Utility of Artificial Intelligence in Orthopedic Surgery Literature Review: A Comparative Pilot Study.

OBJECTIVE: Literature reviews are essential to the scientific process and allow clinician researchers to advance general knowledge. The purpose of this study was to evaluate if the artificial intelligence (AI) programs ChatGPT and Perplexity.AI can perform an orthopedic surgery literature review. MATERIALS AND METHODS: Five different search topics of varying specificity within orthopedic surgery were chosen for each search arm to investigate. A consolidated list of unique articles for each search topic was recorded for the experimental AI search arms and compared with the results of the control arm of two independent reviewers. Articles in the experimental arms were examined by the two independent reviewers for relevancy and validity. RESULTS: ChatGPT was able to identify a total of 61 unique articles. Four articles were not relevant to the search topic and 51 articles were deemed to be fraudulent, resulting in 6 valid articles. Perplexity.AI was able to identify a total of 43 unique articles. Nineteen were not relevant to the search topic but all articles were able to be verified, resulting in 24 valid articles. The control arm was able to identify 132 articles. Success rates for ChatGPT and Perplexity. AI were 4.6% (6 of 132) and 18.2% (24 of 132), respectively. CONCLUSION: The current iteration of ChatGPT cannot perform a reliable literature review, and Perplexity.AI is only able to perform a limited review of the medical literature. Any utilization of these open AI programs should be done with caution and human quality assurance to promote responsible use and avoid the risk of using fabricated search results. [Orthopedics. 2024;47(3):e125-e130.].

Arthroscopic debridement for management of massive, irreparable rotator cuff tears: a systematic review of outcomes.

Background: Surgical management of massive irreparable rotator cuff tears remains controversial. Arthroscopic debridement (AD) has shown promising results especially in the population older than 65 years; however, there is no consensus on the benefits of various AD procedures. The aim of this systematic review was to evaluate the functional midterm to long-term outcomes in patients treated with AD in combination with subacromial decompression, biceps tenotomy, tuberoplasty, or bursectomy, without repair of the rotator cuff tear. Methods: A comprehensive search was performed in PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Cochrane databases for studies reporting clinical outcomes of AD of massive rotator cuff tears. Quality was determined using the Methodological Index for Nonrandomized Studies (MINORS) criteria by two independent reviewers. Pooled frequency-weighted means and standard deviations were calculated for patient-reported outcomes. Results: Sixteen articles containing 643 patients and 662 shoulders met the eligibility criteria. The mean age at the time of surgery was 65.9 ± 4.4 years with a mean follow-up period of 46.5 ± 27.3 months. There was notable clinically significant improvement across all patient-reported outcome scores postoperatively: Constant 70.4 ± 8.9 (P value = .06), University of California, Los Angeles ultrasonography 26.7 ± 5.2 (P value = .001), American Shoulder and Elbow Surgeons score 71.7 ± 2.1 (P value = .12), Disabilities of the Arm, Shoulder, and Hand score 35.3, and visual analog score 1.7 ± 0.9. Forty-nine patients (7%) required reoperation, which most commonly was a reverse total shoulder arthroplasty for the development of rotator cuff arthropathy. Conclusion: Arthroscopic debridement with a combination of subacromial decompression, tuberoplasty, subacromial bursectomy, and biceps tenotomy, for treatment of massive irreparable rotator cuff tears, produces good functional outcomes and improvement in pain at mid to long term follow up for the low-demand population greater than 65 years of age looking for pain relief over substantial increase in function.

Augmented Total Elbow Arthroplasty with Femoral Strut Allograft for Revision of Prosthetic Joint Infection with Distal Humerus Bone Loss and Incomplete Union of Periprosthetic Humeral Shaft Fracture.

Total elbow arthroplasty (TEA) prosthetic joint infection (PJI) in the setting of distal humerus bone loss poses a challenge for restoration of function. This can be complicated by a periprosthetic humeral fracture. Revision surgery in the setting of these pathologies possesses a significant challenge, especially when two or, in this case, all three problems are treated simultaneously. We present the clinical course, operative findings, and definitive treatment with the use of an augmented total elbow arthroplasty and femoral strut allograft reinforcement in detail. A review of the literature regarding the identification and management of infected TEA with augmented prosthesis and bone allograft augmentation of humerus fractures will be outlined in this case report.

Lateralization in reverse shoulder arthroplasty: A review.

Reverse shoulder arthroplasty, as originally designed by Grammont, has revolutionized the treatment of rotator cuff arthropathy as well as fractures about the proximal humerus. The original design consisted of glenoid and humeral components with a medialized center or rotation compared to the native shoulder. Long term outcome studies on this design demonstrated high rates of scapular notching as well as significant loss of external rotation. To combat these flaws, prosthesis design has evolved to include the concept of lateralization whereby the center of rotation is moved laterally compared to the Grammont prosthesis via either the glenoid or humeral components. Lateralization via the glenoid component has sought to reduce scapular notching, however, concerns over early loosening have been raised secondary to increasing stress at the glenosphere/glenoid interface. Lateralization via the humeral component has been theorized to improve the mechanics of the remaining rotator cuff and deltoid musculature while avoiding the problems inherent with glenoid lateralization. While limited clinical evidence is available currently to support one design over the other, multiple biomechanical studies have shown improvements in rates of scapular notching and post-operative external rotation for lateralized humeral and glenoid components. Future research should aim to delineate advantages of one design over the other or optimal combinations of the two designs.

Multiple Cultures and Extended Incubation for Upper Extremity Revision Arthroplasty Affect Clinical Care: A Cohort Study.

Skin flora organisms (SFOs) isolated from 1 to 2 tissue samples during shoulder and elbow revision arthroplasty are difficult to distinguish as contamination or infection. We examined the change in clinical care after implementation of an Arthroplasty Infection Protocol by increasing the number of intraoperative samples held for 10-day incubation to a minimum of 5. METHODS: Infection was defined as ≥3 cultures growing the same SFO or any one culture growing any other virulent organism. SFOs growing in 1 to 2 samples were defined as skin flora contaminant. All cases were compared with pre-Arthroplasty Infection Protocol institution standard to determine changes in microbiological diagnosis and resultant antibiotic treatment. RESULTS: Forty cases fulfilled the inclusion criteria: 50% of these were culture negative, and 35% grew Propionibacteria. When compared with the standard of obtaining one sample, this protocol altered the microbiological diagnosis and subsequent antibiotic treatment in 45% of cases (95% confidence interval 29% to 62%). This protocol had a predictive value of joint sterility in 95% of culture-negative cases (95% confidence interval 74% to 99%). DISCUSSION: The addition of 5 or more samples held for 10-day incubation reliably differentiated between joint infection, contamination, and sterility, which changed the course of care in 45% of surgical cases.

Imaging of the B2 Glenoid: An Assessment of Glenoid Wear.

BACKGROUND: Glenohumeral osteoarthritis (OA) carries a spectrum of morphology and wear patterns of the glenoid surface exemplified by complex patterns such as glenoid biconcavity and acquired retroversion seen in the B2 glenoid. Multiple imaging methods are available for evaluation of the complex glenoid structure seen in B2 glenoids. The purpose of this article is to review imaging assessment of the type B2 glenoid. METHODS: The current literature on imaging of the B2 glenoid was reviewed to describe the unique anatomy of this OA variant and how to appropriately assess its characteristics. RESULTS: Plain radiographs, magnetic resonance imaging, and standard 2-dimensional computed tomography (CT) have all shown acceptable assessments of arthritic glenoids but lack the detailed and highly accurate evaluation of bone loss and retroversion seen with 3-dimensional CT. CONCLUSION: Accurate preoperative identification of complex B2 pathology on imaging remains essential in planning and achieving precise implant placement at the time of shoulder arthroplasty.

Comparison of radiographic and clinical outcomes of revision reverse total shoulder arthroplasty with structural versus nonstructural bone graft.

BACKGROUND: Revision shoulder arthroplasty in the setting of glenoid bone loss poses substantial surgical challenges. This study's purpose was to compare radiographic and clinical results of patients requiring structural iliac crest bone autograft (ICBA) for severe bone loss versus patients with less severe bone loss treated with nonstructural bone allograft (NSBA) in the setting of revision reverse total shoulder arthroplasty (RSA). METHODS: A retrospective cohort of 30 patients (70% of the 43 patients who met the inclusion criteria) undergoing revision RSA with ICBA (n = 15) or NSBA (n = 15) between 2007 and 2015 were analyzed at a minimum 2-year follow-up. Radiographic assessment included bone graft integration, bone graft resorption, glenosphere tilt, glenosphere version, and the presence of scapular notching. Clinical assessment included active range of motion, Penn Shoulder Score, Veterans RAND 12-item health survey, and need for revision surgery. RESULTS: No radiographic difference was found between the ICBA and NSBA groups with regard to implant position, graft integration, scapular notching, implant shift, or failure of fixation (P > .05). Of 15 patients with ICBA, 14 (93%) had at least partial integration of the bone graft. Some degree of resorption of the bone graft was noted in 6 of 15 patients (40%). There was no significant difference in postoperative active range of motion, Penn Shoulder Score, or Veterans RAND 12-item health survey score (P > .05 for all comparisons). One patient in the ICBA group underwent revision surgery for glenoid baseplate failure. CONCLUSION: Revision RSA with glenoid bone grafting resulted in good clinical and radiographic outcomes at short-term follow-up. Patients requiring structural ICBA were not at increased risk of component failure, radiographic or clinical complications, or inferior clinical outcomes.

Hemolytic strains of Propionibacterium acnes do not demonstrate greater pathogenicity in periprosthetic shoulder infections.

BACKGROUND: Hemolysis has been suggested as a feature conferring increased pathogenicity to certain Propionibacterium acnes strains in the setting of shoulder infection. The purpose of this study was to compare the virulence of hemolytic and nonhemolytic P acnes strains in patients undergoing revision shoulder arthroplasty. METHODS: Thirty-nine patients with at least 1 positive culture growth for P acnes at the time of revision surgery were identified with P acnes isolates available for hemolysis testing. Patients were grouped into those with P acnes isolates positive (n = 20) and negative (n = 19) for hemolysis. The groups were retrospectively compared based on objective perioperative findings around the time of revision surgery and the postoperative clinical course, including the need for revision surgery. All cases were classified into categories of infection (definite infection, probable infection, and probable contaminant) based on objective perioperative criteria. RESULTS: The presence of hemolysis was not significantly associated with an increased likelihood of infection (P = .968). Hemolysis demonstrated a 75% sensitivity and 26% specificity for determining infection (definite infection and probable infection categories). The hemolytic and nonhemolytic groups showed no difference regarding preoperative serum erythrocyte sedimentation rate and/or C-reactive protein level (P = .70), number of positive cultures (P = .395), time to positive culture (P = .302), and presence of positive frozen section findings (P = .501). Postoperatively, clindamycin resistance, shoulder function, and the rate of reoperation were not significantly different between the hemolytic and nonhemolytic groups. CONCLUSION: The presence of hemolysis was not associated with increased pathogenicity in patients with P acnes-positive cultures following revision shoulder arthroplasty, when assessed by objective perioperative criteria and the postoperative clinical course.

Drill Penetration Injury to Extensor Tendons: A Biomechanical Analysis.

BACKGROUND: Little is known about extensor tendon failure following drill injury at the time of volar plate fixation. Our goals were to analyze extensor tendon injury following simulated drill penetration, and change in tendon displacement during cyclic loading following simulated drill penetration injury. METHODS: Extensor pollicis longus (EPL) and extensor carpi radialis brevis (ECRB) tendons were harvested from 9 fresh frozen cadaveric arms. Eighteen EPL and 18 ECRB samples were created from harvested tendons. Drill penetration injury was performed in either a continuous or an oscillating mode. Injured tendons were subjected to 1200 cycles at 1- to 15-kg cyclic load at a frequency of 1 Hz, and analyzed for failure at drill sites and change in displacement throughout the testing cycle. RESULTS: Ten EPL samples and 16 ECRB samples completed testing without failure. Tendon type (ECRB, EPL), mode of injury (continuous, oscillating), and location (proximal, distal) did not affect tendon displacement during loading. A single EPL tendon failed following continuous drill penetration injury. Extensor carpi radialis brevis samples had a mean change in displacement of 2.8 (standard deviation [SD]: 1.5 mm) and 5.9 mm (SD: 4.7 mm) for oscillating and continuous modes, respectively. Six EPL samples had a mean change in displacement of 4.7 (SD: 2.7 mm) and 4.3 mm (SD: 1.8 mm) for oscillating and continuous modes, respectively. CONCLUSIONS: Complete extensor tendon failure due to drill penetration was rare. Drill mode did not affect the degree of elongation. Increasing cyclic loading of extensor tendons after drill injury caused modest extensor tendon elongation.