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.

Purpose: Graft diameter in anterior cruciate ligament reconstructions has been shown to influence the risk of failure. It is therefore important to be able to adjust the graft configuration to modify the diameter. To measure the impact of a 6-strand (6S) hamstring autograft configuration on graft diameter compared to the standard 4-strand (4S) configuration. Methods: Cadaveric study on 33 knees, using the usual hamstring graft harvesting technique. Semitendinosus and gracilis tendons were harvested and their length, width, and diameter were measured in 4S and 6S configurations separately by three evaluators. Results: 6S configuration leads to a median increase of 1.5 (range: 0.0–2.0) mm in diameter compared to 4S (p < 0.001). A graft diameter of more than 8 mm is attained in less than a third of 4S grafts within this population in comparison to 84% when the 6S configuration is used. Discussion: The 6S hamstring graft configuration increases the graft diameter by a median of 1.5 millimeters compared to the traditional 4S configuration. It can reliably be used to obtain an 8.5 mm graft diameter or more in cases where the semitendinosus measures at least 270.5 mm and the 4S configuration has a diameter of 7.5 mm or 8 mm. This information helps to better delineate the impact of a 6S configuration in a pre-operative or intra-operative setting to optimize the decisional process and surgical flow and to easily adapt the graft diameter. Level of evidence: V (cadaveric study)

Joint-preserving interventions, such as intra-articular viscosupplementation injections, are evolving and requiring efficacy and safety evaluations through an evidence-based approach. The objective of this study was to assess the use of a hyaluronic acid and corticosteroid-based injection (Cingal™; Anika Therapeutics, Bedford, MA, USA) in improving pain and functional outcomes for patients aged between 40 and 65 with mild to moderate hip osteoarthritis (OA) six months post-injection. This prospective observational study included 100 patients receiving a single ultrasound-guided intra-articular injection of Cingal™. Eligible patients seen in participating orthopaedic, physiatry and sports medicine clinics were evaluated at baseline, one-month, and six-month follow-up. The primary outcome was patient-reported hip pain (Visual Analogue Scale, VAS) at six months post-injection. Secondary outcomes included hip function (Hip Disability and Osteoarthritis Outcome Score, HOOS), quality of life (Short-Form 12, SF-12), pain medication use, range of motion (ROM), physical activity (activity tracker), and adverse events. Ninety-six patients received the injection; 91 had complete data for primary outcome analysis. Statistically significant improvements were observed in VAS (p ​< ​0.001), HOOS (p ​< ​0.001), and SF-12 scores (Physical Component Summary, p ​= ​0.005; Mental Component Summary, p ​= ​0.022) from baseline to six months post-injection. Pain medication use decreased from 50.0% to 34.0% (p ​= ​0.035). No statistically significant change was observed in ROM or activity level. Adverse events were reported in 9.5% of patients: five (5.3%) experienced hip pain for less than seven days, one for more than seven days but less than one month, and three (3.2%) underwent hip arthroplasty. Patients receiving an ultrasound-guided Cingal™ injection for hip OA reported statistically significantly reduced hip pain, improved function and quality of life, and reduced pain medication use at six months. The most common adverse event was transient hip pain. Prospective observational study, Level III.

Purpose: To report conversion rates to total hip arthroplasty (THA), patient‐reported outcome measures, and complication rates in adults aged ≥ 40 years undergoing hip arthroscopy since 2016. Methods: MEDLINE, EMBASE, and PubMed were searched from January 2016 to March 2025, and pertinent data were abstracted from eligible studies according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. To provide an updated synthesis without duplicating prior work, this review was limited to studies published from 2016 onward, following a previous systematic review that comprehensively evaluated outcomes of hip arthroscopy in patients aged 40 years and older through 2015. Inclusion criteria were studies involving patients aged ≥ 40 years who underwent hip arthroscopy, published in English, and reporting at least 1 patient‐reported outcome measure or clinical outcome. Exclusion criteria included studies that were not Level I, II, or III studies with nonsurgical treatments or studies with duplicate patient cohorts. Results: Six studies were included (2 Level II cohort studies, 4 Level III cohort studies), encompassing 33,091 patients (30,549 ≥ 40 years; 92.3%). Among 5 studies (n = 2479), the overall THA conversion rate in patients ≥ 40 ranged from 5% to over 21%. The 2‐year THA conversion rate ranged from 9% to 13% in patients aged 40 to 60 years, and the 5‐year conversion rate was as high as 20.2%. Five studies reporting patient‐reported outcome measures showed significant improvements that exceeded the minimal clinically important difference at a follow‐up period of 2 years. Functional outcomes (Modified Harris Hip Score, Hip Outcome Score Activity of Daily Living Scale, Hip Outcome Score Sport Scale, and Nonarthritic Hip Score) were significantly worse in patients > 45 years compared with those < 45 years. Twenty‐one procedure‐related complications occurred among 1807 hips (1.16%) in patients 40 and older, the 2 most common being superficial soft‐tissue injuries (n = 4) and transient neuropraxia/nerve palsy (n = 3). Conclusions: Although hip arthroscopy continues to display statistically and clinically significant postoperative improvements in patients aged 40 and older, the risk of conversion to THA remains substantially higher compared with younger populations. Level of Evidence: Level III, systematic review of Level II and III studies.

Greater trochanteric pain syndrome (GTPS) is a chronic condition commonly defined as pain in the lateral hip joint that can be severely limiting to activities of daily living, sleep, and overall quality of life. It encompasses numerous disease states causing pain in the region of the greater trochanter of the femur. Noninvasive management approaches for GTPS include corticosteroid injections and physiotherapy, preferred as first-line interventions prior to surgical interventions. Understanding the impact of randomized control trials (RCTs) can enhance the understanding of treatment paradigms. To identify factors and study characteristics associated with the impact, as measured by the citation density of RCTs in the management of GTPS. MEDLINE, EMBASE, CENTRAL, SCOPUS, and Web of Science were searched from database inception to September 5, 2023 for RCTs evaluating conservative and surgical interventions for GTPS. The inclusion criteria for this systematic review were level I evidence, assessment of at least two different approaches to the management of GTPS, published in English, and featuring human subjects. Pertinent study characteristics were extracted from the included trials after title/abstract and full-text screening. Citation metrics were obtained from the Clarivate Web of Knowledge database on September 28, 2023. The fragility index (FI) and continuous fragility index (CFI) were calculated for primary outcomes across all included RCTs. Univariate regression models were used to assess correlations between citation density and a variety of study characteristics. A sub-analysis by category of intervention (injectable modalities, non-invasive modalities, and surgical modalities) was also performed, with an ANOVA of study and bibliometric characteristics. Twenty-one studies published from 2009 to 2023 comprising 1683 patients (1690 hips) met inclusion criteria and were eligible for analysis. Treatments ranged from non-invasive (n ​= ​8), injectable (n ​= ​12), to surgical modalities (n ​= ​1). Eleven different countries were represented amongst the included RCTs; 71.4 ​% were from the United States or Europe, with the remaining 28.6 ​% originating from Australia. The median journal impact factor of published studies was 3.4 (IQR 2.4-4.8). The mean citation density across all three intervention categories were injectable modalities (4.37 ​± ​3.39), noninvasive modalities (3.27 ​± ​1.77), and surgical modalities (1, not applicable). The median CFI was 2 (IQR 0-12). Correlation analysis demonstrated a statistically significant correlation to year published (R ​= ​-0.473, p ​= ​0.03) and study sample size (R ​= ​0.735, p ​< ​0.01). RCTs assessing the management of GTPS demonstrate a varied range of clinical uptake, as evidenced by citation density. An array of different healthcare disciplines is involved in GTPS management, signified by the diversity of journals publishing RCTs on the topic. The median CFI is low compared to other citation analyses in orthopedics, demonstrating that the collective conclusions drawn by these studies are limited by fragility. Additionally, RCTs on surgical treatments for cases refractory to nonsurgical management are notably underrepresented, highlighting the necessity for further evaluation. I.