Background: This study aimed to assess the reproducibility and reliability of Chat-Based GPT (ChatGPT)’s responses to 19 statements regarding the management of hip fractures in older adults as adopted by the American Academy of Orthopaedic Surgeons’ (AAOS) evidence-based clinical practice guidelines. Methods: Nineteen statements were obtained from the 2021 AAOS evidence-based clinical practice guidelines. After generating questions based on these 19 statements, we set a prompt for both the GPT-4o and GPT-4 models. We repeated this process three times at 24 h intervals for both models, producing outputs A, B, and C. ChatGPT’s performance, the intra-ChatGPT reliability, and the accuracy rates were assessed to evaluate the reproducibility and reliability of the hip fracture-related guidelines. Regarding the strengths of the recommendation compared with the 2021 AAOS guidelines, we observed accuracy of 0.684, 0.579, and 0.632 for outputs A, B, and C, respectively. Results: The precision was 0.740, 0.737, and 0.718 in outputs A, B, and C, respectively. For the reliability of the strengths of the recommendation, the Fleiss kappa was 0.409, indicating a moderate level of agreement. No statistical differences in the strengths of the recommendation were observed in outputs A, B, and C between the GPT-4o and GPT-4 versions. Conclusion: ChatGPT may be useful in providing guidelines for hip fractures but performs poorly in terms of accuracy and precision. However, hallucinations remain an unresolved limitation associated with using ChatGPT to search for hip fracture guidelines. The effective utilization of ChatGPT as a patient education tool for the management of hip fractures should be addressed in the future.

This narrative review aims to provide an in-depth understanding of the biomechanical consequences of medial meniscus posterior root tears (MMPRTs), with a particular focus on the role of hoop tension in meniscal function. By revisiting fundamental principles such as load transmission, contact mechanics, and structural stabilization, this review elucidates how MMPRTs compromise both the integrity and function of the knee joint. The disruption of hoop tension is analyzed across various tear patterns, and through a synthesis of biomechanical experiments, the superiority and necessity of anatomical structural restoration over conservative management or meniscectomy are emphasized. A comprehensive grasp of these biomechanical foundations offers a critical perspective on the pathomechanics of MMPRTs and serves as a basis for more rational, evidence-based surgical decision-making in clinical practice.

Kim H, et al. Hip Pelvis. 2023 Dec;35(4):259-267. https://doi.org/10.5371/hp.2023.35.4.259

김형태, et al. J Korean Orthop Assoc. 2022 Oct;57(5):400-408. https://doi.org/10.4055/jkoa.2022.57.5.400

Introduction: Ceramic-polyethylene sandwich liners were introduced to reduce fracture, but high failure rates were reported. We report a fracture clinically recognized 21 years after revision total hip arthroplasty (THA). Case Presentation: A 64-year-old man presented with two weeks of hip pain, clicking, and gait disturbance without trauma. He underwent primary THA for secondary coxarthrosis after slipped capital femoral epiphysis and revision THA for aseptic loosening three years later. Radiographs demonstrated eccentric femoral-head migration and radiopaque fragments. Computed tomography confirmed ceramic layer fracture and migration into the obturator internus muscle. Management and Outcomes: Re-revision of the acetabular cup with a fourth-generation ceramic articulation was performed, with the well-fixed femoral stem retained. At 43 months, he returned to recreational hiking; the modified Harris Hip Score improved from 42.9 to 87.5. Residual fragments remained stable. Conclusion: Long-term surveillance and prompt evaluation of mechanical symptoms are advised for older-generation sandwich liners.