Background: There has been substantial interest from the pharmaceutical industry to study and develop new biologic agents. Previous studies outside of the biologics field have demonstrated that industry funding has the potential to impact the design and findings of clinical trials. The objective of this study was to evaluate the impact of industry funding on randomized controlled trials (RCTs) that investigated the efficacy of biologic therapies. Methods: A review of all RCTs involving biologic therapies in top impact factor medical journals from January 2018 to December 2020 was performed. The relationship between industry funding and the presence of statistically significant primary outcomes and the use of active comparators were analyzed. Results: Among the 157 RCTs included, 120 (76%) were industry funded and 37 (24%) declared no industry funding. Industry-funded studies were significantly more likely to report a statistically significant positive primary outcome compared to studies without industry funding (85% vs. 67%, χ² = 5.867, p = 0.015) and were significantly more likely to utilize placebo or no comparator than non-industry-funded trials (78% vs. 49%, χ² = 4.430, p = 0.035). Conclusions: Industry-funded trials investigating biologic therapies are more likely to yield statistically significant positive outcomes and use placebo comparators when compared to non-industry-funded biologic therapy trials in high-impact medical journals.

This study aimed to evaluate the accuracy of ChatGPT in answering patient questions about femoroacetabular impingement (FAI) and arthroscopic hip surgery, comparing the performance of versions ChatGPT-3.5 (free) and ChatGPT-4 (paid). Twelve frequently asked questions (FAQs) relating to FAI were selected and posed to ChatGPT-3.5 and ChatGPT-4. The responses were assessed for accuracy by three hip arthroscopy surgeons using a four-tier grading system. Statistical analyses included Wilcoxon signed-rank tests and Gwet's AC2 coefficient for interrater agreement corrected for chance and employing quadratic weights. The median ratings for responses ranged from "excellent not requiring clarification" to "satisfactory requiring moderate clarification." No responses were rated as "unsatisfactory requiring substantial clarification." The median accuracy scores were 2 (range 1-3) for ChatGPT-3.5 and 1.5 (range 1-3) for ChatGPT-4, with 25 ​% of ChatGPT-3.5's responses and 50 ​% of ChatGPT-4's responses rated as "excellent." There was no statistical difference in performance between the two versions (p ​= ​0.279) although ChatGPT-4 showed a tendency towards higher accuracy in some areas. Interrater agreement was substantial for ChatGPT-3.5 (Gwet's AC2 ​= ​0.79 [95% confidence interval (CI) ​= ​0.6-0.94]) and moderate to substantial for ChatGPT-4 (Gwet's AC2 ​= ​0.65 [95% CI ​= ​0.43-0.87]). Both versions of ChatGPT provided mostly accurate responses to FAQs on FAI and arthroscopic surgery, with no significant difference between the versions. The findings suggest potential utility of ChatGPT in patient education, though cautious implementation and further evaluation are recommended due to variability in response accuracy and low power of the study. IV.

Background: The specific risk factors for surgical site infection (SSI) in orthopaedic oncology patients undergoing endoprosthetic reconstruction have not previously been evaluated in a large prospective cohort. In the current study, we aimed to define patient- and procedure-specific risk factors for SSI in patients who underwent surgical excision and endoprosthetic reconstruction for lower-extremity bone or soft-tissue tumors using the prospectively collected data of the Prophylactic Antibiotic Regimens in Tumor Surgery (PARITY) trial. Methods: PARITY was a multicenter, blinded, randomized controlled trial with a parallel 2-arm design that aimed to determine the effect of a long duration (5 days) versus short duration (24 hours) of postoperative prophylactic antibiotics on the rate of SSI in patients undergoing surgical excision and endoprosthetic reconstruction of the femur or tibia. In this secondary analysis of the PARITY data, a multivariate Cox proportional hazards regression model was constructed to explore predictors of SSI within 1 year postoperatively. Results: A total of 96 (15.9%) of the 604 patients experienced an SSI. Of the 23 variables analyzed in the univariate analysis, 4 variables achieved significance: preoperative diagnosis, operative time, volume of muscle excised, and hospital length of stay (LOS). However, only hospital LOS was found to be independently predictive of SSI in the multivariate regression analysis (hazard ratio per day = 1.03; 95% confidence interval = 1.01 to 1.05; p < 0.001). An omnibus test of model coefficients demonstrated that the model showed significant improvement over the null model (χ² = 78.04; p < 0.001). No multicollinearity was found. Conclusions: This secondary analysis of the PARITY study data found that the only independent risk factor for SSI on multivariate analysis was hospital LOS. It may therefore be reasonable for clinicians to consider streamlined discharge plans for orthopaedic oncology patients to potentially reduce the risk of SSI. Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Purpose: Intra‐articular hip disorders, such as femoroacetabular impingement syndrome (FAIS), labral tears and chondral damage are common in ice hockey players, particularly in the National Hockey League (NHL). However, evidence on return‐to‐sport (RTS) rates and performance outcomes post‐hip arthroscopy remains limited. This study evaluates RTS rates, career longevity, and performance metrics, including games played, points per game (PPG), save percentage, and performance scores (PS), following hip arthroscopy.Methods: NHL players who underwent hip arthroscopy for intra‐articular pathology between 2000 and 2024 were identified using public records. RTS rates, career duration, and performance metrics were analysed pre‐ and post‐surgery. Paired t‐tests and analyses of variance (ANOVA) were performed across positions (forwards, defensemen and goaltenders).Results: A total of 92 NHL players (103 hips) met inclusion criteria. The overall RTS rate was 79.3%, increasing to 84.9% when excluding players still recovering. RTS was significantly higher in players <30 years (90.0% vs. 64.3%, p = 0.003). The average number of post‐operative seasons played was 2.7, with no positional differences. Forwards showed significant declines in PPG (pre: 0.63 ± 0.38; post: 0.51 ± 0.37; p = 0.013) and PS (pre: 0.60 ± 0.74; post: 0.37 ± 0.69; ∆PS = −0.23; p = 0.026). Defensemen showed no significant change in PPG (p = 0.648) or PS (p = 0.509). Goaltenders had a decline in save percentage (pre: 0.91 ± 0.01; post: 0.89 ± 0.03; p = 0.038), while wins per season were unchanged (p = 0.205). RTS did not significantly differ by position.Conclusion: NHL players undergoing hip arthroscopy have high RTS rates and often resume multi‐season careers. However, forwards experience greater declines in performance, while defensemen and goaltenders are less affected. These results underscore position‐specific recovery trends and may inform rehabilitation strategies in elite hockey athletes.Level of Evidence: Level V.

Background: Cerebral palsy (CP) is the most common motor disability of childhood, predominantly characterized by spasticity. A frequent complication of spastic CP is equinovarus deformity, resulting in pain, instability, and altered gait, significantly affecting ambulation. Surgical intervention, particularly the split posterior tibialis tendon transfer (SPOTT), is often required to correct deformity when conservative management fails. However, the variability in outcomes and recurrence rates across different patient subtypes and surgical techniques remains unclear. This systematic review aimed to evaluate the recurrence rate of equinovarus deformity in children with CP after SPOTT, with a focus on factors such as age, CP subtype, and functional status. Methods: A systematic search of MEDLINE, Embase, and Emcare databases was performed to identify observational studies reporting recurrence rates after SPOTT in pediatric patients with CP (aged ≤18 years). Studies with short follow-up periods (<12 months), non-English articles, conference abstracts, and those involving concomitant bony procedures were excluded. Statistical analyses used random-effects meta-analysis models to calculate pooled recurrence rates. All statistical analyses were performed, and forest plots were generated using R (version 4.3.2). Results: Nine studies (325 patients, 366 feet) met the inclusion criteria. The mean age at surgery was 10.35 years, with a mean follow-up duration of 76.18 months. The overall pooled recurrence rate of equinovarus deformity after SPOTT was 11.4% (95% confidence interval 5.0-17.8), with substantial heterogeneity (I² = 71.9%). Subgroup analysis revealed higher failure rates among nonambulatory patients with quadriplegic CP (47.6%) compared with ambulatory hemiplegic patients (6.6%). The optimal age window for SPOTT seemed to be between 6 and 10 years as younger patients demonstrated increased risks of valgus deformity, whereas older patients had higher recurrence rates. Variations in surgical techniques, including interosseous membrane versus circumtibial routing, were identified as potential sources of heterogeneity. Conclusion: SPOTT seems to be an effective intervention for correcting equinovarus deformity in ambulatory patients with CP, particularly those with hemiplegia or diplegia. However, nonambulatory and quadriplegic patients are at higher risk of recurrence, warranting careful patient selection. These conclusions should be interpreted with caution because of substantial study heterogeneity and the variability in surgical techniques reported. Further high-quality studies with standardized reporting and direct comparisons between surgical techniques are necessary to optimize outcomes and inform clinical practice. Level of Evidence: Therapeutic Level IV, systematic review. See Instructions for Authors for a complete description of levels of evidence.