Evaluation of information from artificial intelligence on rotator cuff repair surgery.

Purpose: The purpose of this study was to analyze the quality and readability of information regarding rotator cuff repair surgery available using an online AI software. Methods: An open AI model (ChatGPT) was used to answer 24 commonly asked questions from patients on rotator cuff repair. Questions were stratified into one of three categories based on the Rothwell classification system: fact, policy, or value. The answers for each category were evaluated for reliability, quality and readability using The Journal of the American Medical Association Benchmark criteria, DISCERN score, Flesch-Kincaid Reading Ease Score and Grade Level. Results: The Journal of the American Medical Association Benchmark criteria score for all three categories was 0, which is the lowest score indicating no reliable resources cited. The DISCERN score was 51 for fact, 53 for policy, and 55 for value questions, all of which are considered good scores. Across question categories, the reliability portion of the DISCERN score was low, due to a lack of resources. The Flesch-Kincaid Reading Ease Score (and Flesch-Kincaid Grade Level) was 48.3 (10.3) for the fact class, 42.0 (10.9) for the policy class, and 38.4 (11.6) for the value class. Conclusion: The quality of information provided by the open AI chat system was generally high across all question types but had significant shortcomings in reliability due to the absence of source material citations. The DISCERN scores of the AI generated responses matched or exceeded previously published results of studies evaluating the quality of online information about rotator cuff repairs. The responses were U.S. 10th grade or higher reading level which is above the AMA and NIH recommendation of 6th grade reading level for patient materials. The AI software commonly referred the user to seek advice from orthopedic surgeons to improve their chances of a successful outcome.

Complications following arthroscopic Bankart repair: a systematic review.

BACKGROUND: Complications are rare after arthroscopic Bankart repair, and as a result, there is a lack of guidance over rates of complications that can be used to consent patients. The purpose of this study is to systematically review the literature to assess the complications after arthroscopic Bankart repair, other than recurrent instability. METHODS: A literature search of MEDLINE, Embase, and the Cochrane Library was performed based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Clinical studies reporting on the complications after arthroscopic Bankart repair were included. RESULTS: A total of 194 studies were included in the analysis, with 13,979 patients and 14,019 shoulders undergoing arthroscopic Bankart repair. The overall complication rate was 0.67%, with frozen shoulder being the most common complication occurring in 0.32%. Persistent pain occurred in 0.17%. The rates of nerve, hardware, and wound complications were 0.07%, 0.05%, and 0.03%, respectively. CONCLUSION: The arthroscopic Bankart repair has a very low rate of complications. Frozen shoulder and persistent pain are the most frequently encountered complications.

Evaluation of Online Artificial Intelligence-Generated Information on Common Hand Procedures.

PURPOSE: The purpose of this study was to analyze the quality and readability of the information generated by an online artificial intelligence (AI) platform regarding 4 common hand surgeries and to compare AI-generated responses to those provided in the informational articles published by the American Society for Surgery of the Hand (ASSH) HandCare website. METHODS: An open AI model (ChatGPT) was used to answer questions commonly asked by patients on 4 common hand surgeries (carpal tunnel release, cubital tunnel release, trigger finger release, and distal radius fracture fixation). These answers were evaluated for medical accuracy, quality and readability and compared to answers derived from the ASSH HandCare materials. RESULTS: For the AI model, the Journal of the American Medical Association benchmark criteria score was 0/4, and the DISCERN score was 58 (considered good). The areas in which the AI model lost points were primarily related to the lack of attribution, reliability and currency of the source material. For AI responses, the mean Flesch Kinkaid Reading Ease score was 15, and the Flesch Kinkaid Grade Level was 34, which is considered to be college level. For comparison, ASSH HandCare materials scored 3/4 on the Journal of the American Medical Association Benchmark, 71 on DISCERN (excellent), 9 on Flesch Kinkaid Grade Level, and 60 on Flesch Kinkaid Reading Ease score (eighth/ninth grade level). CONCLUSION: An AI language model (ChatGPT) provided generally high-quality answers to frequently asked questions relating to the common hand procedures queried, but it is unclear when or where these answers came from without citations to source material. Furthermore, a high reading level was required to comprehend the information presented. The AI software repeatedly referenced the need to discuss these questions with a surgeon, the importance of shared decision-making and individualized care, and compliance with surgeon treatment recommendations. CLINICAL RELEVANCE: As novel AI applications become increasingly mainstream, hand surgeons must understand the limitations and ramifications these technologies have for patient care.

Association Between Preoperative Multidimensional Psychological Distress and Physical Function After Surgery for Sports-Related Injury.

Background: Psychological distress after orthopaedic surgery can lead to worse outcomes, including higher levels of disability and pain and lower quality of life. The 10-item Optimal Screening for Prediction for Referral and Outcome-Yellow Flag (OSPRO-YF) survey screens for multiple psychological constructs relevant to recovery from orthopaedic injury and may be useful to preoperatively identify patients who may require further psychological assessment and possible intervention after surgery. Purpose/Hypothesis: To determine the association between the OSPRO-YF and physiological patient-reported outcomes (PROs). It was hypothesized that higher OSPRO-YF scores (indicating worse psychological distress) would be associated with worse PRO scores at time of return to sport. Study Design: Case series; Level of evidence, 4. Methods: This study evaluated 107 patients at a single, academic health center who were assessed at a sports orthopaedics clinic and ultimately treated surgically for injuries to the knee, shoulder, foot, or ankle. Preoperatively, patients completed the OSPRO-YF survey as well as the following PRO measures: Patient-Reported Outcomes Measurement Information System (PROMIS), Single Assessment Numeric Evaluation, numeric rating scale for pain; American Shoulder and Elbow Surgeons standardized shoulder assessment form for patients with shoulder injuries, the International Knee Documentation Committee score (for patients with knee injuries), and the Foot and Ankle Ability Measure (FAAM; for patients with foot or ankle injuries). At the time of anticipated full recovery and/or return to sport, patients again completed the same PRO surveys. Multivariable regression was used to evaluate the association between total OSPRO-YF score at baseline and PRO scores at the time of functional recovery. Results: The baseline OSPRO-YF score predicted postoperative PROMIS Physical Function and FAAM Sports scores only. A 1-unit increase in the OSPRO-YF was associated with a 0.55-point reduction in PROMIS Physical Function (95% CI, -1.05 to -0.04; P = .033) indicating worse outcomes. Among patients who underwent ankle surgery, a 1-unit increase in OSPRO-YF was associated with a 6.45-point reduction in FAAM Sports (95% CI, -12.0 to -0.87; P = .023). Conclusion: The study findings demonstrated that the OSPRO-YF survey predicts certain long-term PRO scores at the time of expected return to sport, independent of baseline scores.

Pyrocarbon hemiarthroplasty of the shoulder: a systematic review and meta-analysis of clinical results.

BACKGROUND: Hemiarthroplasty is often considered in the setting of preserved glenoid cartilage given the high risk of revision associated with total shoulder arthroplasty. Pyrocarbon (PyC) has been used as an implant material that theoretically allows for formation of a neo-membrane that would act like cartilage to reduce glenoid wear. The purpose of this study was to evaluate the clinical outcomes, radiographic outcomes, revision rates, and complication rates in the existing literature on shoulder hemiarthroplasty using PyC. METHODS: The MEDLINE, Embase, and Scopus databases were searched for articles relating to shoulder hemiarthroplasty using the terms "pyrocarbon" or "pyrolytic carbon." Abstracts and articles were screened against predefined inclusion and exclusion criteria, with a minimum of 24 months' follow-up required. Data on patient demographic characteristics, clinical outcome scores, complications, revision rates, and radiographic findings were recorded. Where appropriate, meta-analysis was performed. RESULTS: Twelve studies were selected for final inclusion, with a total of 536 patients. Among the studies reporting preoperative and postoperative range of motion (ROM), an overall improvement in ROM was observed. The mean Constant score was 70.9 points postoperatively, with a mean improvement of 36.2 points (n = 359, 9 studies). Radiographically, 22.8% of patients (n = 536, 8 studies) had evidence of glenoid erosion, 10.4% had changes in implant positioning, and 9.9% had tuberosity thinning. In addition, 1.5% of patients had radiographic subacromial space reduction, whereas 0.7% had an increase in tuberosity thickness. Across all studies, there was an 8.6% complication rate, with the most common cause being glenoid erosion (2.6%, n = 14). There was an overall 7.7% revision rate (n = 41), with 63% of revisions (n = 26) undergoing conversion to reverse or total shoulder arthroplasty. CONCLUSION: PyC hemiarthroplasty shows overall improvements in ROM and patient-reported outcomes for patients. However, there remains concern for glenoid erosion on radiographic evaluation at minimum 2-year follow-up. Although preliminary studies have shown encouraging results, this systematic review emphasizes the need for longer-term follow-up studies with further radiographic evaluation of the severity of glenoid erosion and the association with functional outcomes and failure risk.

The characteristics of opioid use in patients with proximal humerus fractures.

BACKGROUND: Orthopaedic surgeons prescribe more opioid narcotics than any other surgical specialty. Proximal humerus fractures (PHF) often occur in the high-risk elderly population. The opioid epidemic has led to public policy aimed at reductions in opioid prescription. This study aimed to evaluate the impact that new legislation has had on opioid prescription patterns in patients who sustained proximal humerus fractures. METHODS: A retrospective review of all patients who sustained PHF at a single academic institution from 1/1/2015-12/31/2019 was performed. A total of 762 proximal humerus fractures were identified and final analysis included 383 patients. Collected data included basic demographics and opioid prescriptions obtained through review of the electronic medical record. The North Carolina Strengthen Opioid Misuse Prevention act legislation that went into effect on July 1, 2017. RESULTS: There was no difference in the number of pre- or postoperative opioid prescriptions provided with the new legislation. Our data showed a significant reduction in MeQs prescribed preoperatively pre-STOP act (188.1 MeQs) and post-STOP act (99.4 MeQs). There was also a significant difference in the amount of postoperative narcotics prescribed in the pre-STOP (972.6 MeQs) and post-STOP act (508.6 MeQs) groups (p < 0.01). CONCLUSIONS: With the enactment of the STOP act in North Carolina, we have seen a significant reduction in the amount of narcotic prescribed after sustaining a proximal humerus fracture preoperatively and postoperatively. This data demonstrates the impact that implementation of state-wide regulatory changes in opioid prescribing policy has had for a common orthopedic condition.

Severe Hand Osteoarthritis Strongly Correlates With Major Joint Involvement and Surgical Intervention.

BACKGROUND: The presence of hand osteoarthritis (OA) increases the risk for developing OA in other major joints. Although genetic predisposition has been implicated in its causation, its exact role has yet to be established. The association of hand OA with symptomatic and asymptomatic major joints has not been previously studied. METHODS: Hundred consecutive patients had a hand photo taken for visual documentation of the hand joints. Radiographs of hand and all major symptomatic joints were analyzed and classified using the Kellgren-Lawrence scale by 2 independent observers including an orthopedic radiologist. RESULTS: Severe hand OA was present in 91% of the patients. Radiographic analysis showed that the hip was involved in 88% of the patients, of whom 85.2% (75) were symptomatic and 14.7% (13) were asymptomatic. Hip arthroplasty was required by 62.5% (55) of symptomatic hip patients. Knee involvement was present in 37% of the patients; all were symptomatic and 81.1% (30) of these required knee arthroplasty. Bilateral surgery was performed in 33% (28) and "2 joint (hip and knee)" surgery was performed in 6% (5). Spine involvement was present in 72% of the patients. There was a significant correlation between hand radiographic findings of OA and hip (r = 0.68; P = .03), knee (r = 0.58; P = .042), and spine (r = .39; P = .05) involvement. CONCLUSION: There was a significant correlation between severe hand OA and hip, knee, and spine involvement. Severity of Hand OA can have a predictive value on multiple joint involvement and risk of surgical intervention. This study emphasizes the need to investigate the genetic predisposition in causation of OA.

Role of magnetic resonance imaging in the diagnosis of the painful unicompartmental knee arthroplasty.

BACKGROUND: Unicompartmental knee arthroplasty (UKA) is a well established method for the treatment of single compartment arthritis; however, a subset of patients still present with continued pain after their procedure in the setting of a normal radiographic examination. This study investigates the effectiveness of magnetic resonance imaging (MRI) in guiding the diagnosis of the painful unicompartmental knee arthroplasty. METHODS: An IRB-approved retrospective review identified 300 consecutive UKAs performed over a three years period with 28 cases of symptomatic UKA (nine percent) with normal radiographic images. RESULTS: MRI examination was instrumental in finding a diagnosis that went undetected on radiographs. Based on MRI findings, 10 (36%) patients underwent surgery whilst 18 (64%) were treated conservatively. CONCLUSION: This study supports the use of MRI as a valuable imaging modality for managing symptomatic unicompartmental knee arthroplasty. LEVEL OF EVIDENCE: Case series.

Robotic-assisted femoral osteochondroplasty is more precise than a freehand technique in a Sawbone model.

Robotic-assistance has the potential to improve the accuracy of bony resections, when performing femoral osteochondroplasty in the treatment of cam-type femoroacetabular impingement (FAI). The purpose of this study was to determine the accuracy of robotic-assisted femoral osteochondroplasty and compare this to a conventional open, freehand technique. We hypothesized that robotic-assistance would increase the accuracy of femoral head-neck offset correction in cam FAI. Sixteen identical sawbones models with a cam-type impingement deformity were resected by a single surgeon, simulating an open femoral osteochondroplasty. Eight procedures were performed using an open freehand technique and eight were performed using robotic-assistance, through the creation of a three-dimensional haptic volume. A desired arc of resection of 117.7° was determined pre-operatively using an anatomic plan. Post-resection, all 16 sawbones were laser scanned to measure the arc of resection, volume of bone removed and depth of resection. For each sawbone, these measurements were compared with the pre-operatively planned desired resection, to determine the resection error. Freehand resection resulted in a mean arc of resection error of 42.0 ± 8.5° compared with robotic-assisted resection which had a mean arc of resection error of 1.2 ± 0.7° (P < 0.0001). Over-resection occurred with every freehand resection with a mean volume error of 758.3 ± 477.1 mm(3) compared with a mean robotic-assisted resection volume error of 31.3 ± 220.7 mm(3) (P < 0.01). This study has shown that robotic-assisted femoral osteochondroplasty in the treatment of cam-type FAI is more accurate than a conventional, freehand technique, which are currently in widespread use.