Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews最新文献

Introduction: Artificial intelligence chatbots, such as ChatGPT-4o ("omni"), a large language model developed by OpenAI that integrates text, image, and audio processing with web connectivity, have gained traction as potential patient education tools in orthopaedic surgery. This study aimed to evaluate the accuracy, completeness, and clinical utility of ChatGPT-4o's responses to common patient questions about six widely performed orthopaedic procedures.

Methods: We assessed ChatGPT-4o's responses to five standardized patient-oriented queries for total knee arthroplasty, total hip arthroplasty, anterior cruciate ligament reconstruction, rotator cuff repair, anterior cervical diskectomy and fusion, and carpal tunnel release. Responses were generated using ChatGPT-4o's web-enabled version in January 2025. Two resident orthopaedic surgeons independently rated each response for accuracy, completeness, layperson clarity, misleading content, and conciseness using a structured binary rubric. The validated DISCERN instrument (16 items, max score 80) was adapted for quantitative assessment of information quality. Interrater reliability was assessed with Cohen kappa.

Results: Overall, ChatGPT-4o generated accurate and structured responses, free of overt errors. The average DISCERN score across procedures was 43.5, classifying the information as fair. The highest average DISCERN score was for anterior cervical diskectomy and fusion (mean 45.8 ± 10.1), whereas the lowest was for rotator cuff repair (mean 41.6 ± 5.9). Factual accuracy was high (>90%), but 36% of responses contained some misleading or incomplete information. Responses explaining treatment alternatives were the most accurate and complete, whereas those outlining surgical risks performed worst. Interrater agreement was good (Cohen kappa = 0.64).

Discussion: ChatGPT-4o provided generally accurate, clear, and empathetic explanations of common orthopaedic surgeries, offering a promising adjunct to conventional patient education. However, key limitations particularly regarding alternative treatments, nuanced risks, and lack of tailored advice limit its stand-alone use in clinical practice. Careful oversight and clinician vetting remain essential.

Conclusions: ChatGPT-4o can supplement orthopaedic patient education by offering accessible, engaging content. However, notablenotable gaps in detail and occasional misleading information necessitate careful review and contextual explanation by orthopaedic surgeons.

Background: A challenge in periprosthetic joint infection is the detection of microbiota. Next-generation sequencing (NGS) of microbial ribosomal DNA is one detection method, but false-positive results are of concern. We conducted a simulated joint aspiration study to assess false-positive rates with NGS testing.

Methods: The simulated joint was a 50-mL bottle of sterile saline. Four techniques (n = 20 per technique) were tested. Fluid aspirates were inserted into sterile vacutainers with different needle exchanges analyzed for potential contamination points. The negative control group (n = 20 per technique) consisted of 80 sterile saline bottles tested directly at the NGS laboratory.

Results: Eighty simulated aspirations were performed, two NGS tests per "joint." In three simulated techniques, the positive detection rate was 0.8%. In the fourth technique, where 10 mL of ambient air was aspirated into the syringe, the rate was 10%. The positive detection rate among the negative control bottles was 1.2%.

Conclusion: NGS detected DNA signals from sterile saline aspirations using a sterile technique. However, the false-positive rate was low (0.8%). We theorize that positive DNA signals originated from errant microbe contamination from ambient air drawn into the testing needle bore. We advocate needle exchange at every fluid transfer point.

Introduction: Past studies in Europe and Asia have demonstrated the efficacy of three-dimensional (3D) printing technology in patients with complex congenital scoliosis using multisegmental guides. We aimed to evaluate the Firefly pedicle screw navigation guide, a 3D printed, patient- and level-specific, anatomically matched guide, in patients with congenital scoliosis in the United States.

Methods: We present two patients with complex congenital scoliosis treated with posterior spinal fusion and segmental spinal instrumentation using a 3D printed spine models and level-specific pedicle guides generated from a preoperative CT scan.

Results: Both patients received notable correction of their coronal curvatures, thoracic kyphosis, and lumbar lordosis. Guides allowed for safe placement of pedicle screws in very small, severely dysplastic pedicles that would be difficult with conventional free hand techniques. Both patients are doing well postoperatively.

Conclusion: The use of anatomically matched 3D printed guides and a 3D printed model of the spine allowed for safe, relatively rapid anatomical placement of pedicle screws in two difficult cases. In pediatric spinal deformity surgery from congenital causes, challenging curves, or dysplastic pedicles, 3D printing technology is a viable and effective augment to surgical correction.

Introduction: Intermediate outcomes of foraminal decompression (FD) have not been reported using biportal endoscopic assistance (biportal endoscopic-foraminal decompression [BE-FD]). The goal of this study was to evaluate the clinical and radiologic outcomes of FD and analyzing risk factors for less successful outcomes.

Methods: Patients who underwent BE-FD for single-level lumbar foraminal stenosis were enrolled. Demographic and radiographic parameters were collected. For clinical evaluation, Oswestry Disability Index and Visual Analog Scale (VAS) for back and leg pain were used. Patients were divided into group A with excellent and group B with less satisfactory results.

Results: A total of 141 patients were selected for this study. Ninety-eight of 141 (69.5%) had excellent outcomes. Group B had improvement in Oswestry Disability Index and VAS leg but less than group A. VAS back did not differ between the groups. Fourteen of patients (9.9%) required revision fusion surgery. In univariate analysis, smaller preoperative intervertebral disk height (IVD), smaller preoperative foraminal height (FH), and more disk wedging (DW) were associated with poorer outcomes. Larger change in IVD, FH, and DW was also associated with suboptimal outcomes and lower level of surgery. In multivariate analysis, level of surgery, preoperative DW, and change in IVD, FH, and DW were notable.

Conclusion: BE-FD was able to provide notable symptom improvement; only 9.9% required revision surgery. Lumbar foraminal stenosis pathology in the lower lumbar, less preoperative IVD and FH, and higher disk wedge angle should be taken care with caution when FD is considered because clinical improvement may be less than those patients without those risk factors.

Background: Second victim syndrome (SVS) occurs when healthcare providers experience emotional distress after an adverse medical event. Although studied in other specialties, research is limited on its prevalence in orthopaedic surgery, particularly among Hispanic surgeons. This study evaluated SVS among Hispanic orthopaedic surgeons using the Second Victim Experience and Support Tool and identified support disparities.

Methods: A survey containing the Second Victim Experience and Support Tool questionnaire was sent through e-mail and completed by 70 orthopaedic surgeons in Puerto Rico. Responses were collected electronically from May to September 2024. Descriptive statistics and Likert scores assessed SVS dimensions and support preferences.

Results: The prevalence of psychological distress was moderate (mean: 3.1; SD: 1.2), with emotional distress being the most pronounced. Physical symptoms were less prominent (mean: 2.3; SD: 1.4). Colleague (mean: 2.2; SD: 1.0) and supervisor support (mean: 2.4; SD: 0.9) were inadequate. Institutional support had moderate gaps (mean: 2.7; SD: 1.2). Non-work-related support was highly valued (mean: 1.8; SD: 1.1). Professional self-efficacy declined, increasing self-doubt (mean: 2.6; SD: 1.3). Turnover intention and absenteeism were low (2.2 each). Preferred support included peer discussions (mean: 3.9; SD: 0.8) and employee counseling services (mean: 3.5; SD: 0.9).

Conclusion: Hispanic orthopaedic surgeons experience notable distress and insufficient institutional support following adverse medical events. These findings highlight the importance of implementing strategies to mitigate the impact of SVS and improve resilience among healthcare providers.

Injuries to the cardinal spine are quite uncommon in pediatric patients. Nonetheless, the second cervical vertebra are crucial for the human neck's extension and rotation. Surgery is the most typical treatment for patients who have a type II fracture of the cardinal vertebra's odontoid process along with a considerable displacement of the odontoid process. Nonetheless, surgical intervention is characterized by challenges and problems following surgery. For the first time, a youngster who had a type II fracture of the cardinal vertebra's odontoid process and substantial odontoid process displacement is described in this work. The child healed with conservative treatment. In addition to studying pertinent literature, the case history data, speciality and ancillary investigations, treatment approaches, and treatment outcomes are all thoroughly detailed.

Introduction: Proximal femoral fractures (PFFs) are a notable source of morbidity and mortality in elderly populations, with 1-year mortality rates ranging from 15% to 30% and projected incidence set to rise markedly. Interdisciplinary care models, including the integration of a nurse practitioner (NP), have shown the potential to improve outcomes in this vulnerable population.

Methods: We held a retrospective cohort study to evaluate the impact of adding a geriatric NP to the orthopedic department on mortality and hospitalization outcomes in patients with PFFs. A total of 2,065 patients were included: 1,300 from the preintervention period (2017 to 2020) and 765 from the NP-intervention period (2021 to 2024).

Results: Key outcomes revealed a notable reduction in in-hospital mortality from 5.6% to 2.4% (P = 0.0005) and an improvement in 1-year survival rates during the NP-intervention period. Kaplan-Meier analysis and Cox regression demonstrated a notable survival benefit with NP involvement, with average survival extending from 1.3 to 2.3 years (P < 0.001). The average length of stay decreased from 9.3 to 8.4 days (P = 0.003), and patient transfers to other departments were reduced by nearly one third.

Conclusion: These results highlight the positive effect of a geriatric NP on survival, hospital efficiency, and continuity of care for elderly PFF patients. The NP-led model, focusing on perioperative coordination, discharge planning, and comprehensive care, offers a promising approach to address the growing demand for geriatric fracture management, supporting its broader implementation to improve clinical and economic outcomes.

Implications for clinical practice: Our findings support the adoption of geriatric-focused, NP-led interventions in orthopedic settings to optimize the care of elderly fracture patients, aligning with current trends in interdisciplinary approaches to geriatric health care. Expanding this model may improve outcomes on a larger scale, addressing the growing needs of an aging population while promoting high-quality, cost-effective care in geriatric fracture management.

Background: Limited data exist on factors contributing to delayed repair of patellar tendon ruptures. This study describes the experience of a single surgeon managing acute and chronic patellar tendon tears, focusing on patient demographics, socioeconomic characteristics, and short-term surgical outcomes.

Methods: We conducted a retrospective cohort analysis of patellar tendon repairs performed at a single institution from January 2017 to January 2024. Patients were stratified into acute or chronic groups based on whether surgery occurred within 6 weeks of injury. Socioeconomic background was assessed using the area deprivation index, reported as national percentiles (1% to 100%) and state-normed deciles (1 to 10), with higher rankings indicating greater disadvantage. Mann-Whitney U and chi square tests were used for analysis.

Results: Of the 70 patients included, 45 underwent acute and 25 chronic repairs. Groups did not differ significantly in age, body mass index, race/ethnicity, comorbidities, insurance status, or area deprivation index scores. Surgical complications, infection, revision surgery rates, and postoperative range of motion scores were not statistically different. Functional outcomes such as strength and return to work were not measured.

Discussion: Within our predominantly minority, single-surgeon cohort, our analysis of socioeconomic characteristics revealed an average to moderate level of disadvantage with no notable demographic differences between the two groups. In addition, when appropriately managed, we found no statistically significant differences in surgical complications and postoperative range of motion values. These results reflect a specific practice setting and population. Broader studies incorporating functional outcomes and more diverse populations are needed to better understand delayed presentations and optimize care.

Introduction: Anatomic total shoulder arthroplasty (aTSA) is the preferred treatment for patients with glenohumeral osteoarthritis (GHOA) who have an intact rotator cuff experiencing limited range of motion (ROM) and/or pain unrelieved by nonsurgical care. This study evaluates the impact of socioeconomic status (SES) and social determinants of health (SDOH) on outcomes after aTSA.

Methods: This single-center retrospective study analyzed patients who underwent aTSA for GHOA between 2017 and 2021. Patients were grouped by zip code-based income and social deprivation using definitions from the Department of Housing and Urban Development (HUD), the Federal Reserve (FED), and the Social Deprivation Index (SDI). Demographics, complications, and 2-year American Shoulder and Elbow Surgeons (ASES) scores were collected. Analysis included ANOVA, Kruskal-Wallis, and chi-square tests.

Results: Of 105 patients, 86 (83%) had 2-year ASES scores. No differences were found in preoperative comorbidities. Differences in sex, race, and age were observed among FED and HUD groups, and in race and age among SDI groups. ASES scores differed among FED (P = 0.043) and HUD (P = 0.01) groups, as did active abduction among HUD groups (P = 0.03). No differences were found in ASES by SDI or in postoperative pain, other ROM measures, strength, or complications across groups.

Discussion: This study found differences in ASES scores by FED and HUD, but not by SDI. However, these differences may not be clinically significant. Worse active abduction in lower SES HUD groups was clinically significant. Despite institutional efforts to improve access, these disparities in outcomes highlight the need to reduce barriers to postoperative rehabilitation and recovery.

Aims: Reconstructing hips in moderate-to-severe developmental dysplasia of the hip (DDH) in adults, such as Hartofilakidis type B-C, presents a notable challenge. Despite various surgical procedures available, no approach has shown consistent long-term success. This observational study aimed to report the long-term survivorship and outcomes of a "selective osteotomy treatment algorithm," which involves selective osteotomy combined with anatomic hip restoration, for moderate-to-severe DDH.

Methods: We retrospectively reviewed 24 patients with Hartofilakidis type B (moderate) or C (severe) DDH who underwent total hip arthroplasty with selective osteotomy approach at Siriraj Hospital, Mahidol University, Thailand from 2001 to 2021. We employed a Kaplan-Meier curve to assess procedure survivorship, with revision surgery as the end point. Clinical, functional outcomes assessed with Hip dysfunction and Osteoarthritis Outcome Score for Joint Replacement score, complications, and radiological assessments during follow-up were recorded.

Results: The mean patient age was 56.8 ± 11.8 years (range 37 to 78 years), and mean height was 152.0 ± 11.7 cm (range 111 to 167 cm). The median surgical time was 84 minutes (range 50 to 300 minutes), with a median estimated blood loss of 450 mL (range 100 to 4000 mL). The median follow-up time was 7.8 years (range 4 to 21 years). The Hip dysfunction and Osteoarthritis Outcome Score for Joint Replacement score improved markedly from baseline, with a mean anchor-based increase of 23.70 ± 0.04 at 6 months postoperatively. Three cases encountered revision surgery due to osteotomy nonunion with stem fracture, early dislocation, and periprosthetic joint infection. The survival probability at 12 years was 83.7%. No sciatic nerve injuries were reported. No radiographic pathology was detected during follow-up.

Conclusion: Selective osteotomy combined with anatomic hip restoration is a feasible and effective approach for managing moderate-to-severe DDH, as it demonstrated favorable long-term outcomes. Our approach may serve as a treatment option for patients with similar challenging deformities.