Background/Objectives: Despite the rising tendency to depend on ChatGPT for medical counselling, it is imperative to evaluate ChatGPT’s capacity to address sensitive subjects that patients often hesitate to discuss with their physicians. The objective of this study was to evaluate the recommendations provided by ChatGPT for sexual activity subsequent to total hip arthroplasty (THA) by orthopaedic surgeons with varying degrees of experience, as well as using standardized scoring systems. Methods: Four patient scenarios were developed, reflecting different ages and indications for THA. Twenty-four questions were asked to ChatGPT 4.0, and responses were evaluated by three different orthopaedic surgeons. All responses were also scored using defined standardized scales. Results: No response was found to be ‘faulty’ or ‘partial’ by any of the observers. While the lowest mean score was attributed by the orthopaedic surgeon with less than five years of experience, the highest mean score was attributed by the orthopaedic surgeon with more than 15 years of experience but not actively working in the field of arthroplasty. An analysis of the data across scenarios revealed that in general, the scores decreased in the more specialized scenarios (p > 0.05). Conclusions: ChatGPT shows potential as a supplementary resource for addressing sensitive postoperative questions such as sexual activity after THA. However, its limitations in providing nuanced, patient-specific recommendations highlight the need for further refinement. While ChatGPT can support general patient education, expert clinical guidance remains essential for addressing complex or individualized concerns.

Methods:Results:Conclusion:Amaç:Bu çalışmanın amacı adölesan idiyopatik skolyoz hastalarının pedikül vidası ve rod kombinasyonu ile cerrahi tedavisinde otolog kan transfüzyonu cell saver yönteminin allojenik kan replasmanı üzerine etkisini araştırmaktı. Adölesan idiyopatik skolyoz nedeniyle ameliyat edilen 33 hasta (5 erkek, 28 kadın) çalışmaya alındı. Cell saver kullanılan 16 hasta (ortalama yaş: 17.1±3.9; Grup A) ve kontrol amaçlı, cell saver kullanılmayan 17 hasta (ortalama yaş: 18.7±6.8; Grup B) olmak üzere iki grup oluşturuldu. Hastaların Cobb açıları, pedikül tespit seviyeleri, operasyon süreleri, operasyon sonrası drenajları, hemoglobin değişimleri, allojenik kan replasmanları ve otolog eritrosit miktarları kaydedildi. Her iki grupta tespit edilen omur seviyeleri 12.9±1.54 (Grup A), 12.8±1.47 (Grup B) ve kullanılan vida sayıları 21.1±3.21 (Grup A), 18.7±3.59 (Grup B) idi (p>0.05). Ortalama ameliyat süresi 224 dakika, gruplara göre dağılımı 228±58 (Grup A), 221±60 (Grup B) dakika olarak kaydedildi. Demografik özellikler açısından iki grup arasında istatistiksel olarak anlamlı bir farklılık saptanmadı (p>0.05). Ameliyat öncesi iki grup arasındaki hemoglobin değerleri 12.2±1.47 mg/dl (Grup A) ve 13.1±1.56 mg/dl (Grup B) iken, operasyon sonrası hemoglobin değerleri ise 11.3±1.62 mg/dl (Grup A) ve 9.86±0.93 mg/dl (Grup B) olarak bulundu (p=0.004). Otolog eritrosit replasman miktarı 284±139 ml olarak kaydedildi. Operasyon sonrası birinci günde meydana gelen drenaj miktarı 834±253 ml (Grup A), 759±380 ml (Grup B) idi (p>0.05). Hastalara verilen toplam allojenik kan replasman miktarı 1.88±0.88 ünite (Grup A) ve 1.94±1.34 ünite (Grup B) olarak ölçüldü (p>0.05). Adölesan idiyopatik skolyozun cerrahi tedavisinde cell saver kullanımı ile otolog eritrosit transfüzyonu yapılabilmesine rağmen allojenik kan replasman miktarında anlamlı azalma sağlanamamaktadır.

Ekinci M, et al. Hip Pelvis. 2021 Dec;33(4):200-210. https://doi.org/10.5371/hp.2021.33.4.200

Objectives: This study aims to evaluate patients with conservatively treated stable lateral malleolar fractures with isokinetic tests. Patients and methods: Between January 2016 and November 2017, a total of 24 patients (12 males, 12 females; mean age 40.8±15.0 years; range, 18 to 68 years) with an isolated stable lateral malleolar fracture treated conservatively with the circular cast were included in this prospective study. Calf circumferences, ankle range of motion (ROM), pain levels, and functional outcomes were recorded. The muscle strengths and endurance of the injured side were compared with the non-injured side. All patients were evaluated by isokinetic test after removal of the cast, and three and six months after the rehabilitation period. Results: The ROM was found to be lower after removal of the plaster cast, compared to the contralateral ankle. During cast removal, we also found that both dorsiflexor and plantar flexor muscle strength decreased by 25.6% and 44.7%, respectively, and decreased to 10.3% and 3.6% at three months post-rehabilitation. At the end of six months, no statistically significant difference was found between the two sides. In the dorsiflexion-plantar flexion endurance values, 37.8% and 54.1% deficit were detected before the rehabilitation protocol, respectively (p<0.05). At three months, these values decreased to 6.1% and 13.6%, respectively and the endurances of the injured sides surpassed the non-injured sides (p<0.05) at six months. Conclusion: Conservative management of stable isolated lateral malleolar fractures with circular cast causes atrophy and decreases strength-endurance of the calf muscles due to immobilization. These changes are expected to diminish over time and functional outcomes are excellent with a good rehabilitation program.

Introduction: The aim of this study was to analyze the survival of the Echelon® femoral stems in revision hip surgeries in patients with Paprosky I–IIIA femoral defects. Patients and methods: Sixty-six patients (70 hips) who underwent revision hip surgery with at least 3 years of follow-up data were included in the study between 2000 and 2013. The mean patient age was 64.5 (32–83) years, and the mean follow-up period was 93 (45–206) months. The reasons for revision were aseptic loosening in 55 (78.6%) patients, periprosthetic joint infection in 9 (12.9%) patients, periprosthetic fracture in 4 (5.7%) patients, and stem fracture in 2 (2.9%) patients. The preoperative and postoperative follow-up X-rays and functional scores were evaluated. Results: Five patients died in an average of 70 (45–86) months after surgery due to non-related diseases. We encountered sciatic nerve palsy in two patients and early hip dislocation in two patients, whereas 54 patients were able to walk without any assistive device. The remaining 12 patients required an assistive device to walk. The mean Harris hip score significantly increased from 34 (7–63) preoperatively to 72 (43–96) postoperatively. Aseptic loosening was observed in one patient. The survival of the porous-coated anatomical uncemented femoral stem was 98.4% over 10 years. Conclusion: This study showed that good clinical outcomes and survival can be obtained when using porous-coated anatomical uncemented femoral stems.

BACKGROUND: Tranexamic acid (TXA) has been shown to reduce intraoperative bleeding and the need for post-operative allogenic blood transfusion requirement in surgery. In our randomized controlled study, we aimed to evaluate the effect of pre-operative 15 mg/kg intravenous TXA on total blood loss (TBL), hidden blood loss (HBL), and transfusion requirement in elderly patient group with intertrochanteric femoral fracture (ITFF) and treated with proximal femoral nailing (PFN). METHODS: Patients diagnosed with ITFFs (AO types 31-A1 and 31-A2) and treated using closed reduction and PFN was divided into two groups in our prospective randomized study. Group 1 (TXA group) was administered 15 mg/kg of TXA 15 min before the incision was made, after anesthesia was given, in the form of an IV infusion in 100 cc of saline. Group 2 (control group) was given only 100 cc of isotonic saline. The primary outcome of the study was TBL. The secondary outcomes were the number of transfusions, HBL, and the surgical (intraoperative) blood loss during the operative procedure and post-operative complications. The outcome values were compared between two groups. RESULTS: One hundred and two patients (51 patients in each group) were included in our study. There were no statistically significant differences between the two groups in terms of their demographic characteristics and their pre-operative hemoglobin and hematocrit values. The mean TBL was statistically lower in the TXA group than in the control group (684.6 +/- 370.1 ml vs. 971.2 +/- 505.3 ml, respectively; p=0.002). The amount of intraoperative blood loss was not significantly different between two groups (102.4 +/- 59.3 ml in the TXA group vs. 112.7 +/- 90.1 ml in the control group, p=0.67). However, the mean estimated HBL was significantly lower in the TXA group than in the control group (582.3 +/- 341.2 ml vs. 857.8 +/- 493.1 ml, respectively; p=0.002). The post-operative blood transfusion rate and transfusion unit were found to be significantly lower in the TXA group than in the control group (8% vs. 23.5%, respectively [p=0.033], and 6 U vs. 15 U, respectively [p=0.04]). Both medical and surgical post-operative complications were found to be similar for two groups. CONCLUSION: Single dose of TXA significantly reduces TBL, HBL, and the need for blood transfusions following PFN in elderly patients with ITFFs, while it does not increase the risk of DVT or thromboembolic events.