Can artificial intelligence generate scientific discussion that passes peer review for publication in a high-impact orthopaedic journal?

Background: There is huge interest in the use of artificial intelligence (AI) in the production and assessment of academic material; however, the role of AI remains unclear.

Aim: The purpose of this study was to perform a reviewer-blinded assessment of the quality of scientific discussion generated by an advanced AI language model (ChatGPT-4, Open AI) and determine whether this could be recommended for high-impact journal publication.

Methods: The introduction, methods and results sections of a recently published article from a high-impact journal were input into a current AI model.

Low Risk of Cup Fixation Failure at 10 Years Using Constrained Liners at the Same Time of Acetabular Component Revision.

Background: There remains concern regarding simultaneous constrained liner (CL) implantation during acetabular component revision in revision total hip arthroplasty due to potential fixation loss at the bone-implant interface. There are scarce long-term data on this technique. This study aimed to determine the survivorship free from aseptic cup loosening (fixation failure) and all-cause re-revision when CLs were implanted concurrently with acetabular cup revision.

Metaphyseal Fixation in Revision Total Knee Arthroplasty.

➢ Bone defect management is challenging, but essential, in revision total knee arthroplasty.➢ Appropriate metaphyseal fixation is crucial for stability and implant support.➢ Allografts have been traditionally used to address large defects, but the advent of highly porous metaphyseal cones and sleeves has attracted attention during the past years.

The Selective Use of Acetabular Screws in Routine Primary Total Hip Arthroplasty Is Noninferior to Habitual Screw Use.

Background: The aim of this study was to assess if selective screw insertion can achieve low rates of acetabular component loosening and whether this approach to screw usage is noninferior to habitual screw insertion.

Methods: This was a retrospective international multicenter cohort study assessing 4,707 acetabular components for primary total hip arthroplasties at mean follow-up of 6.5 years.

Distal Femoral Replacement for Revision Total Knee Arthroplasty in Nononcologic Indications: A Single-Institution Outcomes Study.

Background: Distal femoral replacement (DFR) is a salvage procedure to manage massive bone loss in total knee arthroplasty (TKA). Few studies report midterm (five to 10 years) to long-term (> 10 years) outcomes of DFR for nononcologic indications. The purpose of this study was to report the implant survival of DFRs in nononcologic TKA for the entire cohort and by indication, as well as patient-reported clinical outcomes.

Cup-Cage Reconstruction for Pelvic Discontinuity: Encouraging Long-Term Survival.

Background: Pelvic discontinuity (PD) poses a difficult challenge in revision total hip arthroplasty. There is a paucity of evidence assessing 5- to 10-year outcomes of cup cages for PD. This study aimed to review the survivorship and outcomes of cup-cage constructs for PD.

Short-term survival of the cementless triathlon total knee arthroplasty in a young patient cohort.

Background: The purpose of this study is to assess the short-term survivorship of a new cementless total knee arthroplasty (TKA) design in comparison to its cemented predecessor design in a young patient cohort less than 65 years of age.

Methods: We performed a retrospective cohort study of all primary TKAs (cemented and cementless) in patients under the age of 65 at the time of the index procedure, in a single institution between May 2018 and May 2019. Primary outcome variables included aseptic revision and all-cause revision.

Cementless Total Knee Arthroplasty: A State-of-the-Art Review.

» The demographic profile of candidates for total knee arthroplasty (TKA) is shifting toward younger and more active individuals.» While cemented fixation remains the gold standard in TKA, the interest is growing in exploring cementless fixation as a potentially more durable alternative.» Advances in manufacturing technologies are enhancing the prospects for superior long-term biological fixation.

Risk factors for failure of manipulation under anesthesia after total knee arthroplasty.

Background: Manipulation under anesthesia (MUA) is a well-established treatment for stiffness after total knee arthroplasty (TKA). Risk factors for failure of MUA remain largely unknown. The primary aim of this study was to identify risk factors for failure of MUA after TKA.

The John Charnley Award: The Impact of Human Leukocyte Antigen Genotype on Bacterial Infection Rates and Successful Eradication in Total Hip Arthroplasty.

Background: Genetics play an important role in several medical domains; however, the influence of human leukocyte antigen (HLA) genotype on the development of periprosthetic joint infection (PJI) in total hip arthroplasty (THA) remains unknown. The primary aim of this study was to determine if HLA genotype is associated with the development of bacterial PJI in THA. Secondarily, we evaluated the association between HLA genotype and PJI treatment success.

The Wagner Cone Stem for Atypical Femoral Anatomy in Total Hip Arthroplasty: A Report of 320 Cases with Minimum 5-Year Follow-up.

Background: The Wagner Cone Prosthesis was designed to address complex femoral deformities during total hip arthroplasty (THA), but its mid-term component survivorship and functional outcomes remain undetermined. The objectives of this study were to determine the implant survivorship, patient satisfaction, functional outcomes, osseointegration as seen radiographically, implant subsidence, and complications of THA using the Wagner Cone Prosthesis stem at intermediate-term follow-up.

Methods: This study involved 302 patients with proximal femoral deformities, including developmental hip dysplasia and Legg-Calvé-Perthes disease, who underwent a total of 320 primary THAs using the Wagner Cone Prosthesis.

Long-term outcomes of revision total hip arthroplasty with the Zimmer Modular Revision hip system.

Aims: There are limited long-term studies reporting on outcomes of the Zimmer Modular Revision (ZMR) stem, and concerns remain regarding failure. Our primary aim was to determine long-term survival free from all-cause revision and stem-related failure for this modular revision stem in revision total hip arthroplasty (THA). Secondary aims included evaluating radiological and functional outcomes.

Treatment of femoral bone loss in revision total hip arthroplasty: a clinical practice review.

Patient and implant selection is essential to optimize outcome. Femoral bone loss classifications such as the American Academy of Orthopaedic Surgeons, Gross, and Paprosky classifications permit surgeons to systematically manage bone stock deficiencies and guide implant selection. Here we provide a comprehensive report on the pitfalls and management of this reconstructive challenge.

Porous Tantalum Metaphyseal Cones for Severe Femoral and Tibial Bone Defects in Revision Total Knee Arthroplasty are Reliable for Fixation at Mean 5-Year Follow-Up.

Background: Porous tantalum metaphyseal cones may facilitate reconstructions of severe bone defects during revision total knee arthroplasty (TKA), but there remains a paucity of data on their outcomes at mean 5 years of follow-up. This study reports the component survivorship, patient satisfaction, functional outcomes, radiographic osseointegration, and complications of revision TKA with porous tantalum metaphyseal cones at mid-term (mean 5-year) follow-up.

Methods: This study included 152 patients who had a mean age of 66 years (range, 33 to 86 years) undergoing revision TKA with porous tantalum metaphyseal cones.

Articulating Spacers in Total Hip Arthroplasty: Surgical Technique and Outcomes.

Although one-stage exchange arthroplasty is gaining popularity, two-stage exchange arthroplasty remains the gold standard for the treatment of periprosthetic joint infections. Use of an articulating spacer for this procedure offers an avenue for maintaining hip motion and controlled weight-bearing, allowing local antibiotic elution. However, there is no uniform consensus on the optimal surgical protocol for using articulating spacers.

Clinical Outcomes and Risk Factors for Re-Revision Due to Trunnion Corrosion in Primary Metal-on-Polyethylene Total Hip Arthroplasty.

Background: There is a paucity of literature regarding the mid-term (greater than 2 years) outcomes of revision for adverse local tissue reaction to metal debris due to corrosion at the head-neck junction (trunnionosis) in metal-on-polyethylene total hip arthroplasty (THA), and risk factors for re-revision remain largely unknown. We aimed to report the re-revision-free survival and functional outcomes for this patient population and to identify risk factors for re-revision.

Methods: A total of 80 hips (79 patients) with a metal-on-polyethylene THA who had undergone revision for trunnionosis at our institution were included.

Navigated Versus Conventional Total Knee Arthroplasty: A Systematic Review and Meta-analysis of Prospective Randomized Controlled Trials.

Background: Recent evidence on the cost-effectiveness of technology in total knee arthroplasty (TKA) demonstrated that navigated computer-assisted methods (N-TKA) is likely to be most cost-effective in the clinical setting. The aim of the current meta-analysis is to compare radiographic, clinical and functional outcomes between conventional TKA (C-TKA) and N-TKA methods.

Methods: All prospective randomized controlled trials (pRCTs) comparing primary TKA performed using C-TKA and N-TKA techniques were eligible for inclusion.

Factors Associated With Length of Stay for Hip and Knee Arthroplasty: A 20-Year Single-Province Population-Based Analysis of Longitudinal Temporal Trends.

Background: With notable benefits in reducing length of stay (LOS), this study aimed to quantify the temporal trend and the factors contributing to increased LOS for primary and revision total hip (THA and rTHA) and knee (TKA and rTKA) arthroplasty. The study was carried out for a large population-based cohort over a 20-year period.

Methods: This was a retrospective population-based study assessing the LOS for all primary and revision THA and TKA procedures between 2003 and 2022.

Cannabis and Pain Control After Total Hip and Knee Arthroplasty.

Cannabis use among the elderly has increased over the previous 2 decades. This has translated to a greater proportion of orthopedic procedures being undertaken on these patients. This review provides clinicians with evidence-based information on the effects of cannabis on pain control in THA and TKA, to help counsel these patients and facilitate their perioperative management.

Periprosthetic Fractures After a Total Knee Arthroplasty.

As the number of total knee arthroplasties performed continues to increase, complications such as postoperative periprosthetic fractures are becoming increasingly more common. Femoral periprosthetic fractures are the most common type of fractures around a total knee arthroplasty, whereas tibial and patellar periprosthetic fractures are infrequent. Treatment principles depend on the bone the fracture is located, the status of the implant fixation, bone stock, and the type of implants available.

The Diagnostic Utility of Serum Metal Ion Markers for High-Grade Aseptic Lymphocyte-Dominated Vasculitis-Associated Lesions (ALVALs) in Revision Hip and Knee Arthroplasty: An International Multicenter Study.

Background: Aseptic lymphocyte-dominated vasculitis-associated lesions (ALVALs) are typically described in the context of metal-on-metal (MoM) hip bearings. This study explores the diagnostic utility of preoperative serum cobalt and chromium ion levels in determining the histological grade of ALVAL in revision hip and knee arthroplasty.

Methods: This was a multicenter retrospective review of 26 hips and 13 knees assessing the correlation between preoperative ion levels (mg/L (ppb)) and the histological grade of ALVAL from intraoperative specimens.

Optimization of surgical tourniquet usage to improve patient outcomes: Translational cross-disciplinary implications of a surgical practice survey.

Tourniquet use is common practice in many millions of orthopaedic procedures annually. Recent reviews of risks and benefits of surgical tourniquet use have primarily involved meta-analyses, many of which have forgone a comprehensive risk-benefit analysis to simply question whether "tourniquet or no tourniquet" use produces improved patient outcomes, often leading to limited, inconclusive, or conflicting results. To investigate further, a pilot survey was undertaken to determine current practices, opinions, and understandings among orthopaedic surgeons in Canada regarding use of surgical tourniquets in total knee arthroplasties (TKAs).

Malseating of Modular Dual Mobility Liners: High Prevalence in Revision Total Hip Arthroplasty.

Background: Modular dual mobility (MDM) acetabular components have become increasingly more popular in total hip arthroplasty (THA). Uncertainty remains regarding liner malseating and its consequences after 5 to 10 years, especially in patients who undergo revision THA. The objective of this study was to analyze the prevalence of malseating and implant survivorship of patients who underwent revision THA using an MDM liner.

International primary knee arthroplasty registry review: findings from current reports.

Introduction: International joint registries provide high volumes of information in relation to the performance of total knee arthroplasty on a global scale. Distillation of this data can be challenging, particularly with the establishment of more arthroplasty registries on a yearly basis. We therefore aim to present key information from these registries in relation to primary total knee arthroplasty.