Evaluating ChatGPT responses in the context of a 53-year-old male with a femoral neck fracture: a qualitative analysis.

PURPOSE: The integration of artificial intelligence (AI) tools, such as ChatGPT, in clinical medicine and medical education has gained significant attention due to their potential to support decision-making and improve patient care. However, there is a need to evaluate the benefits and limitations of these tools in specific clinical scenarios. METHODS: This study used a case study approach within the field of orthopaedic surgery. A clinical case report featuring a 53-year-old male with a femoral neck fracture was used as the basis for evaluation. ChatGPT, a large language model, was asked to respond to clinical questions related to the case. The responses generated by ChatGPT were evaluated qualitatively, considering their relevance, justification, and alignment with the responses of real clinicians. Alternative dialogue protocols were also employed to assess the impact of additional prompts and contextual information on ChatGPT responses. RESULTS: ChatGPT generally provided clinically appropriate responses to the questions posed in the clinical case report. However, the level of justification and explanation varied across the generated responses. Occasionally, clinically inappropriate responses and inconsistencies were observed in the generated responses across different dialogue protocols and on separate days. CONCLUSIONS: The findings of this study highlight both the potential and limitations of using ChatGPT in clinical practice. While ChatGPT demonstrated the ability to provide relevant clinical information, the lack of consistent justification and occasional clinically inappropriate responses raise concerns about its reliability. These results underscore the importance of careful consideration and validation when using AI tools in healthcare. Further research and clinician training are necessary to effectively integrate AI tools like ChatGPT, ensuring their safe and reliable use in clinical decision-making.

The ability of artificial intelligence tools to formulate orthopaedic clinical decisions in comparison to human clinicians: An analysis of ChatGPT 3.5, ChatGPT 4, and Bard.

Background: Recent advancements in artificial intelligence (AI) have sparked interest in its integration into clinical medicine and education. This study evaluates the performance of three AI tools compared to human clinicians in addressing complex orthopaedic decisions in real-world clinical cases. Questions/purposes: To evaluate the ability of commonly used AI tools to formulate orthopaedic clinical decisions in comparison to human clinicians. Patients and methods: The study used OrthoBullets Cases, a publicly available clinical cases collaboration platform where surgeons from around the world choose treatment options based on peer-reviewed standardised treatment polls. The clinical cases cover various orthopaedic categories. Three AI tools, (ChatGPT 3.5, ChatGPT 4, and Bard), were evaluated. Uniform prompts were used to input case information including questions relating to the case, and the AI tools' responses were analysed for alignment with the most popular response, within 10%, and within 20% of the most popular human responses. Results: In total, 8 clinical categories comprising of 97 questions were analysed. ChatGPT 4 demonstrated the highest proportion of most popular responses (proportion of most popular response: ChatGPT 4 68.0%, ChatGPT 3.5 40.2%, Bard 45.4%, P value < 0.001), outperforming other AI tools. AI tools performed poorer in questions that were considered controversial (where disagreement occurred in human responses). Inter-tool agreement, as evaluated using Cohen's kappa coefficient, ranged from 0.201 (ChatGPT 4 vs. Bard) to 0.634 (ChatGPT 3.5 vs. Bard). However, AI tool responses varied widely, reflecting a need for consistency in real-world clinical applications. Conclusions: While AI tools demonstrated potential use in educational contexts, their integration into clinical decision-making requires caution due to inconsistent responses and deviations from peer consensus. Future research should focus on specialised clinical AI tool development to maximise utility in clinical decision-making. Level of evidence: IV.

Radiolucent line assessment in cemented stemmed total knee (RISK) arthroplasty: validation of a modernized classification system.

BACKGROUND: This study aims to implement and assess the inter- and intra-reliability of a modernized radiolucency assessment system; the Radiolucency In cemented Stemmed Knee (RISK) arthroplasty classification. Furthermore, we assessed the distribution of regions affected by radiolucency in patients undergoing stemmed cemented total knee arthroplasty. METHODS: Stemmed total knee arthroplasty cases over 7-year period at a single institution were retrospectively identified and reviewed. The RISK classification system identifies five zones in the femur and five zones in the tibia in both the anteroposterior (AP) and lateral planes. Post-operative and follow-up radiographs were scored for radiolucency by four blinded reviewers at two distinct time points four weeks apart. Reliability was assessed using the kappa statistic. A heat map was generated to demonstrate the reported regions of radiolucency. RESULTS: 29 cases (63 radiographs) of stemmed total knee arthroplasty were examined radiographically using the RISK classification system. Intra-reliability (0.83) and Inter-reliability (0.80) scores were both consistent with a strong level of agreement using the kappa scoring system. Radiolucency was more commonly associated with the tibial component (76.6%) compared to the femoral component (23.3%), and the tibial anterior-posterior (AP) region 1 (medial plateau) was the most affected (14.9%). CONCLUSION: The RISK classification system is a reliable assessment tool for evaluating radiolucency around stemmed total knee arthroplasty using defined zones on both AP and lateral radiographs. Zones of radiolucency identified in this study may be relevant to implant survival and corresponded well with zones of fixation, which may help inform future research.

Oncologic outcomes in myxofibrosarcomas: the role of a multidisciplinary approach and surgical resection margins.

BACKGROUNDS: Myxofibrosarcomas (MFS) are malignant soft tissue sarcomas with an infiltrative growth pattern and propensity for local recurrence(LR).We aimed to assess our management of MFS and make recommendations about the role of a multidisciplinary team approach and margin widths. METHODS: Fifty-seven patients were identified with MFS treated at a single sarcoma centre between 1998 and 2020. Patients were stratified based on whether they presented for a planned resection (59.6%) or after an unplanned resection (40.4%) performed at a non-specialized facility. All patients underwent radiotherapy before definitive surgery. RESULTS: 73.7% underwent a combined onco-plastic approach. The 5 year LRFS rate was 78.2% (84.4%, planned, versus 70.1%, unplanned, P = 0.194) and found comparable oncological outcomes between the planned and unplanned groups for the 5 year metastasis free survival (74.5% versus 86.1%, P = 0.257), disease free survival (70.1% versus 72.4%, P = 0.677), and Overall Survival (64.5% versus 75.9%, P = 0.950). Margin width ≥ 2 cm was obtained in 84.2% of cases and improved local control (HR = 0.22; 95% CI 0.06-0.81; P = 0.023), metastasis (HR = 0.24; 95% CI 0.07-0.80; P = 0.019) and mortality rates (HR = 0.23; 95% CI 0.09, 0.61; P = 0.003) compared to <2 cm. Margin width > 3 cm did not further affect oncological outcomes. CONCLUSION: Our study shows that a multidisciplinary team approach allows the achievement of low local recurrence rate and good oncological outcomes of myxofibrosarcomas, regardless of presentation status. We recommend a minimum of 2 cm margin width.

Kinematic alignment results in clinically similar outcomes to mechanical alignment: Systematic review and meta-analysis.

PURPOSE: It is unclear whether a difference in functional outcome exists between kinematically aligned (KA) and mechanically aligned (MA) knee replacements. The aim of this study is to perform a comprehensive systematic review and meta-analysis of the available level I-IV evidence. METHODS: A meta-analysis of randomised controlled trials and observational studies comparing patient reported outcome measures (PROMs), range of motion (ROM), gait analysis and complications in TKA with KA and MA was performed. Quality assessment was performed for each study using the Joanna Briggs Institute (JBI) critical appraisal tools. RESULTS: Twelve randomised controlled trials and fourteen observational studies published between 2014 and 2022 were included in the final analysis. Meta-analysis revealed KA to have significantly better Oxford Knee Score (OKS) (p = 0.02), Forgotten Joint Score (FJS) (p = 0.006), Knee Society Score (KSS) Objective Knee (p = 0.03) and KSS Functional Activity (p = 0.008) scores. However, these improvements did not exceed the minimum clinically important difference (MCID) values reported in the literature. Subgroup analysis showed robotic assisted KA-TKA to have a clinically superior FJS (p = 0.0002) and trend towards KSS Objective Knee score (p = 0.10), compared to PSI. Gait and plantar pressure distribution of KA cohorts more closely represented healthy cohorts, and KA showed a weak association of a decreased knee adduction moment (KAM) compared to MA. Differences in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), range of motion and complications were not significant between groups. CONCLUSION: Although KA results in several improved functional outcomes, these do not reach clinical significance. Further standardised large-scale randomised studies are required to improve the quality of evidence. As it stands, it is difficult to recommend one philosophy over the other.

Atypical femur fractures associated with bisphosphonate therapy: post-operative outcomes.

PURPOSE: Bisphosphonates are commonly used medication for the treatment of osteoporosis, and a well-established complication of this medication is bisphosphonate-associated atypical femur fractures (BAAFFs). The aim of this study was to assess the post-operative functional and radiographic outcomes of surgically treated BAAFFs. METHODS: An analysis of patients treated at a university-affiliated institution was performed. Patients who had undergone surgical fixation for a subtrochanteric or shaft of femur fracture which had been classified as atypical and treated with bisphosphonate therapy at the time of fracture were included. The outcome measures assessed included post-operative complications, length of stay, discharge destination, post-operative function, independence in activities of daily living (ADLs) and fracture union. RESULTS: Twenty patients were included in this study with a mean age of 75.2 years. The cohort was predominantly female. The average duration of bisphosphonate therapy was 7.35 years. Nine patients had contralateral bisphosphonate-related stress reactions at the time of their initial fracture and underwent prophylactic surgical intervention. The majority of patients received cephalomedullary nail fixation (95%) with more than half (65.0%) of the cohort experiencing one or more post-operative complications. The median length of stay was 6.5 days and 50% of the cohort required inpatient rehabilitation. At final review, independent mobilisation was recorded in only 10.0% of patients, and 70% of patients were dependent with their ADLs at their latest follow-up. Average follow-up was 8 months, and only six cases demonstrated union at the six-month review, with delayed union between 9 and 12 months being common. CONCLUSION: Patients with BAAFFs experience high rates of complications, record poor post-operative functional outcomes, and demonstrate a delayed time to union. Nearly half of our cohort had radiographic evidence of bilateral pathology.

Methodological Challenges in Predicting Periprosthetic Joint Infection Treatment Outcomes: A Narrative Review.

The management of periprosthetic joint infection (PJI) generally requires both surgical intervention and targeted antimicrobial therapy. Decisions regarding surgical management-whether it be irrigation and debridement, one-stage revision, or two-stage revision-must take into consideration an array of factors. These include the timing and duration of symptoms, clinical characteristics of the patient, and antimicrobial susceptibilities of the microorganism(s) involved. Moreover, decisions relating to surgical management must consider clinical factors associated with the health of the patient, alongside the patient's preferences. These decisions are further complicated by concerns beyond mere eradication of the infection, such as the level of improvement in quality of life related to management strategies. To better understand the probability of successful surgical treatment of a PJI, several predictive tools have been developed over the past decade. This narrative review provides an overview of available clinical prediction models that aim to guide treatment decisions for patients with periprosthetic joint infection, and highlights key challenges to reliably implementing these tools in clinical practice.

Tibial tuberosity-trochlear groove distance: does it measure up?

Recognized anatomic variations that lead to patella instability include patella alta and trochlea dysplasia. Lateralization of the extensor mechanism relative to the trochlea is often considered to be a contributing factor; however, controversy remains as to the degree this contributes to instability and how this should be measured. As the tibial tuberosity-trochlear groove (TT-TG) is one of most common imaging measurements to assess lateralization of the extensor mechanism, it is important to understand its strengths and weaknesses. Care needs to be taken while interpreting the TT-TG value as it is affected by many factors. Medializing tibial tubercle osteotomy is sometimes used to correct the TT-TG, but may not truly address the underlying anatomical problem. This review set out to determine whether the TT-TG distance sufficiently summarizes the pathoanatomy, and if this assists with planning of surgery in patellar instability. Cite this article: Bone Jt Open 2022;3(3):268-274.

Patterns and Predictors of Outpatient Antibiotic Dispensation Following Total Hip and Knee Arthroplasty.

BACKGROUND: This study aimed to evaluate the month-to-month prevalence of antibiotic dispensation in the 12 months before and after total knee arthroplasty (TKA) and total hip arthroplasty (THA) and to identify factors associated with antibiotic dispensation in the month immediately following the surgical procedure. METHODS: In total, 4,115 THAs and TKAs performed between April 2013 and June 2019 from a state-wide arthroplasty referral center were analyzed. A cross-sectional study used data from an institutional arthroplasty registry, which was linked probabilistically to administrative dispensing data from the Australian Pharmaceutical Benefits Scheme. Multivariable logistic regression was carried out to identify patient and surgical risk factors for oral antibiotic dispensation. RESULTS: Oral antibiotics were dispensed in 18.3% of patients following primary TKA and 12.0% of patients following THA in the 30 days following discharge. During the year after discharge, 66.7% of TKA patients and 58.2% of THA patients were dispensed an antibiotic at some point. Patients with poor preoperative health status were more likely to have antibiotics dispensed in the month following THA or TKA. Older age, undergoing TKA rather than THA, obesity, inflammatory arthritis, and experiencing an in-hospital wound-related or other infectious complications were associated with increased antibiotic dispensation in the 30 days following discharge. CONCLUSION: A high rate of antibiotic dispensation in the 30 days following THA and TKA has been observed. Although resource constraints may limit routine wound review for all patients by a surgeon, a select cohort may benefit from timely specialist review postoperatively. Several risk factors identified in this study may aid in identifying appropriate candidates for such changes to follow-up care.

The influence of patellofemoral stabilisation surgery on joint congruity: an MRI surface mapping study.

BACKGROUND: In the unstable patellofemoral joint (PFJ), the patella will articulate in an abnormal manner, producing an uneven distribution of forces. It is hypothesised that incongruency of the PFJ, even without clinical instability, may lead to degenerative changes. The aim of this study was to record the change in joint contact area of the PFJ after stabilisation surgery using an established and validated MRI mapping technique. METHODS: A prospective MRI imaging study of patients with a history of PFJ instability was performed. The patellofemoral joints were imaged with the use of an MRI scan during active movement from 0° through to 40° of flexion. The congruency through measurement of the contact surface area was mapped in 5-mm intervals on axial slices. Post-stabilisation surgery contact area was compared to the pre-surgery contact area. RESULTS: In all, 26 patients were studied. The cohort included 12 male and 14 female patients with a mean age of 26 (15-43). The greatest mean differences in congruency between pre- and post-stabilised PFJs were observed at 0-10 degrees of flexion (0.54 cm2 versus 1.18 cm2, p = 0.04) and between 11° and 20° flexion (1.80 cm2 versus 3.45 cm2; p = 0.01). CONCLUSION: PFJ stabilisation procedures increase joint congruency. If a single axial series is to be obtained on MRI scan to compare the pre- and post-surgery joint congruity, the authors recommend 11° to 20° of tibiofemoral flexion as this was shown to have the greatest difference in contact surface area between pre- and post-operative congruency.

Bilateral acetabular fractures: Mechanism, fracture patterns and associated injuries.

INTRODUCTION: Acetabular fractures are uncommon and their management is often reserved for specialist pelvic and acetabular surgeons. Bilateral acetabular fractures are a particularly rare subgroup. We report the incidence, fracture pattern, mechanism of injury and outcome of patients presenting to a tertiary trauma centre with traumatic bilateral acetabular fractures. METHOD: Bilateral acetabular fractures were identified from a prospective database of acetabular fractures presenting to one institution over a six-year period. Patient notes and imaging studies were reviewed to identify demographics, mechanism of injury, Injury Severity Score, fracture pattern and management. Timing of operative management was explored. Patient outcomes were collected in the form of radiographs and Oxford Hip Scores at a minimum of one-year post injury. RESULTS: Eight patients with bilateral acetabular fracture were identified from a database which contained records of 519 patients with acetabular fractures (incidence of 1.5% amongst patients with acetabular fractures). Motor vehicle accidents were the most common mechanism. Four acetabular fracture patterns were observed within the cohort. Radiographic union occurred in all cases and Oxford Hip Scores are suggestive of moderate to well functioning hip joints. Fractures were treated as single or staged procedures. CONCLUSION: Bilateral acetabular fractures are very rare due to the unique degree and pattern of force required to fracture both acetabula. They are associated with 4 main fracture patterns and present with Injury Severity Scores that averaged 25 (severe). They are typically observed in young males with road traffic collision being the most common mechanism of injury.

Bilateral distal femoral endoprosthesis for trauma.

In this paper, we describe the outcome of bilateral distal femoral endoprosthesis for the management of acute severe trauma. We also review the literature to ascertain the published functional results of distal femoral endoprosthesis for acute trauma of native knees. In severely comminuted intra-articular fractures, such as those our patient sustained, reconstruction is not always possible, and predictable outcomes can rarely be assured with conviction. Endoprosthesis is an established treatment modality for replacement after resection in limb salvage surgery. In this regard, there is a limited but vital role that endoprosthesis can play in acute complex trauma. We demonstrate a good short-term outcome when bilateral endoprostheses are utilised for complex distal femur trauma.

An Alternative Site for Pin Placement in External Fixation of Pelvic Fractures: Lateral Posterior Pelvic External Fixator Surgical Technique.

Introduction: The application of an external fixator for unstable pelvic fractures is an important component of many resuscitation protocols. Moreover, certain pelvic fractures may be treated with an external fixator without requiring further internal fixation. We report our initial clinical results with an alternate pelvic external fixator site, the lateral posterior external fixator (LPEF), and describe the surgical technique. Methods and Materials: From 2010 to 2013, we identified 27 consecutive patients (mean age 44.6 years, range 18-80 years) treated by the same surgeon (MKR) with an LPEF in a level 1 trauma center. Retrospective data collection included mechanism of injury, surgical interventions, and complications. Results: The LPEF was used in 16 patients as acute pelvic stabilization and converted at a median of 2 days (interquartile range 1-3.5) to internal fixation, whereas in 10 patients, it was used as definitive treatment and removed at a median of 48 days (interquartile range 37-64). One patient died on day 14, secondary to his severe closed head injury. The only surgical complications were two wound infections (20%, 2/10 in the group of definitive LPEFs), which resolved without sequelae after the removal of the LPEF (at 36 and 50 days) and antibiotics, one case of loss of fixation leading to the removal of the LPEF at 71 days, and one patient who had hypergranulating external fixator sites and eventually healed without any cutaneous sequelae. All fractures consolidated in a good position. Discussion: The described techniques of pelvic external fixation include the anterosuperior (iliac wing), supra-acetabular (anteroinferior), and subcristal (anterior superior iliac spine) insertion sites. The reported infection rates in definitive pelvic fracture treatment range from 20 to 40%. Due to the localization of the insertion sites, the lateral femoral cutaneous nerve is potentially at risk with the last two techniques. On the other hand, the LPEF insertion site is quite safe, as it is anatomically far from any nerves and the inguinal region, and allows easy access for laparotomy. The results in this series suggest that the lateral posterior pelvic external fixator technique is an alternative to previous techniques with a low risk of complications.

Plate and screw fixation of arthroscopically assisted tibial tuberosity osteotomy: technique and results.

INTRODUCTION: We describe a fixation technique for tibial tuberosity osteotomies (TTO) utilising a plate and screw construct which adheres to established principles of bone healing. We record and discuss the complication profile and benefits of this technique. METHOD: The technique is outlined, and thirty consecutive case of TTO fixed with this combination of plate and screws were analysed during a study period from January 2018 to October 2018. All patients were followed up clinically to 3 months post-operation for the purpose of identifying early complications of surgery. Radiographic series were reviewed at 2, 6 and 12 weeks post-operation for evidence of fracture, loss of position, hardware failure and union. RESULTS: All cases went on to clinical and radiographic union by 12 weeks. We identified one case of hardware failure, one case of superficial infection and one case of stiffness requiring manipulation. CONCLUSION: We have found this technique of plate and screw construct to be effective in arthroscopically assisted TTO fixation leading to consistent union without loss of position with a low complication profile.

Desmoplastic Fibroma: A Rare Pathological Midshaft Femoral Fracture Treated With Resection, Acute Shortening, and Re-lengthening: A Case Report.

CASE: We report a rare case of desmoplastic fibroma (DF) of the midshaft femur presenting as a pathological fracture. This rare benign bone tumor was treated with an acute en bloc excision and femoral shortening over an intramedullary nail. Once union of the acute shortening had been achieved, further surgery was undertaken to lengthen the femur with the use of Intramedullary Skeletal Kinetic Distractors. At 3 years after fracture, our patient had achieved equal leg lengths, had normal knee function, and was disease free. CONCLUSIONS: DF resulting in pathological fracture of the midshaft femur is extremely rare and has not been reported to occur in the femoral diaphysis. This location is important as preservation of the joint above and below is preferable and en bloc excision is recommended. Restoration of bone stock after en bloc excision is difficult and recurrence needs to be monitored.

Survival and functional outcome of revision total knee arthroplasty with a total stabilizer knee system: minimum 5 years of follow-up.

INTRODUCTION: Revision knee arthroplasty surgery can range from patella resurfacing or polyethylene exchange, to staged revision and revision to a more constrained implant. Subsequently, the ability to elicit outcomes becomes difficult to obtain and hence information on functional outcome and survivorship for all modes of failure with a single revision system is valuable. METHODS: We retrospectively assessed 100 consecutive revision knee replacements that were converted from a primary knee replacement to a Triathlon total stabilizer (TS) knee system (Stryker Orthopaedics, Mahwah, NJ). Inclusion criteria included failure of a primary knee replacement of any cause converted to a Stryker TS knee system. Midterm outcome of at least 5 years was required. Implants survivorship, Oxford Knee Score (OKS), Forgotten Joint Score (FJS-12), Short Form (SF-) 12, reported patient satisfaction and radiographic analysis were recorded. RESULTS: The all-cause survival rate at 5 years was 89.0% [95% confidence interval (CI) 87.3 to 90.7]. The all-cause survival rate was generally static after the first 4 years. The mean OKS was 27 (SD 11.9, range 0 to 46), FJS was 32.3 (SD 30.4, range 0 to 100), SF-12 physical component summary was 40.6 (SD 17.6, range 23.9 to 67.1), and mental component summary was 48.3 (SD 15.5, range 23.9 to 69.1). Reported patient satisfaction in patients who were not re-revised was 82%. CONCLUSION: The midterm survivorship of cemented Stryker Triathlon TS knee revision for all-cause mode of failure is good to excellent; however, future follow-up is required to ensure this survivorship is observed into the long term. Despite limited functional outcome, overall patient satisfaction rates are high.

Preparing the femur before the acetabulum does not reduce total blood loss in primary total hip replacement.

INTRODUCTION: Total hip replacement is a common and effective surgical intervention for patients with debilitating joint pain but it does represent a significant surgical intervention. For such interventions, blood loss is a potential cause of morbidity and mortality. Optimisation of surgical interventions focuses on reducing such risks. The aim of this study was to determine whether the order of surgical steps, preparing the femur before or after the acetabulum, was associated with the amount of total blood loss in total hip replacement. METHODS: We performed a retrospective study of 100 patients undergoing primary total hip replacement between 2014 and 2018. This was a before and after (interrupted time series) study around the introduction of femur first preparation for total hip replacement in our unit. Fifty patients underwent a standard femoral preparation after placement of the acetabular component. The second 50 patients had the femoral canal prepared and broached prior to the acetabular component. Estimated blood volume and total blood loss associated with the perioperative period were calculated for each patient and a multiple regression analysis performed to account for other patient and surgical variables associated with perioperative blood loss. RESULTS: There was a small reduction in total blood loss for the group who underwent femoral preparation prior to acetabular preparation with a mean difference of 39 mls. This difference however was not clinically or statistically (p = 0.392) significant. Gender (p < 0.0001), Body Mass Index (BMI; p < 0.0001), preoperative haematocrit (p < 0.0001), postoperative haematocrit (p < 0.0001) and age (p = 0.004) were the only factors significantly associated with the total volume of blood loss. CONCLUSIONS: Whether the femur was prepared before or after the acetabulum did not significantly predict the total volume of blood loss for primary total hip replacement.

Open acetabular fracture: Case report and literature review.

Acetabular fractures are a rare injury, with a reported annual incidence of 3 patients per 100,000 per year. Open fractures of the acetabulum are extremely rare, with only explosive penetrating trauma (blast or gunshot injury) being previously reported. An open acetabular fracture as a result of blunt trauma is presented, in which the only indication was a wound in the buttock, in which early definitive surgical management of the injury provided a good clinical outcome.

Exogenous steroid-induced hypoadrenalism in a person living with HIV caused by a drug-drug interaction between cobicistat and intrabursal triamcinolone.

We report a diagnosis of exogenous steroid-induced hypoadrenalism in a person living with HIV caused by a drug-drug interaction (DDI) between intrabursal triamcinolone and the pharmacokinetic booster cobicistat. A 53-year-old woman living with HIV, managed with dolutegravir and cobicistat-boosted darunavir, presented to the orthopaedic clinic with worsening hip pain. She was diagnosed with greater trochanteric pain syndrome (GTPS) of the hip and was treated with intrabursal injection of bupivacaine and triamcinolone. Seven days following this injection, she presented with Cushingoid features, an undetectable cortisol and was diagnosed with exogenous steroid-induced hypoadrenalism. Cobicistat is a cytochrome P450 3A inhibitor and in this case inhibited clearance of intrabursal triamcinolone, leading to exogenous glucocorticoid excess and adrenal suppression. This is the first report to describe this predictable DDI with cobicistat following intrabursal glucocorticoid injection. This case highlights the complexities in managing non-HIV-related chronic morbidities in people living with HIV.