Orthopadie (Heidelberg, Germany)最新文献

{"title":"[Use of artificial intelligence for next-gen anamnesis and communication in orthopedics & trauma surgery : From chatbots to ambient intelligence].","authors":"Marco-Christopher Rupp, Alexandros Doucas, Sebastian Siebenlist","doi":"10.1007/s00132-026-04832-x","DOIUrl":"https://doi.org/10.1007/s00132-026-04832-x","url":null,"abstract":"<p><strong>Background: </strong>Against the backdrop of increasing patient volumes, rising case complexity, and physicians' limited time, AI-driven systems for anamnesis, triage, and documentation offer substantial potential for efficiency gains in medical history taking and clinical communication. Their development spans from rule-based decision trees to machine learning and large language model (LLM) dialogues, and further to \"ambient\" documentation that records the physician-patient interaction, autonomously extracts relevant information, and generates structured notes. Applications can be categorized by level of interaction (patient-, physician-, or system-facing) and by stage of care (before, during, and after the visit).</p><p><strong>Practice: </strong>In routine practice, there is an evident shift away from generic symptom checkers-focused on safety but limited in diagnostic accuracy-toward domain-specific, curated intake and triage tools that demonstrate higher process relevance in elective care. The most immediate benefits currently arise from ambient documentation assistants: reduced typing workload, shorter post-visit processing times, and more complete, structured notes-always subject to final physician review and responsibility. Responsible deployment requires adherence to regulatory frameworks and compliance with MDR and the EU AI Act. A locally piloted example is \"OrthoCopilot,\" an adaptive, offline intake system generating structured summaries for physicians' preparation.</p><p><strong>Requirements: </strong>Stepwise introduction of AI-based technologies should be guided by measurable performance indicators (consultation time, workload, completeness, correction effort, billing quality), comply with prevailing regulations, enable early efficiency gains, support institutions in building internal expertise, and prepare the ground for the transition toward more advanced multimodal AI models.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Does endoprosthetic treatment of medial femoral neck fractures in obese patients using a minimally invasive anterolateral approach have a higher complication rate? : A retrospective case-control study].","authors":"Ferdinand Zellner, Christian Wulbrand, Bernd Füchtmeier, Michael Zellner, Franz Müller","doi":"10.1007/s00132-026-04841-w","DOIUrl":"https://doi.org/10.1007/s00132-026-04841-w","url":null,"abstract":"<p><strong>Background: </strong>Different minimally invasive approaches have been established in the management of elective hip arthroplasty. However, there is almost no data on the endoprosthetic treatment of femoral neck fractures in obese patients.</p><p><strong>Materials and methods: </strong>The monocentric case-control study is based on the retrospective evaluation of a database. Included were patients with a body mass index (BMI) of > 30 kg/m² who received endoprosthetic treatment due to a femoral neck fracture. The cohort was dichotomized based on the surgical approach: direct lateral (DL) and minimally invasive anterolateral (MIV AL). Demographic and perioperative variables were collected. The primary study objective was the comparison of general and specific complications. The secondary study objective was the comparison of survival rate and mobility according to the Parker score.</p><p><strong>Results: </strong>A total of 155 surgeries conducted between 2011 and 2024 were included, of which 52 procedures were performed using a DL approach and 103 procedures using an MIV AL approach. The mean age of the overall cohort was 77.9 ± 9.4 years, and the mean BMI was 33.4 ± 3.2 kg/m². The demographic variables showed a homogeneous distribution. The overall revision rate was noticeably higher for the MIV AL approach, but not statistically significant (p = 0.18). Dislocations (n = 7) and infections (n = 3) occurred exclusively in the MIV AL group. There was no significant difference in mortality or survival rates. The 30-day and 1‑year mortality rates were 0% and 9.0%, respectively (p = 0.776). The mean survival rate according to Kaplan-Meier was 7.1 years (95% confidence interval, 6.12-8.03) without significant differences regarding the surgical approaches (log rank = 0.656). Mobility according to Parker (n = 78) at the time of follow-up was also comparable (p = 0.60).</p><p><strong>Conclusion: </strong>The MIV AL approach to endoprosthetic treatment of femoral neck fractures in obese patients showed a higher, but not significant, dislocation and infection rate compared to the DL approach. For the overall cohort, mortality rates were low. Recording the surgical approaches and BMI in registry data would be useful to generate larger case numbers.</p><p><strong>Level of evidence: </strong> III; retrospective case-control study.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Writing with a system-ChatGPT in the scientific practice of orthopedics and trauma surgery].","authors":"Philipp Zehnder, Dominik Völk, Conrad Ketzer, Michael Zyskowski, Peter Biberthaler","doi":"10.1007/s00132-026-04833-w","DOIUrl":"https://doi.org/10.1007/s00132-026-04833-w","url":null,"abstract":"<p><p>With the emergence of generative AI models such as ChatGPT, a new phase of scientific work is also beginning in orthopedics and trauma surgery. As a language-based deep learning model (LLM), ChatGPT offers a wide range of possible applications-especially in the creation, translation, and optimization of scientific texts. It supports authors in finding ideas, linguistic elaboration, and can even be used to check for plagiarism. It is a particularly valuable tool for non-native speakers. However, despite all the opportunities, its use involves considerable risks; studies show a high rate of incorrect or invented references. In addition, journals are sometimes flooded due to mass publication as a result of easier text generation. The scientific discourse, therefore, calls for clear rules on the use of LLM-particularly with regard to transparency, authorship, and the integrity of scientific work.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Effectiveness of digital therapy approaches in prevention, rehabilitation and rehabilitation aftercare].","authors":"Sebastian Knapp, Frank Merten, Filippo Martino, Jessica Huss","doi":"10.1007/s00132-026-04830-z","DOIUrl":"https://doi.org/10.1007/s00132-026-04830-z","url":null,"abstract":"<p><strong>Background: </strong>Digital therapy applications offer great potential to improve the therapeutic care of patients with musculoskeletal complaints and contribute to maintaining their ability to work.</p><p><strong>Aim of the study: </strong>The study summarizes the current status of studies on the use of digital therapy applications recognized by the pension insurance in the orthopaedic field of prevention, rehabilitation, and rehabilitation aftercare and describes their effectiveness.</p><p><strong>Material and methods: </strong>The review was designed as a scoping review. Quantitative outcome measures such as ability to work, health-related quality of life, or sports medicine assessments were extracted and reported. The characteristics of the studies included were compared in tabular form.</p><p><strong>Results: </strong>Digital therapy programs were well accepted and proved to be comparably effective to traditional formats, with context-specific advantages for some outcome parameters.</p><p><strong>Discussion: </strong>Digital therapies are an effective therapy format with flexibility in terms of location and time.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complementary roles of convolutional neural networks and multimodal large language models (ChatGPT) in radiographic implant identification : A clinical and exploratory study.","authors":"Christian Riediger, Mark Ferl, Martin Lohrengel, Sebastian Illiger, Christoph H Lohmann, Maria Schönrogge","doi":"10.1007/s00132-026-04836-7","DOIUrl":"https://doi.org/10.1007/s00132-026-04836-7","url":null,"abstract":"<p><strong>Background: </strong>Accurate identification of implants in total knee arthroplasty (TKA) is essential for revision arthroplasty but is often complicated by incomplete documentation. While convolutional neural networks (CNNs) achieve high accuracy in implant recognition, the role of multimodal large language models (LLMs), such as ChatGPT remains unclear.</p><p><strong>Methods: </strong>This study combined a retrospective radiographic analysis of 80 bicompartmental TKA cases with a structured comparison of CNN-based classification and LLM-based interpretive reasoning. The analysis included four implant systems. Convolutional neural networks served as benchmark references, while a multimodal large language model (ChatGPT) was evaluated for implant identification, reasoning, and confidence estimation.</p><p><strong>Results: </strong>Radiographs in anteroposterior projection showed higher recognition performance than lateral views across all systems. The combined use of both projections improved reliability, indicating dependence on complementary morphological features. Convolutional neural network-based approaches achieved accuracies exceeding 99%. In contrast, the evaluated large language model provided contextual interpretation and implant suggestions but lacked measurable classification accuracy. Confidence levels were moderate (median 0.63-0.70). Interrater agreement was moderate to substantial (κ = 0.52-0.74).</p><p><strong>Conclusion: </strong>Convolutional neural network-based algorithms remain the gold standard for implant classification. Multimodal large language models provide complementary strengths in contextual reasoning. Hybrid approaches may improve clinical workflows in revision arthroplasty.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[25/f-sudden onset of ankle pain with fatigue : Preparation for the medical specialist examination: Part 84].","authors":"Norbert Harrasser","doi":"10.1007/s00132-026-04829-6","DOIUrl":"https://doi.org/10.1007/s00132-026-04829-6","url":null,"abstract":"","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147824455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[AI-based surgical planning of adult spinal deformities : Analysis of an AI-based tool for correction planning and execution employing patient-specific contoured rods].","authors":"Patrick Strube, Alexander Hölzl, Anna-Maria Vogel, Georg Matziolis, Chris Lindemann","doi":"10.1007/s00132-026-04831-y","DOIUrl":"https://doi.org/10.1007/s00132-026-04831-y","url":null,"abstract":"<p><strong>Background: </strong>Optimal alignment correction can potentially lower the high complication rates of adult scoliosis surgeries. AI tools can help make the analysis and planning process easier as well as improve the surgical realization via patient-specific rod manufacturing.</p><p><strong>Objectives: </strong>Investigation of an AI-based tool regarding this.</p><p><strong>Materials and methods: </strong>Analysis of the first 10 AI-tool used-cases of adult scoliosis in our department regarding outcome and limitations.</p><p><strong>Results: </strong>The method allows time-sparing analysis and significant improvement of the spine profile. Limitations result from unimplemented parameters in the model and from arbitrary bias caused by the planner, which influence the surgical success rate of adult scoliosis.</p><p><strong>Conclusions: </strong>The presented AI-tool represents a practicable and easy to use method for restoring the balance of patients. Extension of the model could potentially lower complication rates in the future.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147824483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Legg-Calvé-Perthes disease in early childhood: conservative versus surgical management : A risk-adapted containment approach].","authors":"Ferdinand Wagner, Felix Endres","doi":"10.1007/s00132-026-04799-9","DOIUrl":"10.1007/s00132-026-04799-9","url":null,"abstract":"<p><strong>Background: </strong>Early-onset Legg-Calvé-Perthes disease (LCPD) carries a favorable prognosis in the majority of cases; key determinants of outcome are adequate containment (acetabular coverage) of the femoral head and preservation of range of motion during the initial Waldenström stages.</p><p><strong>Decision-making: </strong>We present practical classifications and a treatment strategy that prioritizes conservative management and focuses operative interventions on \"hips at risk.\" In children younger than approximately 6 years of age, treatment includes activity modification and dedicated ROM therapy. \"Hip-at-risk\" signs-particularly progressive decentering of the femoral head-identify the subgroup that benefits from early containment surgery.</p><p><strong>Therapy: </strong>Proximal femoral varus osteotomy is technically straightforward and widely established; its limitations include limb-length discrepancy and potential worsening of an existing abductor weakness; in childhood, pelvic Tönnis triple osteotomy addresses containment most comprehensively in LCPD and, in experienced hands, can be performed with low morbidity and early mobilization. As a general principle, the procedure should be selected that most reliably restores containment for the individual hip and with which the treating center has the greatest expertise.</p><p><strong>Conclusion: </strong>Centralization of care would be desirable to generate robust long-term data and guidelines for this-perhaps surprisingly-insufficiently standardized condition.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":"344-350"},"PeriodicalIF":0.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Femoral head osteotomy for complex deformity after Legg-Calvé-Perthes disease].","authors":"Michael Leunig, Reinhold Ganz","doi":"10.1007/s00132-026-04800-5","DOIUrl":"10.1007/s00132-026-04800-5","url":null,"abstract":"<p><p>Complex hip deformities after Legg-Calvé-Perthes disease are characterized by an enlarged, asymmetrically deformed femoral head, a short femoral neck, a high-riding greater trochanter, and secondary acetabular dysplasia. These features lead to intra- and extra-articular impingement, instability, abductor weakness, and early osteoarthritis. Conventional osteotomies or isolated acetabular reorientations do not directly address the femoral head deformity and, therefore, show limited results. Detailed analysis of the vascular anatomy enabled the development of intracapital osteotomy with central segment resection, without significantly compromising femoral head perfusion. Since 2001, this procedure, often combined with periacetabular osteotomy (PAO), has been used to restore sphericity and joint stability. Early data demonstrate significant radiological and functional improvements. Despite its technical complexity, the procedure is considered a promising option; long-term and multicenter studies are warranted.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":"369-378"},"PeriodicalIF":0.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Osteotomies of the pediatric hip joint].","authors":"Christian Ziegler, Felix Endres","doi":"10.1007/s00132-026-04826-9","DOIUrl":"10.1007/s00132-026-04826-9","url":null,"abstract":"<p><p>Pelvic and femoral osteotomies, including soft-tissue balancing of the pediatric hip joint, aim to restore as physiological a geometry and biomechanics as possible in order to improve function and prevent wear. The main indications are developmental (DDH) and neurogenic dysplasia (NDH), Perthes disease (LCP), and femoral head slippage (ECF/SCFE). In childhood, acetabular roof plasty (PDP) and the Salter osteotomy (SIO) are the primary options; after growth is complete, triple pelvic osteotomy (TPO) and periacetabular osteotomy (PAO) are available, with the former potentially being performed even before skeletal maturity. If incongruity is present, shelf and Chiari osteotomies may be considered as salvage procedures. The outcome depends on correct indication, selection of the appropriate procedure, adequate consideration of soft tissue conditions, and structured follow-up care.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":"361-368"},"PeriodicalIF":0.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147791480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}