American Academy Of Orthopaedic Surgeons Research Articles

Perioperative Management of Traditional and Direct Oral Anticoagulants in Hip Fracture Patients

Hip fractures are an increasingly common injury in the senior population and almost always require surgical fixation or prosthetic replacement. These surgeries, according to the American Academy of Orthopaedic Surgeons, are considered high-risk for bleeding, especially in a population fraught with comorbidities and often presenting on anticoagulation medications. Direct oral anticoagulants represent a class of drugs that have been becoming more popular in use in this population, with many benefits over the historically used Warfarin. There are recommendations for preoperative discontinuation and postoperative resumption of these medications, which can be more readily managed for elective surgeries. However, there is a paucity of literature detailing best practice guidelines for the perioperative management of direct oral anticoagulants when a patient presents with a hip fracture. This review article summary of the periprocedural management of DOACs for hip surgery was developed by examining the American College of Chest Physicians evidence-based clinical practice guidelines, Perioperative Guidelines on Antiplatelet and Anticoagulant Agents written by anesthesiologists, various retrospective studies, and drug labels for pharmacokinetic data. These recommendations should be used as a guideline, along with the collaboration of multidisciplinary hospital teams during inpatient admission, to manage these complex patients.

Results of Randomized Controlled Trials of Platelet-Rich Plasma in Lower Extremity Tendinopathy Are Not Influenced By Industry Sponsorship

To determine whether industry affiliation influences the results of randomized controlled trials (RCTs) studying the use of platelet-rich plasma (PRP) for the treatment of patellar or Achilles tendinopathy. PubMed, Scopus, Cochrane, and Medline databases were searched in July 2023 for RCTs published between 2009 and July 2023 investigating PRP for treatment of patellar or Achilles tendinopathy. Industry affiliation (IA) was determined by analyzing each study's funding or conflict of interest section. Author disclosures were searched on The American Academy of Orthopaedic Surgeons (AAOS) disclosure database and the Centers for Medicare & Medicaid Services open payments database. An IA designation was given if an author had a relevant disclosure or if the company funding the study manufactured PRP. Otherwise, a non-industry affiliated (NIA) designation was given. Fisher exact analysis was used to determine if PRP had a favorable, no significant, or unfavorable effect on outcome. Analysis was done on 22 studies (10 IA and 12 NIA), with 17 (77.3%) studies reporting a conflict of interest or funding for the research, 4 (18.2%) reporting no conflict of interest, and 1 (4.5%) with no reporting. Of the 22 included studies, 8 (36.4%) reported favorable outcomes regarding PRP utilization and 14 (63.6%) reported no significant effect. Favorable outcomes were found in 4 (40.0%) of the 10 IA studies and no significant effect was reported in 6 (60.0%). The 12 NIA studies included 4 (33.3%) with favorable results and 8 (66.7%) with no significant effect. The comparison between industry affiliation and results reported was not statistically significant (p = 1). Results of RCTs evaluating use of PRP on lower extremity tendinopathy were not influenced by industry sponsorship. The majority of biomedical research is funded through industry sponsorship. While this relationship is necessary as technologies are developed, it is important to scrutinize studies for evidence of industry bias to understand how this bias may be affecting study results published in the literature.

Analysis of Hip Preservation Questions on the Orthopaedic In-Training Examination Over the Past 20 Years.

The orthopaedic in-training examination (OITE) is a 275-question test for orthopaedic residents administered annually. As the field of orthopaedics changes, the OITE evolves its content. The incidence of hip preservation-related procedures has increased substantially over the past decade; nonetheless, an analysis of the trends of hip preservation questions on the OITE has not yet been performed. The purpose of the study was to evaluate the number and type of questions on the OITE related to hip preservation to determine whether trends over time paralleled the increases in hip-related care in clinical practice. It was hypothesized that the frequency of hip preservation questions on the OITE would increase with time. Cross-sectional study. Each OITE between 2002 and 2021 was reviewed for questions related to hip preservation. The types of questions included under "hip preservation" were those related to femoroacetabular impingement (FAI), athletic soft tissue injuries of the hip, acetabular labral tears, hip arthroscopy, and surgical management of adult hip dysplasia-excluding arthroplasty. Questions were quantified and categorized by topic, taxonomy level, associated imaging, and cited sources. There were 30 hip preservation-related questions between 2002 and 2021. Of these, 77% occurred within the past 10 years. Also, 14 questions (47%) had associated images in the question stem-the most common being radiographs (n = 8 questions). The most commonly tested subcategories were FAI (n = 11 questions [37%]), athletic injuries (n = 7 questions [23%]), and anatomy (n = 7 questions [23%]). Over the last 10 years, 97.9% of citations were from journal articles-the most common being the Journal of the American Academy of Orthopaedic Surgeons, Clinical Orthopedics and Related Research, and the American Journal of Sports Medicine. The frequency of hip preservation-related questions on the OITE has increased with time, reflecting trends in clinical practice.

Randomized Controlled Trials on Platelet-Rich Plasma for Knee Osteoarthritis Poorly Adhere to the Minimum Information for Studies Evaluating Biologics in Orthopaedics (MIBO) Guidelines: A Systematic Review

Background: Platelet-rich plasma (PRP) treatment for knee osteoarthritis has grown exponentially over the past decade; however, its scientific evaluation is highly variable. The American Academy of Orthopaedic Surgeons addressed the need for the standardization of orthobiologics studies by publishing the Minimum Information for Studies Evaluating Biologics in Orthopaedics (MIBO) guidelines in May 2017. In total, the MIBO guidelines are divided into 12 categories, encompassing 23 checklist items. Hypothesis/Purpose: The purpose of this study was to analyze how well randomized controlled trials (RCTs) on PRP interventions for knee osteoarthritis adhered to the MIBO guidelines. We hypothesized that most articles would report <80% of the MIBO criteria. Study Design: Systematic review; Level of evidence, 1. Methods: PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were used to perform a systematic review in the PubMed/MEDLINE and Web of Science databases. Inclusion criteria included English-language RCTs that assessed PRP interventions for knee osteoarthritis and reported beginning patient enrollment in June 2017 or later. The original 23 MIBO checklist items were separated and modified into a 44-point checklist. Adherence was determined by calculating the total percentage of checklist items that each article adequately and clearly reported from the 44-point checklist. Results: A total of 25 RCTs (2356 patients) were included in this study. The weighted mean age was 57.7 ± 4.4 years, with 42.9% being male. On average, only 53.1% ± 10.4% (range, 31.8%-77.3%) of the 44-point MIBO checklist items were reported per article. No articles had adherence rates ≥80%, 5 (20.0%) had rates between 60% and 79.9%, and 20 (80.0%) had rates ≤59.9%. Categories fluctuated in adherence, with “Intervention” having the greatest adherence (100.0%) and “Activation” having the lowest (14.0%). Additionally, 4 (33.3%) categories had adherence rates ≥80%, 0 had rates from 60% to 79.9%, and 8 (66.7%) had rates ≤59.9%. Conclusion: The overall mean adherence to MIBO guidelines by RCTs on PRP interventions for knee osteoarthritis was 53.1%. To increase the reproducibility, improve transparency, and assess the treatment efficacy of future PRP studies, reporting of MIBO guidelines should be improved.

The use of triple antibiotic prophylaxis during total knee replacement surgeries in Awka, Nigeria

Introduction: Total knee arthroplasty periprosthetic joint infection (PJI) poses a significant challenge in orthopaedic surgery, often resulting in early failure and associated with high morbidity and mortality rates. Various treatment strategies exist, including debridement, antibiotic therapy, and prosthesis retention, with preventive measures such as antibiotic-impregnated cement and prophylactic antibiotics administration recommended by the American Academy of Orthopaedic Surgeons (AAOS). Methodology: This prospective cohort study was conducted in an orthopaedic hospital in Awka, Southeast Nigeria, spanning seven years (2014-2021). A total of 134 patients who underwent primary and revision knee arthroplasty were included. The hospital's antibiotic prophylaxis protocol for implant surgeries, including arthroplasties, involved a triple combination of ceftriaxone, ciprofloxacin, and metronidazole administered pre-, intra-, and postoperatively for a minimum of 7 days. Results: The study population had a mean age of 63.6 years, predominantly female (77.7%), and of Christian faith (100%). Most participants were of Igbo ethnicity (99.3%), married (90.7%), and engaged in business (37.7%). Severe osteoarthritis was the primary diagnosis in 97.0% of cases, while rheumatoid arthritis accounted for 3.0%. The triple antibiotic prophylaxis regimen resulted in only one case of superficial infection, with no instances of deep infection recorded. Conclusion: Triple antibiotics prophylaxis, comprising ceftriaxone, ciprofloxacin, and metronidazole, demonstrated effectiveness in preventing infections associated with total knee arthroplasty. This regimen maintained surgical site infection prevalence within acceptable limits for clean surgeries, without observable antibiotic resistance in the study population.

Readability of Trauma-related Patient Education Materials From the American Academy of Orthopaedic Surgeons and Orthopaedic Trauma Association Websites.

Web-based resources serve as a fundamental educational platform for orthopaedic trauma patients; however, they are frequently written above the recommended sixth-grade reading level, and previous studies have demonstrated this for the American Academy of Orthopaedic Surgeons (AAOS) web-based articles. In this study, we perform an updated assessment of the readability of AAOS trauma-related educational articles as compared with injury-matched education materials developed by the Orthopaedic Trauma Association (OTA). All 46 AAOS trauma-related web-based (https://www.orthoinfo.org/) patient education articles were analyzed for readability. Two independent reviewers used (1) the Flesch-Kincaid Grade Level (FKGL) and (2) the Flesch Reading Ease (FRE) algorithms to calculate the readability level. Mean readability scores were compared across body part categories. A one-sample t-test was done to compare mean FKGL with the recommended sixth-grade readability level and the average American adult reading level. A two-sample t-test was used to compare the readability scores of the AAOS trauma-related articles with those of the OTA. The average (SD) FKGL and FRE for the AAOS articles were 8.9 (0.74) and 57.2 (5.8), respectively. All articles were written above the sixth-grade reading level. The average readability of the AAOS articles was significantly greater than the recommended sixth-grade reading level (P < 0.001). The average FKGL and FRE for all AAOS articles were significantly higher compared with those of the OTA articles (8.9 ± 0.74 versus 8.1 ± 1.14, P < 0.001 and 57.2 ± 5.8 versus 65.6 ± 6.6, P < 0.001, respectively). Excellent agreement was observed between raters for the FKGL 0.956 (95% confidence interval, 0.922 to 0.975) and FRE 0.993 (95% confidence interval, 0.987 to 0.996). Our findings suggest that after almost a decade, the readability of the AAOS trauma-related articles remains unchanged. The AAOS and OTA trauma patient education materials have high readability levels and may be too difficult for patient comprehension. A need remains to improve the readability of these commonly used trauma education materials.

What Is the Representation of Sexual and Gender Minority Identities Among Orthopaedic Professionals in the United States?

Background There is substantial corroborating evidence that orthopaedic surgery has historically been the least diverse of all medical and surgical specialties in terms of race, ethnicity, and sex. Growing recognition of this deficit and the benefits of a diverse healthcare workforce has motivated policy changes to improve diversity. To measure progress with these efforts, it is important to understand the existing representation of sexual and gender minorities among orthopaedic professionals. Questions/purposes (1) What proportion of American Academy of Orthopaedic Surgeons (AAOS) members reported their identity as a sexual or gender minority? (2) What demographic factors are associated with the self-reporting of one’s sexual orientation and gender identity? Methods The AAOS published the updated membership questionnaire in January 2022 to collect information from new and existing society members regarding age and race or ethnicity and newly added categories of gender identity, sexual orientation, and pronouns. The questionnaire was updated with input from a committee of orthopaedic surgeons and researchers to ensure face validity. The AAOS provided a deidentified dataset that included the variables of interest: membership type, gender identity, sexual orientation, pronouns, age, race, and ethnicity. Of 35,427 active AAOS members, 47% (16,652) updated their membership questionnaire. To answer our first study question, we calculated the prevalence of participants who self-reported as lesbian, gay, bisexual, transgender, queer, or another sexual or gender minority identity (LGBTQ+) and other demographic characteristics of the 16,652 respondents. Categorical demographic data are described using frequencies and proportions. Median and IQR were used to describe the central tendency and variability. To answer our second study question, we conducted a stratified analysis to compare demographic characteristics between those who self-reported LGBTQ+ identity and those who did not. Visual methods (quantile-quantile plots) and statistical tests (Kolmogorov-Smirnov and Shapiro Wilk) confirmed that the age of AAOS member was not normally distributed. Therefore, a Kruskal Wallis test was used to determine the statistical associations between age and self-reported LGBTQ+ status. Chi-square tests were used to determine bivariate statistical associations between categorical demographic characteristics and self-reported LGBTQ+ status. A multivariable logistic regression model was developed to identify the independent demographic characteristics associated with respondents who self-reported LGBTQ+ identity. Further stratified analyses were not conducted to protect the anonymity of AAOS members. An alpha level of 5% was established a priori to define statistical significance. Results Overall, 3% (109 of 3679) and fewer than 1% (3 of 16,182) of the AAOS members (surgeons, clinicians, allied healthcare providers, and researchers) who updated their membership profiles reported identifying as a sexual (lesbian, gay, bisexual, queer) or gender minority (nonbinary or transgender), respectively. No individual self-identified as transgender. Five percent (33 of 603) of women and 3% (80 of 3042) of men self-identified as a sexual minority (such as lesbian, gay, bisexual, or queer). AAOS members who self-identified as LGBTQ+ were younger (OR 0.99 [95% confidence interval (CI) 0.98 to 0.99]; p &lt; 0.001), less likely to self-identify as women (OR 0.86 [95% CI 0.767 to 0.954]; p &lt; 0.001), less likely to be underrepresented in medicine (OR 0.49 [95% CI 0.405 to 0.599]; p &lt; 0.001), and less likely to be an emeritus or honorary member (OR 0.75 [95% CI 0.641 to 0.883]; p &lt; 0.003). Conclusion The proportion of self-reported LGBTQ+ AAOS members is lower than the 7% of the general US population. The greater proportion of younger AAOS members reporting this information suggests progress in the pursuit of a more-diverse field. Clinical Relevance The study findings support standardized collection of sexual orientation and gender identity data to better identify and address diversity gaps. As orthopaedic surgery continues to transform to reflect the diversity of musculoskeletal patients, all orthopaedic professionals (surgeons, clinicians, allied healthcare providers, and researchers), regardless of their identities, are essential in the mission to provide equitable and informed orthopaedic care. Sexual and gender minority individuals may serve as important mentors to the next generations of orthopaedic professionals; individuals from nonminority groups should serve as important allies in achieving this goal.

Treatment of Shoulder Osteoarthritis With Intact Rotator Cuff and Severe Glenoid Retroversion

The American Academy of Orthopaedic Surgeons has developed an Appropriate Use Criteria (AUC) for Treatment of Shoulder Osteoarthritis with Intact Rotator Cuff and Severe Glenoid Retroversion. Evidence-based information, in conjunction with the clinical expertise of physicians, was used to develop the criteria to determine the appropriateness of various treatments of shoulder osteoarthritis with intact rotator cuff and severe glenoid retroversion. The AUC for Treatment of Shoulder Osteoarthritis with Intact Rotator Cuff and Severe Glenoid Retroversion were derived by identifying scenarios evident during the clinical decision-making process on this topic. These scenarios relied on definitions and general assumptions, mutually agreed upon by the writing panel during scenario development. These definitions and assumptions were necessary to provide consistency in the interpretation of the clinical scenarios among experts rating the scenarios and readers using the final criteria. Writing panel members of this AUC developed patient scenarios using these guiding principles: comprehensive (covers a wide range of patients), mutually exclusive (no overlap between patient scenarios/indications), homogeneous (final ratings should result in equal application in each of the patient scenarios), and manageable (number of total rating items [ie, number of patient scenarios × number of treatments] should be practical for the rating panel). The target number of total rating items was &lt;1,500. This means that not all patient indications and treatments can be assessed using AUC. A total of 240 patient scenarios and five treatments were developed by the writing panel, a group of clinicians who are specialists in this AUC topic. Next, a separate, multidisciplinary, rating panel (made up of specialists and non-specialists) rated the appropriateness of treatment of each patient scenario using a nine-point scale to designate a treatment as “appropriate” (median rating, 7 to 9), “may be appropriate” (median rating, 4 to 6), or “rarely appropriate” (median rating, 1 to 3).

Prevalence of disability secondary to work-related musculoskeletal injuries among orthopaedic surgeons

BackgroundOrthopaedic surgeons encounter many work-place hazards that can lead to musculoskeletal injuries (MSI) and their clinical sequelae. This study aims to evaluate musculoskeletal injuries among orthopaedic surgeons and compare their rates of disability claims and time off work. Additionally, this study provides a perspective on the financial impact of work-related injuries among orthopaedic surgeons. MethodsAn electronic survey was developed to assess work-place hazards among orthopaedic surgeons. The survey included questions on demographics, musculoskeletal injuries, and disabilities. Electronic surveys were emailed to all current members of the American Academy of Orthopaedic Surgeons (AAOS) between March and April 2021 in the United States. Descriptive statistics were run for all variables and chi-squared and t-tests when applicable. Results1645 members of the AAOS completed the survey (7.03 % response rate), and 243 (14.9 %) reported a work-related injury to their place of employment at some point during their career. Of the respondents, 1129 (76.4 %) reported having active disability insurance, and 61 (3.7 %) orthopaedic surgeons filed a disability claim secondary to a work-related injury at some point during their career. Of the surgeons that claimed disability, 39 (66.1 %) returned to work, and 20 (33.9 %) had an early retirement. Foot/ankle injuries led to the highest rates of early retirement overall (62.5 %). ConclusionThis study captures the prevalence of disability claims made by orthopaedic surgeons due to work-place hazards. To our knowledge, this is the first study to broadly compare disability claims amongst orthopaedic surgeons. This data should be used to implement changes in the orthopaedic community to decrease injuries and disability claims.

Academic Degree Bias Among Speaking and Leadership Roles at the American Academy of Orthopaedic Surgeons Annual Meetings, 2016-2021.

This study examined the proportion of Doctors of Osteopathic Medicine (DOs) across various speaking and leadership roles at recent American Academy of Orthopaedic Surgeons (AAOS) annual meetings. Design: Meeting programs from the AAOS were publicly accessed and compiled between 2016 and 2021. Two categories of AAOS meeting participants were created. Invited speaker and faculty roles included moderators of symposia and program committee members while authors of presented papers were classified into academic roles. The proportion of DOs in each role type (invited speaker, academic) was recorded for each meeting program. The representation of DOs in these roles was then examined longitudinally across our analysis period using Pearson's Correlation. Results: Overall, 1.1% (119/10,636) of all roles were held by DOs. Across our analysis period, DOs were disproportionately underrepresented as invited faculty or speakers (0.1%, 4/2791) compared with academic roles (0.1% vs 1.5%, p<0.001). Specifically, DOs were underrepresented as program committee members (0.08% vs 1.5%, p<0.001), symposia lecturers (0.1% vs 1.5%, p=0.004), and moderators of paper presentations (0.3% vs 1.5%, p=0.01). Conclusion: Between 2016-2021, DOs were disproportionately represented as invited speakers or faculty at AAOS annual meetings. Our definition of diverse perspectives may need to expand to include osteopathic physicians.

Understanding Variations in the Management of Displaced Distal Radius Fractures With Satisfactory Reduction.

The American Academy of Orthopaedic Surgeons has set forth Clinical Practice Guidelines (CPGs) to help guide management of closed, displaced distal radius fractures (DRFs). There still exists variation in practice regarding operative vs nonoperative decision-making. This study aims to identify which factors influence the decision to treat DRFs not indicated for surgery by the CPGs after initial closed reduction. Fifteen sets of DRFs and clinical vignettes were distributed via email to over 75 orthopedic residency programs, Orthopaedic Trauma Association, and New York Society for Surgery of the Hand membership. A Qualtrics survey collected respondent demographics, choice of treatment, and rationale. Responses were received from 106 surgeons and resident trainees. The odds of selecting operative management for fractures with 5 or more radiographic instability signs versus 3 or 4 was 3.11 (P < .05). Age over 65, higher patient activity level, and dominant-hand injury were associated with greater odds of operative management (3.4, 30.28, and 2.54, respectively). In addition, surgeons with more years in practice and high-volume surgeons had greater odds of selecting operative management (2.43 and 2.11, respectively). Assessment of instability at the time of injury, patient age and activity level, as well as surgeon volume and time in practice independently affect the decision to manage well-reduced DRF with surgical or nonsurgical treatment. The source of heterogeneity in the treatment of these fractures is borne at least in part from a lack of formal direction on the importance of prereduction instability from the CPGs.

The Musculoskeletal Tumor Society Clinical Practice Guideline on the Management of Metastatic Humeral Disease.

Management of Metastatic Humeral Disease is based on a systematic review of published studies surrounding the management of metastatic disease, multiple myeloma, and lymphoma limited to the humerus. This guideline contains seven action statements to assist orthopaedic surgeons, orthopaedic oncologists, physicians, and any other qualified healthcare professionals involved in the surgical management of metastatic disease of the humerus. It is also intended to serve as an information resource for decision makers, researchers, and developers of clinical practice guidelines. In addition to providing pragmatic practice recommendations, this guideline also highlights gaps in the literature and informs areas for future research and quality measure development. This guideline has been endorsed by the American Academy of Orthopaedic Surgeons.

Machine learning review of hand surgery literature

Background: Latent Dirichlet Allocation is an artificial intelligence model which processes text into topics, and has had broad application in medicine, political science, and engineering. As the orthopedic hand literature continues to grow, such technology may have value in efficiently conducting identifying trends and conducting systematic reviews. The purpose of this study is to demonstrate the use of Latent Dirichlet Allocation and machine learning to review literature and summarize the past 21 yr of hand surgery research. Methods: All original research articles published in the Journal of Hand Surgery (American), Journal of Hand Surgery (European), Hand, Journal of Bone and Joint Surgery (JBJS), Clinical Orthopaedics and Related Research (CORR), Journal of the American Academy of Orthopaedic Surgeons (JAAOS) and Plastic and Reconstructive Surgery (PRS) from 2000-2021 were analyzed using Latent Dirichlet Allocation, generating 50 topics which were then ranked by popularity and trended over the previous 21 yr. Results: Research article abstracts totaling 11,501 from 2000-2020 were extracted and analyzed to create 50 topics. Conclusion: This is the first study of its kind to utilize machine learning models for reviewing the hand surgery literature. Machine learning possesses the ability to rapidly process a large body of test and assess the current state of research and trends or research topics, which can aid clinicians and researchers in time-intensive tasks to provide clues that will promote areas of further study.

Contemporary management of open extremity fractures: What You Need to Know.

Open extremity fractures are high-risk injuries prone to significant complications, including soft tissue loss, bone defects, infection, infected nonunion, and the necessity for limb amputation. Large-scale multicenter prospective studies from the "Lower Extremity Assessment Project" (LEAP) and the "Major Extremity Trauma Consortium" (METRC) have provided novel scientific insights pertinent to the timeliness and appropriateness of specific treatment modalities aimed at improving outcomes of patients with open extremity injuries. These include the imperative for early administration of intravenous antibiotics within three hours of injury, preferably within one hour of hospital admission. Unlike the proven value of early antibiotics, the time to initial surgical débridement does not appear to affect infection rates and patient outcomes. Recent evidence-based consensus guidelines from the American Academy of Orthopaedic Surgeons (AAOS) provide scientific guidance for preventing surgical site infections in patients with open extremity fractures and support the decision-making of limb salvage versus amputation in critical open extremity injuries. Patient survival represents the overarching priority in the management of any trauma patient with associated orthopaedic injuries. Therefore, the timing and modality of managing open fractures must take into account the patient's physiology, response to resuscitation, and overall injury burden. The present review was designed to provide a state-of-the-art overview on the recommended diagnostic workup and management strategies for patients with open extremity fractures, based on the current scientific evidence.

Prompt engineering in consistency and reliability with the evidence-based guideline for LLMs

The use of large language models (LLMs) in clinical medicine is currently thriving. Effectively transferring LLMs’ pertinent theoretical knowledge from computer science to their application in clinical medicine is crucial. Prompt engineering has shown potential as an effective method in this regard. To explore the application of prompt engineering in LLMs and to examine the reliability of LLMs, different styles of prompts were designed and used to ask different LLMs about their agreement with the American Academy of Orthopedic Surgeons (AAOS) osteoarthritis (OA) evidence-based guidelines. Each question was asked 5 times. We compared the consistency of the findings with guidelines across different evidence levels for different prompts and assessed the reliability of different prompts by asking the same question 5 times. gpt-4-Web with ROT prompting had the highest overall consistency (62.9%) and a significant performance for strong recommendations, with a total consistency of 77.5%. The reliability of the different LLMs for different prompts was not stable (Fleiss kappa ranged from −0.002 to 0.984). This study revealed that different prompts had variable effects across various models, and the gpt-4-Web with ROT prompt was the most consistent. An appropriate prompt could improve the accuracy of responses to professional medical questions.

Psychometric Properties of the Oral Health Values Scale and Cultural Adaptation in the Indian Population.

The Oral Health Values Scale is a multidimensional instrument that identifies and measures a person's values related to oral health. This scale has been validated in American respondents. This study aims to evaluate the adaptability and validity of the Oral Health Values Scale in the Hindi language (H-OHVS). A total of 240 adults participated in the study that was carried out from July to November 2022. An offline one-to-one survey was carried out to collect data by an investigator blinded to the study protocol. The translation and testing of the OHVS were carried out based on the cross-cultural adaptation guidelines of the American Academy of Orthopedic Surgeons (AAOS) Evidence-Based Medicine Committee. The content validity was assessed by an expert panel. Construct validity was analyzed through Exploratory Factor Analysis (EFA), utilizing principal component analysis with varimax rotation. The internal consistency of the Hindi version of OHVS was evaluated using Cronbach's alpha. The results showed that H-OHVS had an Item-level Construct Validity Index (I-CVI) ranging from 0.82 to 1.00. Two components, compliance and hesitance, were formed on H-OHVS accounting for 63.91% of the cumulative variance. The resulting model fit indices on confirmatory factor analysis presented an adequate fit to the data.The overall Cronbach's alpha coefficient for H-OHVS (α = 0.868) presents excellent internal consistency. The study findings provide a certain degree of evidence in favor of this scale and establish the Oral Health Values Scale (OHVS) as a psychometrically sound measure.

Biomechanical risk factors for ACL injury differ between the sexes when performing a high-intensive exergame

Introduction&#x0D; Incidence rates in anterior cruciate ligament (ACL) injuries, which are linked to multiple factors, are higher in females than males (Sutton &amp; Bullock, 2013). However, the main contributors to the difference in risk are biomechanical factors such as increased knee valgus (KV), knee internal rotation (KIR), or decreased hip flexion (HF; Seyedahmadi et al., 2022). Returning back to sports after an injury requires extensive rehabilitation as well as training of dual-task situations in order to be physically and cognitively prepared. Exergaming represents a dual task including a cognitive and a motor component and may be used as training modality during rehabilitation. It is known that performing a dual-task leads to altered landing movement patterns in healthy athletes (Dai et al., 2018). Before an exergame for rehabilitation after ACL injury can be implemented and tailored to the specific needs of female and male athletes, the movement patterns of males and females need to be understood. Therefore, the aim of this study was to identify biomechanical differences between males and females when performing a high-intensive exergame.&#x0D; Methods&#x0D; Using 3D-motion capture (Vicon) kinematics were measured in 18 healthy athletes (9 male, 9 female) during a 25-min exergame (Sphery Racer, ExerCube). The exergame included nine different exercises of which 8 were used for analysis. The exercises were separated into neutral (squat, jump, burpee) and side-specific exercises (low-touch, mid-touch, high-touch, punch, lunge). For analysis, the maximal KV, maximal KIR, and the minimal HF were extracted during 10-30° knee flexion. These maximal values were then compared between the sexes, the exercises, and both legs with a linear mixed model, for each the neutral and the side-specific exercises.&#x0D; Results&#x0D; A main effect of sex was only found for side-specific exercises in KIR (F(1, 16) = 6.1, p = .02) with females exhibiting higher values. For KV and HF in side-specific exercises as well as all variables in neutral exercises, no significant main effect for sex was found. However, there was a main effect of exercise in KV; KIR, and HF in neutral (p &lt; .001) as well as in side-specific exercises (p &lt; .001).&#x0D; Discussion/Conclusion&#x0D; Differences in KIR between males and females primarily exist during touches and punches. Therefore, exergames should incorporate this fact to counteract increased risk for knee injuries in females.&#x0D; References&#x0D; Dai, B., Cook, R. F., Meyer, E. A., Sciascia, Y., Hinshaw, T. J., Wang, C., &amp; Zhu, Q. (2018). The effect of a secondary cognitive task on landing mechanics and jump performance. Sports Biomechanics, 17(2), 192–205. https://doi.org/10.1080/14763141.2016.1265579&#x0D; Seyedahmadi, M., Minoonejad, H., Karimizadeh Ardakani, M., Heidari, Z., Bayattork, M., &amp; Akbari, H. (2022). What are gender differences in lower limb muscle activity during jump-landing tasks? A systematic review and meta-analysis. BMC Sports Science, Medicine &amp; Rehabilitation, 14(1), Article 77. https://doi.org/10.1186/s13102-022-00469-3&#x0D; Sutton, K. M., &amp; Bullock, J. M. (2013). Anterior cruciate ligament rupture: Differences between males and females. The Journal of the American Academy of Orthopaedic Surgeons, 21(1), 41–50. https://doi.org/10.5435/jaaos-21-01-41

The carbon footprint of American Academy of Orthopaedic Surgeons and Pediatric Orthopaedic Society of North America national meetings

BackgroundThe health care sector contributes substantially to carbon emissions. Estimating the carbon emissions of an event can help determine its climate impact. This study calculates the carbon footprints of the 2019 American Academy of Orthopaedic Surgeons (AAOS) Annual Meeting and the 2019 Pediatric Orthopaedic Society of North America (POSNA) Annual Meeting. MethodsData regarding attendance volume, geographic origin of attendees and vendors, hotel room nights, event space, and duration of meetings were obtained from AAOS and POSNA. Data were entered into an online calculator designed to measure the carbon footprint of large events (www.terrapass.com). ResultsThe AAOS 2019 annual meeting was attended by 29 448 people, requiring 66 000 hotel room nights and 2 308 800 ft2 of convention center space for 5 days. We estimated 7179 short, 8374 medium, and 13 421 long-haul round-trip flights. The POSNA 2019 annual meeting was attended by 1103 people, requiring 1932 hotel room nights and 52 100 ft2 of convention center space for 4 days. We estimated 501 short, 280 medium, and 280 long-haul round-trip flights. The AAOS 2019 meeting emitted 26 075 metric tonnes of carbon dioxide equivalents (CO2e), while the POSNA 2019 meeting emitted 544 metric tonnes. Eighty-one percent of the carbon emissions from AAOS and 80% from POSNA came from flight travel alone. Carbon neutralization of in-person AAOS and POSNA annual meetings would require carbon-offset purchases of approximately $273 700 and $5700, respectively. ConclusionsAnnual orthopaedic meetings contribute to climate change through their large carbon footprint. Leaders in the field of orthopaedics should consider strategies to mitigate the impact of such meetings, examples of which include transitioning to hybrid formats when appropriate and by purchasing carbon offsets for essential in-person participation. Key Concepts1)Calculating the carbon footprint of an event estimates its total carbon dioxide emissions to help determine how to reduce its climate impact.2)The AAOS 2019 meeting emitted 26 075 metric tonnes (MT) of carbon dioxide equivalents (CO2e), while the POSNA 2019 meeting emitted 544MT, with ∼80% coming from air travel alone.3)Carbon neutralization of in-person AAOS and POSNA annual meetings would require carbon-offset purchases of approximately $273 700 and $5700, respectively. Level of EvidenceIV

Trends in Deep Vein Thrombosis Prophylaxis After Total Knee Arthroplasty: 2016 to 2021

BackgroundIn 2011, the American Academy of Orthopaedic Surgeons released a consensus recommending venous thromboembolism (VTE) prophylaxis after total knee arthroplasty (TKA). The purpose of our study was to examine (1) incidences of postoperative complications, including pulmonary embolism (PE), deep vein thrombosis (DVT), and transfusion rates; (2) trends from 2016 to 2021 in VTE prophylaxis; and (3) independent risk factors for 90-day total complications following TKA between aspirin, enoxaparin, rivaroxaban, and warfarin. MethodsUsing a national, all-payer database from 2016 to 2021, we identified all patients who underwent primary TKA. Exclusions included all patients who had prescribed anticoagulants within 1 year prior to TKA, hypercoagulable states, and cancer. Data were collected on baseline demographics, including age, sex, diabetes, and a comorbidity index, in each of the VTE prophylaxis cohorts. Postoperative outcomes included rates of PE, DVT, and transfusion. Multivariable regressions were performed to determine independent risk factors for total complications at 90 days following TKA. ResultsFrom 2016 to 2021, aspirin was the most used anticoagulant (n = 62,054), followed by rivaroxaban (n = 26,426), enoxaparin (n = 20,980), and warfarin (n = 13,305). The cohort using warfarin had the highest incidences of PE (1.8%) and DVT (5.7%), while the cohort using aspirin had the lowest incidences of PE (0.6%) and DVT (1.6%). The rates of aspirin use increased the most from 2016 to 2021 (32.1% to 70.8%), while the rates of warfarin decreased the most (19.3% to 3.0%). Enoxaparin, rivaroxaban, and warfarin were independent risk factors for total complications at 90 days. ConclusionsAn epidemiological analysis of VTE prophylaxis use from 2016 to 2021 shows an increase in aspirin following TKA compared to other anticoagulant cohorts in a nationally representative population. This approach provides more insight and a better understanding of anticoagulation trends over this time period in a nationally representative sample.

Harms Reporting in the RCTs Underpinning the AAOS Clinical Practice Guidelines for Clavicle Fractures

Background: The American Academy of Orthopaedic Surgeons (AAOS) publishes clinical practice guidelines (CPGs) for various pathologies. An extension to the Consolidated Standards for Reporting (CONSORT) checklist provides authors with a framework for reporting harms in randomized controlled trials (RCTs). Objectives: The purpose of this study was to measure harms reporting among RCTs cited as supporting evidence for the AAOS CPG on the treatment of clavicle fractures. This study also sought to determine whether these reporting rates changed over time. Methods: Adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we used the AAOS CPG for clavicle fractures and conducted a linear regression analysis to model the relationship between the year of publication and the total CONSORT checklist percentage adherence over time. Results: There were 28 RCTs cited as supporting evidence for the clavicle fractures CPG included in the final sample. The average number of the 18 CONSORT Extension for Harms items appropriately reported across all included RCTs was 9.32 (51.8%). Nine checklist items had more than 50% compliance (50%), 3 items had between 20% and 50% compliance (16.7%), and 6 items had less than 20% compliance (33.3%). The linear regression model demonstrated no significant improvement in CONSORT Harms reporting over time. Conclusions: Adverse events are inadequately reported in RCTs cited as supporting evidence for the AAOS Treatment of Clavicle Fractures CPGs. We recommend the utilization of standardized adverse event reporting tools specific to orthopedic trauma literature to facilitate ease in adverse event reporting among RCTs.