Hassan, Mahad M.

Abstract As artificial intelligence (AI) Large Language Models (LLM) like ChatGPT become more common in healthcare, patients increasingly use them to find medical information. While ChatGPT may support health literacy, its readability and accuracy compared to established resources remain unclear. The purpose of this study is to evaluate ChatGPT-4 responses on femoroacetabular impingement (FAI) and its surgical management compared to AAOS OrthoInfo content. We hypothesize that ChatGPT may deliver medically accurate information, but its readability may fall short when compared to OrthoInfo. Nine questions based on the OrthoInfo FAI page were submitted to ChatGPT-4, with and without a readability prompt. Topics included anatomy, pathology, cause, symptoms, workup, imaging, treatment, role of hip arthroscopy, and outcomes. Readability was assessed using validated indices. Accuracy was independently rated using a 4-point scale. Statistical comparisons were made using t-tests and ANOVA (P < 0.01 threshold). OrthoInfo content had a mean reading grade level of 8.0 and a Flesch Reading Ease score of 60.7. Unprompted ChatGPT responses were significantly less readable (grade level 16.2; Flesch score 21.7; P < 0.001). Prompting for readability improved ChatGPT outputs (grade level 10.6; Flesch score 58.2), making them comparable to OrthoInfo (P < 0.09). Accuracy was high across all sources, though OrthoInfo's response on FAI causes scored slightly lower (3.5 versus 4.0; P < 0.46). ChatGPT provides accurate information on FAI. However, without prompting, its complexity may hinder patient understanding. Prompting for readability enables ChatGPT to match established resources like OrthoInfo. Tailored prompting is key to using LLM effectively in patient education and promoting health literacy.

Background: Social media use has grown across healthcare delivery and practice, with dramatic changes occurring in response to the coronavirus (COVID-19) pandemic. The purpose of this study was to conduct a comprehensive systematic review to determine the current landscape of social media use by (1) orthopaedic surgery residencies/fellowship training programs and (2) individual orthopaedic surgeons and the change in use over time. Methods: We searched 3 electronic databases (PubMed, MEDLINE, and Embase) from their inception to April 2022 for all studies that analyzed the use of social media in orthopaedic surgery. Two reviewers independently determined study eligibility, rated study quality, and extracted data. Methodology was in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results: Twenty-eight studies were included, of which 11 analyzed social media use by orthopaedic surgery residency and fellowship training programs and 17 examined its use by individual orthopaedic surgeons. Among residency and fellowship programs, Instagram was identified as the most common platform used, with 42% to 88% of programs reporting program-specific Instagram accounts, followed by Twitter/X (20%-52%) and Facebook (10%-38%). Social media was most commonly used by programs for recruitment and information dissemination to prospective residency applicants (82% and 73% of included studies, respectively). After the start of the COVID-19 pandemic, there was a 620% and 177% increase in the number of training programs with Instagram and Twitter/X accounts, respectively. Individual use of social media ranged from 1.7% to 76% (Twitter/X), 10% to 73% (Facebook), 0% to 61% (Instagram), 22% to 61% (LinkedIn), and 6.5% to 56% (YouTube). Conclusions: Instagram, Twitter/X, and Facebook are the premier platforms that patients, residency applicants, and institutions frequent. With the continued growth of social media use anticipated, it will be critical for institutions and individuals to create and abide by guidelines outlining respectful and professional integration of social media into practice. Level of Evidence: Level IV.

Background: Although hip bracing after hip arthroscopy is relatively common, it is not an evidence-based practice; no comparative studies or clinical trials exploring its effectiveness exist. Purpose: We sought to summarize the rates of and indications for hip bracing after hip arthroscopy, surgeons’ preferences on braces, and the types of braces used. Methods: A systematic review was conducted using the PubMed, Embase, and Medline databases to identify studies that examined hip bracing following hip arthroscopy. Two independent reviewers identified relevant studies with final inclusion determined by the senior author. Full-length, original research articles regarding relevant subject matter that were published prior to January 2022 were included in the analysis. Results: Of the 52 articles that underwent full-text review, 14 were included (10 clinical case series, comparative studies, or case-control studies and 4 cross-sectional studies of surgeon-specific postoperative rehabilitation protocols). These studies revealed that the practice of hip bracing after hip arthroscopy is relatively common among orthopedic surgeons, with up to 40% of surgeons using them. Surgical indications for postoperative brace use varied widely. Recommendations on the length of brace use varied, but range of motion restrictions were consistent. Conclusions: Although up to 40% of surgeons use post-hip arthroscopy bracing, there is insufficient evidence to determine whether it improves patient outcomes. Research producing higher levels of evidence regarding the efficacy of bracing following hip arthroscopy is necessary to understand the physical, mental, and economic costs and benefits to patients.

ABSTRACTFemoroacetabular impingement (FAI) is a common femoral and/or acetabular abnormality that can cause progressive damage to the hip and osteoarthritis. FAI can be the result of femoral head/neck overgrowth, acetabular overgrowth or both femoral and acetabular abnormalities, resulting in a loss of native hip biomechanics and pain upon hip flexion and rotation. Radiographic evidence can include loss of sphericity of the femoral neck (cam impingement) and/or acetabular retroversion with focal or global overcoverage (pincer impingement). Operative intervention is indicated in symptomatic patients after failed conservative management with radiographic evidence of impingement and minimal arthritic changes of the hip, with the goal of restoring normal hip biomechanics and reducing pain. This is done by correcting the femoral head–neck relationship to the acetabulum through femoral and/or acetabular osteoplasty and treatment of concomitant hip pathology. In pincer impingement cases with small lunate surfaces, reverse periacetabular osteotomy is indicated as acetabular osteoplasty can decrease an already small articular surface. While surgical dislocation is regarded as the traditional gold standard, hip arthroscopy has become widely utilized in recent years. Studies comparing both open surgery and arthroscopy have shown comparable long-term pain reduction and improvements in clinical measures of hip function, as well as similar conversion rates to total hip arthroplasty. However, arthroscopy has trended toward earlier improvement, quicker recovery and faster return to sports. The purpose of this study was to review the recent literature on open and arthroscopic management of FAI.