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Musbahi O, Nurek M, Pouris K, Vella-Baldacchino M, Bottle A, Hing C, Kostopoulou O, Cobb JP, Jones GG. Can ChatGPT make surgical decisions with confidence similar to experienced knee surgeons? Knee 2024; 51:120-129. [PMID: 39255525 DOI: 10.1016/j.knee.2024.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 08/04/2024] [Accepted: 08/15/2024] [Indexed: 09/12/2024]
Abstract
BACKGROUND Unicompartmental knee replacements (UKRs) have become an increasingly attractive option for end-stage single-compartment knee osteoarthritis (OA). However, there remains controversy in patient selection. Natural language processing (NLP) is a form of artificial intelligence (AI). We aimed to determine whether general-purpose open-source natural language programs can make decisions regarding a patient's suitability for a total knee replacement (TKR) or a UKR and how confident AI NLP programs are in surgical decision making. METHODS We conducted a case-based cohort study using data from a separate study, where participants (73 surgeons and AI NLP programs) were presented with 32 fictitious clinical case scenarios that simulated patients with predominantly medial knee OA who would require surgery. Using the overall UKR/TKR judgments of the 73 experienced knee surgeons as the gold standard reference, we calculated the sensitivity, specificity, and positive predictive value of AI NLP programs to identify whether a patient should undergo UKR. RESULTS There was disagreement between the surgeons and ChatGPT in only five scenarios (15.6%). With the 73 surgeons' decision as the gold standard, the sensitivity of ChatGPT in determining whether a patient should undergo UKR was 0.91 (95% confidence interval (CI): 0.71 to 0.98). The positive predictive value for ChatGPT was 0.87 (95% CI: 0.72 to 0.94). ChatGPT was more confident in its UKR decision making (surgeon mean confidence = 1.7, ChatGPT mean confidence = 2.4). CONCLUSIONS It has been demonstrated that ChatGPT can make surgical decisions, and exceeded the confidence of experienced knee surgeons with substantial inter-rater agreement when deciding whether a patient was most appropriate for a UKR.
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Affiliation(s)
- Omar Musbahi
- MSk Lab, Sir Michael Uren Hub, Imperial College London, London, UK.
| | - Martine Nurek
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Kyriacos Pouris
- MSk Lab, Sir Michael Uren Hub, Imperial College London, London, UK
| | | | - Alex Bottle
- School of Public Health, Imperial College London, London, UK
| | - Caroline Hing
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Olga Kostopoulou
- Department of Surgery and Cancer, Imperial College London, London, UK; Institute of Global Health Innovation, Imperial College London, London, UK
| | - Justin P Cobb
- MSk Lab, Sir Michael Uren Hub, Imperial College London, London, UK
| | - Gareth G Jones
- MSk Lab, Sir Michael Uren Hub, Imperial College London, London, UK
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Song K, Qi L, Mu Z, Sun H, Zhai S, Liu D, Li S, Luo Y, Liu P. Health-related quality of life after total knee arthroplasty and unicompartmental knee arthroplasty for unicompartmental osteoarthritis: A systematic review and meta-analysis. J Orthop Surg (Hong Kong) 2024; 32:10225536241256245. [PMID: 38763777 DOI: 10.1177/10225536241256245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2024] Open
Abstract
BACKGROUND While previous research has demonstrated potential advantages of unicompartmental knee arthroplasty (UKA) over total knee arthroplasty (TKA), particularly in terms of clinical outcomes such as function and pain relief, the specific impact on health-related quality of life (HRQOL) remains unclear. This systematic review and meta-analysis aim to address this gap by comparing HRQOL outcomes between UKA and TKA, providing valuable insights for clinical decision-making. METHODS We conducted a literature search in the PubMed, Embase, Cochrane Controlled Register of Trials (CENTRAL), and Web of Science databases up to July 15, 2023. Eligible studies assessed HRQOL using EQ-5D, SF-36, or SF-12 and were assessed for methodological quality using the Newcastle-Ottawa Scale (NOS). RESULTS Seven eligible studies were included, comprising a total of 64,585 patients with 35,809 undergoing TKA and 28,776 undergoing UKA. Patient age ranged from 52.0 to 67.7 years with an average BMI ranging from 27.2 to 31.0 kg/m2. Follow-up periods ranged from 6 months to 10 years. Five studies (63,829 patients) that evaluated HRQOL using EQ-5D showed significantly better outcomes for UKA compared to TKA (MD -0.04, 95% CI -0.05 to -0.02). Two studies (756 patients) that evaluated HRQOL using SF-36 showed no significant difference between TKA and UKA. Five studies (63,286 patients) that evaluated functional outcomes using Oxford Knee Score (OKS) showed significantly better functional scores for UKA compared to TKA (MD -1.29, 95% CI -1.86 to -0.72). Four studies (24,570 patients) that reported patient satisfaction showed no statistically significant difference between TKA and UKA (MD 0.97, 95% CI 0.90 to 1.05). Further subgroup analysis did not affect the conclusions. CONCLUSIONS Our meta-analysis suggests that UKA is associated with better HRQOL and knee function, as well as similar patient satisfaction, compared to TKA for patients with unicompartmental osteoarthritis.
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Affiliation(s)
- Ke Song
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, PR China
- Qilu Hospital of Shandong University Dezhou Hospital (Dezhou People's Hospital), Dezhou, PR China
| | - Liping Qi
- Qilu Hospital of Shandong University Dezhou Hospital (Dezhou People's Hospital), Dezhou, PR China
| | - Zongyou Mu
- Qilu Hospital of Shandong University Dezhou Hospital (Dezhou People's Hospital), Dezhou, PR China
| | - Houyi Sun
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, PR China
| | - Shenhao Zhai
- Qilu Hospital of Shandong University Dezhou Hospital (Dezhou People's Hospital), Dezhou, PR China
| | - Dehua Liu
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, PR China
| | - Shihao Li
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, PR China
| | - Yange Luo
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, PR China
| | - Peilai Liu
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, PR China
- Qilu Hospital of Shandong University Dezhou Hospital (Dezhou People's Hospital), Dezhou, PR China
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D’Amario F, De Berardinis L, Zanon G, Qordja F, Vitale U, Gigante AP. First Italian Experience with the Oxinium Metal-Backed Fixed-Bearing Medial Journey II Unicompartmental Knee System: Promising Short-Term Outcomes of 145 Cases. J Clin Med 2024; 13:1303. [PMID: 38592148 PMCID: PMC10932057 DOI: 10.3390/jcm13051303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 02/21/2024] [Accepted: 02/23/2024] [Indexed: 04/10/2024] Open
Abstract
(1) Background: Unicompartmental knee arthroplasty (UKA) provides a viable alternative to total knee arthroplasty (TKA) in patients with isolated medial osteoarthritis (OA). From 2007 to 2021, 23% of all primary knee arthroplasties in Italy were UKAs. We retrospectively evaluated clinical outcomes and satisfaction in patients implanted with a new oxinium metal-backed fixed-bearing medial unicompartmental prosthesis at a 24-month follow-up. (2) Methods: From December 2020 to December 2021, 145 patients were treated by a single surgeon at a single institution using the hypoallergenic Journey II prosthesis. Clinical outcome measures included the Knee Society Knee Score (KSKS), Knee Society Function Score (KSFS), Oxford Knee Society (OKS) score, University of California Los Angeles Activity Score (UCLA), the Physical Component Summary (PCS), and the Mental Component Summary (MCS), and were calculated preoperatively and at 12 and 24 months. The Forgotten Joint Score-12 (FJS-12) was calculated at 12 and 24 months. Patient satisfaction was collected at 24 months. The scores were compared using the Friedman test. (3) Results: All clinical scores improved significantly from baseline to 24 months (p < 0.0001), except for the FJS-12, which from 12 to 24 months did not improve significantly (p = 0.041). Patient satisfaction was 9.32 ± 0.74 out of 10. No patient experienced complications or required revision surgery. (4) Conclusions: The Journey II unicompartmental prosthesis is a valuable treatment option for end-stage medial OA, improving knee function, providing pain relief, and ensuring high patient satisfaction at 24 months.
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Affiliation(s)
- Federico D’Amario
- Orthopedic Unit, Humanitas San Pio X, Via Francesco Nava, 31, 20159 Milano, Italy; (F.D.); (G.Z.)
| | - Luca De Berardinis
- Clinical Orthopedics, Department of Clinical and Molecular Sciences, School of Medicine, Università Politecnica delle Marche, Via Tronto, 10/a, 60126 Ancona, Italy; (F.Q.); (A.P.G.)
| | - Giacomo Zanon
- Orthopedic Unit, Humanitas San Pio X, Via Francesco Nava, 31, 20159 Milano, Italy; (F.D.); (G.Z.)
| | - Fjorela Qordja
- Clinical Orthopedics, Department of Clinical and Molecular Sciences, School of Medicine, Università Politecnica delle Marche, Via Tronto, 10/a, 60126 Ancona, Italy; (F.Q.); (A.P.G.)
| | - Umberto Vitale
- IRCCS Humanitas Research Hospital, Via Manzoni, 56, Rozzano, 20089 Milano, Italy;
| | - Antonio Pompilio Gigante
- Clinical Orthopedics, Department of Clinical and Molecular Sciences, School of Medicine, Università Politecnica delle Marche, Via Tronto, 10/a, 60126 Ancona, Italy; (F.Q.); (A.P.G.)
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Lobenhoffer P. [Implant-associated fracture of the tibial plateau in cementless medial unicondylar knee prosthesis : Locking plate osteosynthesis]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2023; 35:397-402. [PMID: 37857816 DOI: 10.1007/s00064-023-00829-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 06/06/2023] [Accepted: 06/08/2023] [Indexed: 10/21/2023]
Abstract
THE PROBLEM Cementless medial unicondylar knee prostheses with mobile inlays have proved to be successful and are increasingly being used worldwide; however, there is a risk of fracture of the medial tibial plateau in the postoperative healing phase. THE SOLUTION In most cases we observed split fractures starting from the keel of the implant. These can be treated with a small posteromedial locking plate, whereby the upper screws are inserted through the keel slot and then interlocked. This achieves an optimally strong bond between the implant and the screws and a stable construct. SURGICAL TECHNIQUE A longitudinal skin incision is made at the level of the keel slot. A radial T‑plate is placed subcutaneously. The plate is fixed with a lag screw in the middle section. The compression usually closes the fracture gap. Then three locking cortical bone screws are inserted through the keel slot in the transverse section of the plate. Distal fixation by locking or standard screws. POSTOPERATIVE MANAGEMENT Immediate pain-adapted partial weight bearing, unrestricted mobility. Healing of the fracture and full weight bearing mostly achieved after 4 weeks.
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Affiliation(s)
- Philipp Lobenhoffer
- go:h Gelenkchirurgie Orthopädie Hannover, Bertastr. 10, 30159, Hannover, Deutschland.
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Panzram B, Barbian F, Reiner T, Hariri M, Renkawitz T, Walker T. Clinical and Functional Results of Cementless Unicompartmental Knee Arthroplasty with a Minimum Follow Up of 5 Years-A Consecutive Cohort of 201 Patients. J Clin Med 2023; 12:jcm12041694. [PMID: 36836231 PMCID: PMC9966646 DOI: 10.3390/jcm12041694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/06/2023] [Accepted: 02/13/2023] [Indexed: 02/23/2023] Open
Abstract
The number of unicompartmental knee replacements (UKR) is increasing. Alongside various advantages, the revision rate of cemented UKR is higher compared to total knee arthroplasty (TKR). In contrast, cementless fixation shows reduced revision rates, compared to the cemented UKR. However, most of the recent literature is based on designer-dependent studies. In this retrospective, single-center cohort study, we investigated patients who underwent cementless Oxford UKR (OUKR) between 2012 and 2016 in our hospital with a minimum follow-up of five years. Clinical outcome was evaluated using the OKS, AKSS-O, AKSS-F, FFbH-OA, UCLA, SF-36, EQ-5D-3L, FJS, ROM, pain, and satisfaction measures. Survival analysis was performed with reoperation and revision as endpoints. We included 201 patients (216 knees) for clinical evaluation. All outcome parameters increased significantly from pre- to postoperative stages. The five-year survival rate was 96.1% for revision surgery and 94.9% for reoperation. The main reasons for revision were the progression of osteoarthritis, inlay dislocation, and tibial overstuffing. Two iatrogenic tibial fractures appeared. Cementless OUKR shows excellent clinical outcome and high survival rates after five years. The tibial plateau fracture in cementless UKR represents a serious complication and requires modification of the surgical technique.
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Mohammad HR, Judge A, Murray DW. The Influence of Surgeon Caseload and Usage on the Long-Term Outcomes of Mobile-Bearing Unicompartmental Knee Arthroplasty: An Analysis of Data From the National Joint Registry for England, Wales, Northern Ireland, and the Isle of Man. J Arthroplasty 2023; 38:245-251. [PMID: 35964854 DOI: 10.1016/j.arth.2022.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 08/04/2022] [Accepted: 08/07/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Unicompartmental knee arthroplasty (UKA) revision rates are variable and known to be influenced by a surgeon's caseload (number of UKAs performed annually) and usage (UKA as a proportion of overall knee arthroplasty practice). It is not known which is more important. We explored the influence of caseload and usage on cemented and cementless UKA. METHODS A total of 34,277 medial Oxford UKAs (23,707 cemented and 10,570 cementless) from the National Joint Registry were analyzed. UKAs were subdivided by the following: (1) surgeon caseload, into low (<10 UKAs/y) and high (≥10 UKAs/y) categories; and (2) usage, into low (<20%) and high (≥20%) categories. The 10-year revision rates were compared. RESULTS The 10-year survival of the low-caseload/low-usage cemented and cementless UKA was 82.8% (CI 81.6-83.9) and 86.2% (CI 72.1-93.4), respectively. The 10-year survival of the high-caseload/high-usage cemented and cementless UKA was 90.0% (CI 89.2-90.6) and 93.3% (CI 91.3-94.8), respectively. For cemented UKA, the high-caseload/high-usage group had lower revision rates (hazard ratio [HR] 0.57, CI 0.52-0.63, P < .001) compared to the low-caseload/low-usage group. The high-caseload/low-usage (HR 0.74, CI 0.66-0.83, P < .001) and the low-caseload/high-usage (HR 0.86, CI 0.74-0.99, P = .04) groups also had lower revision rates than the low-caseload/low-usage group. CONCLUSION Mobile-bearing UKA revision rates improve with both increasing surgeon UKA caseload and usage. Surgeons using cemented UKA who have usage ≥20% and caseload ≥10/year had a 10-year survival of 90%. Higher survivorship was associated with higher caseload, higher usage, and cementless fixation. LEVELS OF EVIDENCE III.
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Affiliation(s)
- Hasan R Mohammad
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Oxford, United Kingdom; Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Level 1 Learning and Research Building, Southmead Hospital, Westbury-on-Trym, Bristol, United Kingdom; Barts Bone & Joint Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, London, United Kingdom
| | - Andrew Judge
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Oxford, United Kingdom; Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Level 1 Learning and Research Building, Southmead Hospital, Westbury-on-Trym, Bristol, United Kingdom
| | - David W Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Oxford, United Kingdom
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Affiliation(s)
- Jesus M Villa
- Levitetz Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, Florida
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8
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Macchiarola L, Espinosa M, Pirone M, Lucidi GA, Cucurnia I, Grassi A, Marín Fermín T, Zaffagnini S. Simultaneous medial unicompartmental knee replacement and anterior cruciate ligament reconstruction: a narrative review and technical note. ANNALS OF JOINT 2023; 8:6. [PMID: 38529248 PMCID: PMC10929284 DOI: 10.21037/aoj-22-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 01/06/2023] [Indexed: 03/27/2024]
Abstract
Background and Objective Reconstruction of the anterior cruciate ligament (ACL) simultaneously with medial unicompartmental knee arthroplasty (UKA) has been suggested as an alternative treatment in patients with ACL deficiency and localized osteoarthritis (OA) in young patients. The objectives of this review were to report the current concepts on the topic and describe an original surgical technique of simultaneous medial UKA and ACL reconstruction. Methods A literature search was performed on PubMed, including articles written in English until June 2021. The articles regarding ACL reconstruction and UKA were reviewed using the narrative approach. Inclusion criteria: (I) original articles about ACL reconstruction and unicompartmental knee replacement; (II) written in English; (III) involving three or more cases. Two non-blinded authors reviewed the titles and abstracts of each article identified in the literature search. Key Content and Findings The articles regarding ACL reconstruction and UKA were reviewed using the narrative approach. Conclusions There is controversial evidence about performing the UKA simultaneously with an ACL reconstruction. Biomechanical and clinical studies show that the benefits of restoring good joint stability outweigh the possible risks associated with performing both surgeries at the same time. With this strategy, it is possible to obtain good clinical results with a high survival rate of the implant and patient satisfaction.
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Affiliation(s)
- Luca Macchiarola
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Dipartimento di Medicina Clinica e Sperimentale, Università degli Studi di Foggia, Foggia, Italy
- Department of Surgery, Aspetar Orthopedics and Sports Medicine Hospital, Doha, Qatar
| | - Maximiliano Espinosa
- Departamento de Traumatología, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Massimo Pirone
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Gian Andrea Lucidi
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Ilaria Cucurnia
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Grassi
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Stefano Zaffagnini
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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