrical arches were observed in 30 patients. Post-surgery, 18.5% of patients experienced a transition from a normal foot arch to a high arch, and 4.6% transitioned to flatfoot. Analysis of variables such as surgical site, limb length discrepancy, age, gender, BMI, foot loading patterns and functional scores (MSTS, TESS and AOFAS) showed no significant associations with these changes.ConclusionAlthough no significant correlation was identified between functional scores and foot loading patterns following lower limb endoprosthetic surgery, a notable prevalence of abnormal foot arches was observed. We recommend routine podiatry consultations for these patients to address and manage potential foot-related complications.</p>","PeriodicalId":16608,"journal":{"name":"Journal of Orthopaedic Surgery","volume":"33 1","pages":"10225536251326059"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preventing neurological deterioration after ambulation in posterior decompression and fusion for thoracic ossification of the posterior longitudinal ligament.","authors":"Toru Funayama, Masao Koda, Hiroshi Takahashi, Hiroshi Noguchi, Kousei Miura, Hisanori Gamada, Shun Okuwaki, Tomoaki Shimizu, Kotaro Sakashita, Takahiro Sunami, Masaki Tatsumura, Masashi Yamazaki","doi":"10.1177/10225536251338903","DOIUrl":"https://doi.org/10.1177/10225536251338903","url":null,"abstract":"<p><p>PurposeThe objective of this study was to clarify the characteristics of immediate neurological deterioration (ND) after ambulation and its potential preventative measures using multi-rod reinforcement during posterior decompression and fusion (PDF) with instrumentation for thoracic ossification of the posterior longitudinal ligament (T-OPLL).MethodsStudy 1: Fifteen patients with T-OPLL who underwent PDF before 2020 were included. Demographic, radiographic, intraoperative, and postoperative data were compared between the 6 patients with ND and 9 patients without ND after ambulation. Study 2: The primary (incidence of ND after ambulation) and the secondary (postoperative hospital stay) outcomes were compared between 15 patients with a multi-rod construct since 2020 (multi-rod group) and 15 patients with a dual-rod construct before 2020 (dual-rod group; patients who were indicated in study 1).ResultsStudy 1: ND after ambulation tends to occur only in the upper or middle thoracic spine. The mean maximum OPLL occupation ratio was significantly different between the groups (ND vs non-ND, 67.7% vs 53.4%; <i>p</i> = .021). Study 2: The incidence of ND after ambulation (dual-rod vs multi-rod, 40% vs 6.7%; <i>p</i> = .040) and the mean duration of the postoperative hospital stay (dual-rod vs multi-rod, 51.2 days vs 25.6 days; <i>p</i> = .007) were significantly different between the groups.ConclusionsImmediate ND after ambulation occurs in the upper or middle thoracic spine, and a higher maximum OPLL occupation ratio is a significant risk factor. Multi-rod reinforcement can reduce its incidence, regardless of maximum OPLL occupation ratio, and duration of postoperative hospital stay, which could be a potential preventative measure.</p>","PeriodicalId":16608,"journal":{"name":"Journal of Orthopaedic Surgery","volume":"33 1","pages":"10225536251338903"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144009477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dynamic evaluation of vertebral alveolar echinococcosis using MR T2 mapping.","authors":"Jinhuan Han, Yushan Chang, Hui Guo","doi":"10.1177/10225536251318140","DOIUrl":"10.1177/10225536251318140","url":null,"abstract":"<p><strong>Objective: </strong>To explore the diagnostic value of MR T2 mapping in monitoring and evaluating the rabbit vertebral model with <i>Echinococcus multilocularis</i> infection.</p><p><strong>Materials and methods: </strong>24 New Zealand white rabbits were randomly divided into the experimental group (<i>n</i> = 16), saline control group (<i>n</i> = 4), and blank control group (<i>n</i> = 4). The experimental group underwent surgery to drill holes on the surface of the spinous process of the 12th thoracic vertebra, fill it with a gelatin sponge, and adsorb multilocular hydatid suspension. The saline control group received an operation with saline, and the blank control group did not receive any intervention. The model rabbits were dynamically evaluated by routine MRI and MR T2 mapping once a month after surgery, 6 times. Two rabbits with positive imaging results were randomly selected every 2 months for histopathological examination to evaluate the severity and pathological features of the rabbit model with <i>Echinococcus multilocular</i> infection.</p><p><strong>Results: </strong>There was no significant difference in the T2 mapping values between the diseased vertebrae and the undiseased vertebrae in the experimental group at the 1st month after surgery (<i>t</i> = 1.7, <i>p</i> = .119), and the differences were statistically significant at the 2nd to 6th month after surgery (<i>p</i> < .05). In the 1st and 2nd months after an operation, there was no significant difference in T2 values between the vertebrae of the saline control group, the blank control group, and the experimental group. In the third, fourth, fifth, and sixth months after surgery, the vertebrae of the experimental group were compared with that of the saline control group and the blank control group, and the difference was statistically significant (<i>p</i> < .05). There was no significant difference in T2 mapping values every month after surgery between the saline control group and the blank control group (<i>p</i> > .05).</p><p><strong>Conclusion: </strong>The MR T2 mapping technique can quantitatively evaluate the changes of vertebral alveolar echinococcosis, and it shows sensitivity to pathological changes in vertebrae prior to detectable damage using conventional MRI; this offers potential for early detection of vertebral alveolar echinococcosis.</p>","PeriodicalId":16608,"journal":{"name":"Journal of Orthopaedic Surgery","volume":"33 1","pages":"10225536251318140"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The future outlook for data in orthopedic surgery: A new era of real-time innovation.","authors":"Nicolaas C Budhiparama, Nanne P Kort, Rèmigio Kort, Imelda Lumban-Gaol","doi":"10.1177/10225536251331664","DOIUrl":"10.1177/10225536251331664","url":null,"abstract":"<p><p>The orthopedic field is on the brink of a significant transformation-a shift from retrospective analysis to real-time decision-making fueled by data. The dependence on historical trends or long-term studies is yielding to an era where data flows dynamically, allowing medical professionals to adjust protocols instantly. This isn't just an evolution; it's a revolution. Data is no longer a passive observer of outcomes-it's an active participant in shaping them.Imagine a future where wearable devices, artificial intelligence (AI) algorithms, and predictive analytics come together to guide surgeons in real time. For example, wearables monitor vital signs during surgery and oversee rehabilitation while AI analyzes data to predict complications. Postoperative protocols adapt to individual recovery journeys, not averages. Complication risks are flagged preemptively, and treatment plans evolve with patient progress. This shift empowers orthopedic professionals to respond and anticipate, creating a level of care precision that was once unimaginable.What if we viewed data not merely as a tool but as collaborators? With AI and machine learning, the surgical suite of tomorrow transforms into ecosystems where data communicates directly providing insights, suggesting strategies, and enhancing outcomes. This collaborative approach encourages our conventional medical mindset to prioritize adaptability and individualization.The provocative truth is that the game-changer in orthopedics isn't a new implant design or surgical technique-it's the mindset shift to trust real-time data as the foundation of every decision. Orthopedics is no longer about perfecting procedures but refining protocols for every patient consistently.As we race toward the future, equitable access becomes crucial. As William Gibson noted, \"The future is already here - it's just not very evenly distributed.\" We must ensure these breakthroughs reach everyone, bridging the gap between potential and practice. The future of orthopedics isn't just a vision - it's a promise, and it's time to deliver.</p>","PeriodicalId":16608,"journal":{"name":"Journal of Orthopaedic Surgery","volume":"33 1","pages":"10225536251331664"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Innovative 3D-printed porous TC4 prosthesis with nano-thin tantalum coating for treating complex wrist bone defects: A preliminary report of 3 cases.","authors":"Chang Chen, Huaquan Fan, Ge Chen, Zhong Li, Puquan Wang, Fuyou Wang","doi":"10.1177/10225536251335363","DOIUrl":"https://doi.org/10.1177/10225536251335363","url":null,"abstract":"<p><p><b>Background:</b> Bone defects pose a significant orthopedic challenge, impacting millions of patients worldwide annually. In our prior research, we innovatively applied magnetron sputtering (MSP) technology to prepare nano thin amorphous tantalum (Ta) coatings on titanium alloy (Ti - 6Al - 4V, TC4) substrate, achieving exceptional interfacial adhesion, comprehensive coverage, and notable biological attributes. The purpose of this study is to investigate the clinical outcomes of TC4-based Ta-coated implants in addressing wrist bone defects, thereby offering valuable insights for future clinical applications. <b>Methods:</b> A prospective observational study was conducted from October 2023 to December 2024 to assess the clinical efficacy of TC4-based Ta-coated implants. Three patients, comprising two males and one females, were included and underwent personalized prosthesis design and surgical implantation in accordance with established protocols. Postoperative assessments were conducted utilizing the Visual Analogue Scale (VAS), and Cooney modification of the Green and O'Brien score to gauge the patients' symptomatic relief and functional recovery. Additionally, regular imaging follow-ups were implemented to monitor the progress and outcomes. <b>Results:</b> All three patients underwent surgery successfully. As of the latest follow-up, all patients exhibited significant improvements in pain symptoms (assessed using VAS scores) and functional outcomes. No patients experienced serious complications such as infection, prosthesis loosening, or vascular and nerve damage. <b>Conclusion:</b> This study confirmed the clinical efficacy of customized TC4-based Ta-coated implants in the treatment of wrist bone defects. The nanoscale Ta coating significantly enhances the bone integration ability, thereby effectively improving clinical outcomes. This innovative approach not only demonstrates the potential to overcome the inherent drawbacks of conventional titanium alloys and pure Ta but also offers a highly prospective solution for the treatment of complex wrist bone defects. Future research should be directed towards enhancing manufacturing processes and undertaking more extensive clinical trials for providing evidence-based guidance for clinical applications.</p>","PeriodicalId":16608,"journal":{"name":"Journal of Orthopaedic Surgery","volume":"33 1","pages":"10225536251335363"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143997264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparitive performance of artificial intelligence-based large language models on the orthopedic in-training examination.","authors":"Andrew Y Xu, Manjot Singh, Mariah Balmaceno-Criss, Allison Oh, David Leigh, Mohammad Daher, Daniel Alsoof, Christopher L McDonald, Bassel G Diebo, Alan H Daniels","doi":"10.1177/10225536241268789","DOIUrl":"10.1177/10225536241268789","url":null,"abstract":"<p><strong>Background: </strong>Large language models (LLMs) have many clinical applications. However, the comparative performance of different LLMs on orthopedic board style questions remains largely unknown.</p><p><strong>Methods: </strong>Three LLMs, OpenAI's GPT-4 and GPT-3.5, and Google Bard, were tested on 189 official 2022 Orthopedic In-Training Examination (OITE) questions. Comparative analyses were conducted to assess their performance against orthopedic resident scores and on higher-order, image-associated, and subject category-specific questions.</p><p><strong>Results: </strong>GPT-4 surpassed the passing threshold for the 2022 OITE, performing at the level of PGY-3 to PGY-5 (<i>p</i> = .149, <i>p</i> = .502, and <i>p</i> = .818, respectively) and outperforming GPT-3.5 and Bard (<i>p</i> < .001 and <i>p</i> = .001, respectively). While GPT-3.5 and Bard did not meet the passing threshold for the exam, GPT-3.5 performed at the level of PGY-1 to PGY-2 (<i>p</i> = .368 and <i>p</i> = .019, respectively) and Bard performed at the level of PGY-1 to PGY-3 (<i>p</i> = .440, .498, and 0.036, respectively). GPT-4 outperformed both Bard and GPT-3.5 on image-associated (<i>p</i> = .003 and <i>p</i> < .001, respectively) and higher-order questions (<i>p</i> < .001). Among the 11 subject categories, all models performed similarly regardless of the subject matter. When individual LLM performance on higher-order questions was assessed, no significant differences were found compared to performance on first order questions (GPT-4 <i>p</i> = .139, GPT-3.5 <i>p</i> = .124, Bard <i>p</i> = .319). Finally, when individual model performance was assessed on image-associated questions, only GPT-3.5 performed significantly worse compared to performance on non-image-associated questions (<i>p</i> = .045).</p><p><strong>Conclusion: </strong>The AI-based LLM GPT-4, exhibits a robust ability to correctly answer a diverse range of OITE questions, exceeding the minimum <b>score for the 2022 OITE</b>, and outperforming predecessor GPT-3.5 and Google Bard.</p>","PeriodicalId":16608,"journal":{"name":"Journal of Orthopaedic Surgery","volume":"33 1","pages":"10225536241268789"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognosis after one- and two-stage revision surgery for periprosthetic joint infection: A systematic review and meta-analysis.","authors":"Yiyuan Sun, Menghao Liu, Dan Xiao, Qi Li, Huan Xiong, Xue Luo, Boyu Zhu, Weili Fu","doi":"10.1177/10225536251315973","DOIUrl":"10.1177/10225536251315973","url":null,"abstract":"<p><strong>Objective: </strong>Revision surgeries for periprosthetic joint infections (PJIs) in arthroplasty can follow either one- or two-stage treatment protocols. Previous studies have reported similar reinfection rates and reductions in complication rates for both treatment options. However, the literature on the selection of one protocol is still controversial. Thus, our aim was to compare the outcomes, including reinfections, complications, reoperations, and mortality, associated with one- and two-stage revision surgeries for PJI via a systematic review and meta-analysis of comparative studies.</p><p><strong>Methods: </strong>Comparative studies were identified through searches in PubMed, EMBASE, the Web of Science, and the Cochrane Library as of November 2023. RevMan version 5.3 was used for the analyses. The included studies directly compared one-stage revisions with two-stage revisions for PJI. The primary outcomes included reinfection, complications, reoperation, and mortality.</p><p><strong>Results: </strong>Sixteen cohort studies (fifteen retrospective and one prospective) were included in the systematic review. All studies comprising 2039 patients were included in the meta-analysis. Fourteen studies reported reinfection patient risk postrevision; when pooled via random effects models, 10.02% of patients in the one-stage group and 14.75% of patients in the two-stage group were reinfected, indicating low heterogeneity (risk ratio = 0.69; 95% CI = 0.50 - 0.94, I² = 0%). A pooled analysis of ten studies reported complications between the two groups. Compared with the two-stage group, the one-stage group was associated with significantly fewer complications (risk ratio = 0.76; 95% CI = 0.63 - 0.91, I² = 27%). The meta-analysis revealed no significant difference in reoperation events between the 1st-stage and 2nd-stage groups in nine studies (risk ratio = 0.77; 95% CI = 0.59 - 1.01, I² = 20%) or in mortality in ten studies (risk ratio = 0.93; 95% CI = 0.49 - 1.78, I² = 0%).</p><p><strong>Conclusions: </strong>Among the available observational studies, the meta-analysis revealed a lower incidence of reinfection and complications in the one-stage group than in the two-stage group, but there were no significant differences in reoperation events or mortalities.</p>","PeriodicalId":16608,"journal":{"name":"Journal of Orthopaedic Surgery","volume":"33 1","pages":"10225536251315973"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}