Field Of Orthopaedic Surgery Research Articles

Disintegration of Bone Cement Using Pulsating Water Jet: A Comparative Study of Standard and Extended Nozzles

The paper deals with erosion of bone cement using a pulsating water jet at a pressure of 15 MPa, comparing the effectiveness of standard and extended nozzle with the length of 100 mm and diameter d = 0,3 mm. The research addresses the problem of optimizing bone cement removal techniques, which is critical for various medical applications, including revision surgeries and bone cement removal. The study employs an design of experiments where bone cement samples are subjected to erosion using a pulsating water jet system equipped with both standard and specially designed extended nozzles. Key parameters such as maximal depth, groove width and volume rate were measured and analyzed. Findings indicate that the extended nozzle significantly enhances the erosion process, achieving higher material removal rates and smoother surface finishes compared to the standard nozzle. The results demonstrate the potential of the extended nozzle design in improving the efficiency and precision of bone cement removal, offering valuable insights for medical practitioners and researchers in the field of orthopedic surgery.

From Policy to Practice: Challenges in Implementing PROMs Reporting Under the New CMS Mandate.

The Centers for Medicare & Medicaid Services (CMS) recently introduced mandatory reporting of patient-reported outcomes (PROs) following primary, elective total joint arthroplasty (TJA) procedures. This article explores the implications and implementation challenges of this policy shift in the field of orthopaedic surgery. With a review of the existing literature, we analyze the potential benefits and limitations of PROs, discuss the role of CMS in health-care quality improvement initiatives, explain the predicted difficulties in the successful implementation of this new mandate, and provide recommendations for the successful integration of the reporting of PROs in clinical practice.

Emerging Concepts in Periprosthetic Joint Infection Research: The Human Microbiome.

Microorganisms, including bacteria, fungi, and viruses, that reside on and within the human body are collectively known as the human microbiome. Dysbiosis, or disruption in the microbiome, has been implicated in several disease processes, including asthma, obesity, autoimmune diseases, and numerous other conditions. While the Human Microbiome Project (HMP) and the generation of descriptive studies it inspired established correlations between characteristic patterns in the composition of the microbiome and specific disease phenotypes, current research has begun to focus on elucidating the causal role of the microbiome in disease pathogenesis. Within the field of orthopaedic surgery, researchers have proposed the concept of a "gut-joint axis" by which the intestinal microbiome influences joint health and the development of diseases such as osteoarthritis and periprosthetic joint infection (PJI). It is theorized that intestinal dysbiosis increases gut permeability, leading to the translocation of bacteria and their metabolic products into the systemic circulation and the stimulation of proinflammatory response cascades throughout the body, including within the joints. While correlative studies have identified patterns of dysbiotic derangement associated with osteoarthritis and PJI, translational research is needed to clarify the precise mechanisms by which these changes influence disease processes. Additionally, an emerging body of literature has challenged the previously held belief that certain body sites are sterile and do not possess a microbiome, with studies identifying distinct microbial genomic signatures and a core microbiome that varies between anatomic sites. A more thorough characterization of the joint microbiome may have profound implications for our understanding of PJI pathogenesis and our ability to stratify patients based on risk. The purpose of this review was to outline our current understanding of the human microbiome, to describe the gut-joint axis and its role in specific pathologies, including PJI, and to highlight the potential of microbiome-based therapeutic interventions in the field of orthopaedics.

3D‐Printed Dual‐Bionic Scaffolds to Promote Osteoconductivity and Angiogenesis for Large Segment Bone Restoration

AbstractLarge segment bone defects pose a significant challenge in the field of orthopedic surgery, requiring effective and innovative approaches for restoration. However, many existing scaffolds are bioinert and do not support crucial processes such as cell adhesion, proliferation, and vascularization. In this study, a dual‐bionic 3D printing bredigite scaffold is developed, featuring a combination of physical structure and bioactive functions. Specifically, the structure‐mimetic scaffold has an isotropic single‐cell structure suitable for defects with varying load‐bearing requirements and allowing the ingrowth of vessels and bone. Meanwhile, an extracellular matrix peptide‐mimetic β‐amino acid polymer DM50CO50 and deferoxamine are modified onto the scaffold simultaneously to promote the adhesion of bone marrow mesenchymal stem cells and vascularization. The dual‐bionic scaffolds demonstrate outstanding osteogenic and angiogenic properties in a rat model with large segment bone defects to promote bone restoration, implying a promising strategy in designing scaffolds to promote osteoconductivity and angiogenesis for large segment bone restoration.

Enhancing the precision of continuum robots in orthopedic surgery based on mechanical principles.

In the field of orthopedic surgery, the notched continuum robot has garnered significant attention due to its passive compliance, making it particularly suitable for procedures in complex and delicate bone and joint regions. However, accurately modeling the notched continuum robot remains a significant challenge. This paper proposes a high-precision mechanical modeling method for the notched continuum robot to address this issue. The flexible beam deflection prediction model based on the beam constraint model is established. The force balance friction model considering internal friction is established. An accurate static model is obtained, which can accurately estimate the deformation and deflection behavior of the robot according to the input driving force. The kinematic model of the notched continuum robot based on the static model is established. This method achieves high accuracywhile ensuring computational efficiency. Experimental results demonstrate that the static model's error is only 0.1629mm, which corresponds to 0.25% of the total length of the continuum robot, which is 66mm. This research provides valuable insights into the modeling and control of continuum robots and holds significant implications for advancing precision in orthopedic surgery.

Angiotensin II receptor blockers and their applications in orthopaedic surgery and musculoskeletal medicine.

Angiotensin II receptor blockers (ARBs) are commonly prescribed for hypertension and heart failure, and have well-described antifibrotic properties throughout medical literature. The etiology and pathogenesis of fibrosis is biologically complex with a multitude of factors playing a role in the process. Consequently, pathologic fibrosis may be significant within orthopaedics contributing to post-operative stiffness and, ultimately, negative patient outcomes. The pharmacology of ARBs has been described to combat fibrosis in preclinical settings, while the literature of ARBs antifibrotic properties in relation to orthopaedics remains scarce. However, fibrosis is one of the primary factors contributing to tissue healing and functional recovery in the field of orthopaedic surgery. Fibrosis has specifically been described in relation to shoulder surgery, knee arthroplasty and hip arthroscopy. As such, outcomes of various orthopaedic surgeries are dependent upon a balance between tissue healing and stiffness, both of which may be mediated by a fibrotic response. Importantly, ARBs have recently emerged as a potential therapy to combat fibrosis-mediated stiffness in orthopaedic surgery patients. Thus, the following review article seeks to highlight the basic and clinical science of ARBs with emphasis on their implications and indications for orthopaedic surgery and musculoskeletal medicine.

Enhancing orthopaedic surgery research: developing manuscripts using systematic checklists.

Writing and publishing research is important in the fields of orthopaedic surgery, and medicine in general. In recent years, the number of orthopaedic publications has significantly increased, highlighting the value of possessing the ability to write and publish a paper. However, publishing research is not an easy task, especially if English is not a native language. Non-native English speakers have been reported to experience barriers to writing and publishing research in English, the dominant language of scientific publication. This affects not only individual researchers, but also the scientific community in general. To improve reporting in scientific manuscripts, many peer-reviewed guidelines have been published for a variety of study designs and study types. These guidelines are made available through the EQUATOR (Enhancing the QUAlity and Transparency Of health Research) Network and have associated checklists that guide authors in the synthesis of their research manuscript. Whether you are a non-native English speaker or a novice research writer, these checklists can ameliorate the process of building your manuscript. The purpose of this paper is to empower orthopaedic researchers, and researchers in general, through an easy-to-follow framework for writing a research manuscript using available checklists and general research knowledge.

Sex, Race, and Ethnicity of Faculty and Department Chairs in Orthopaedic Surgery and Comparable Fields: 2015 to 2022.

The field of orthopaedic surgery has disproportionately low numbers of women and underrepresented in medicine (URM) groups. Although the representation of women and URM in orthopaedics has increased over the past several years, the growth has not kept up with other surgical specialties. This is a retrospective review of data presented by the Association of American Medical Colleges (AAMC) regarding US medical school faculty and department chair makeup in 2018 to 2022 and 2015 data from the AAMC Group on Women in Medicine and Sciences reports. Data regarding the sex and race/ethnicity of faculty and department chairs in orthopaedic surgery, a comparable surgical specialty (otolaryngology), surgery, and all medical fields were assessed. Otolaryngology was chosen as a comparable specialty because orthopaedic surgery and otolaryngology are the only two surgical specialties classified within the AAMC faculty report, separate from any medical counterpart. Among orthopaedic surgery, otolaryngology, surgery, and all clinical sciences, the representation of women and individuals from URM groups increased between 2015 and 2022. During this time, orthopaedic surgery had the lowest growth rate of the four groups in female faculty (+0.63%/year), URM faculty (+0.32%/year), and URM department chairs (+0.11%/year). However, orthopaedic surgery did have an increase in female department chairs (0.96%/year to 7% in 2022), similar to increases seen in surgery and all clinical sciences. The increase in representation in female and URM faculty and department chairs in orthopaedic surgery lags behind comparable fields and medicine as a whole. In addition, orthopaedic surgery had the lowest representation of female and URM faculty in 2015 and 2022. Improving the representation of female and URM orthopaedic faculty and department chairs is critical because this may encourage more diverse medical students to consider pursuing a career in the field.

Three-dimensional printing in orthopaedic surgery: A review of current and future applications

Three-dimensional (3D) printing is a form of technology in which 3D physical models are created. It has been used in a variety of surgical specialities ranging from cranio-maxillo-facial to orthopaedic surgery and is currently an area of much interest within the medical profession. Within the field of orthopaedic surgery, 3D printing has several clinical applications including surgical education, surgical planning, manufacture of patient-specific prostheses/patient specific instruments and bone tissue engineering. This article reviews the current practices of 3D printing in orthopaedic surgery in both clinical and pre-clinical settings along with discussing its potential future applications.

Remote Summer Research Program to Improve Opportunity and Mentorship for Underrepresented Students With Interest in Orthopaedic Surgery: 3-Year Experiences.

Medical students are challenged with a limited number of research opportunities to help prepare for an exceptionally competitive process for matching in an orthopaedic residency. The aim of this study was to assess the 3-year experience of our 8 to 10-week remote summer research program in support of underrepresented students with an interest in orthopaedic surgery. We received over 500 applications, and a total of 37 students (7.4%) participated in the program over the past 3 years. A total of 14 faculty mentors were matched with 1 or 2 students each. The research program delivered a curriculum including (1) research-related topics led by a content expert; (2) weekly faculty lectures discussing topics including orthopaedic conditions, diversity in orthopaedics, leadership, and work-life balance; and (3) a minimum of 8 weeks of mentorship experience with an assigned faculty and a peer mentor. Students and faculty were surveyed to measure skill progression, research productivity, and program satisfaction. Program participants represented a range of race/ethnic backgrounds and research experience levels. The cohort included a high rate of female (51%) and Black (35%) participants relative to representation of these groups in orthopaedic surgery. Postprogram surveys indicated that all participants improved their research skills, orthopaedic interest, and mentorship/networking skills. Most students (89%) stated that they were adequately matched to their faculty mentor. Most students (79%) indicated that they contributed to either manuscript or conference abstract as coauthors. The study findings suggest improved research skills, interest, and confidence to pursue orthopaedic residency and mentorship/networks in the field. Our long-term vision is to improve the accessibility and quality of mentorship for underrepresented students to foster an equitable pathway into the field of orthopaedic surgery.

Robotic Assistance and Haptic Feedback in Arthroscopic Procedures: Design and Preliminary Evaluation of a Two-Arm System

Robot-assisted arthroscopic surgery has been receiving growing attention in the field of orthopedic surgery. Most of the existing robot-assisted surgical systems in orthopedics place more focus on open surgery than minimally invasive surgery (MIS). In traditional arthroscopic surgery, the surgeon needs to hold an arthroscope with one hand while performing the surgical operations with the other hand, which can restrict the dexterity of the surgical performance and increase the cognitive load. On the other hand, the surgeon heavily relies on the arthroscope view when conducting the surgery, whereas the arthroscope view is a largely localized view and lacks depth information. To assist the surgeon in both scenarios, in this work, we develop a two-arm robotic system. The left-arm robot is used as a robot-assisted arthroscope holder, and it can hold the arthroscope still at a designated pose and reject all other potential disturbances, while also allowing the operator to move it via a pedal switch whenever needed. The left-arm robot is implemented with an impedance controller and a gravity iterative learning (Git) scheme, where the former can provide compliant robot behavior, thus ensuring a safe human–robot interaction, while the latter can accurately learn for gravity compensation. The right-arm robot is used as a robot-assisted surgical tool, providing virtual fixture (VF) assistance and haptic feedback during the surgery. The right-arm robot is implemented with a point-based VF algorithm, which can generate VF directly from point clouds in any shape, render force feedback, and deliver it to the operator. Furthermore, the VF, the bone, and the surgical tool position are visualized in a 3D digital environment as additional visual feedback for the operator. A series of experiments are conducted to evaluate the effectiveness of the prototype. The results demonstrate that both arms can provide satisfactory assistance as designed.

The Relevance of Implanted Percutaneous Electrical Nerve Stimulation in Orthopedics Surgery: A Systematic Review.

Background: Percutaneous peripheral nerve stimulation (PNS) is a form of neuromodulation that involves the transmission of electrical energy via metal contacts known as leads or electrodes. PNS has gained popularity in orthopedic surgery as several studies have supported its use as a pain control device for patients suffering from pain due to orthopedic pathologies involving the knee, shoulder, and foot. The purpose of this systematic review is to summarize the literature involving peripheral nerve stimulation in orthopedic surgery. The existing body of literature provides support for further research regarding the use of PNS in the management of knee pain, hip pain, shoulder pain, foot pain, and orthopedic trauma. Notably, the evidence for its efficacy in addressing knee and shoulder pain is present. Methods: This study was conducted following PRISMA guidelines. Seven hundred and forty-five unique entries were identified. Two blinded reviewers assessed each article by title and abstract to determine its relevance and categorized them as "include", "exclude", and "maybe". After a preliminary review was completed, reviewers were unblinded and a third reviewer retrieved articles labeled as "maybe" and those with conflicting labels to determine their relevance. Twenty-eight articles were included, and seven hundred and seventeen articles were excluded. Articles discussing the use of PNS in the field of orthopedic surgery in patients > 18 years of age after 2010 were included. Exclusion criteria included neuropathic pain, phantom limb pain, amputation, non-musculoskeletal related pathology, non-orthopedic surgery related pathology, spinal cord stimulator, no reported outcomes, review articles, abstracts only, non-human subjects. Results: A total of 16 studies analyzing 69 patients were included. All studies were either case series or case reports. Most articles involved the application of PNS in the knee (8) and shoulder (6) joint. Few articles discussed its application in the foot and orthopedic trauma. All studies demonstrated that PNS was effective in reducing pain. Discussion: Peripheral nerve stimulation can be effective in managing postoperative or chronic pain in patients suffering from orthopedic pathology. This systematic review is limited by the scarcity of robust studies with substantial sample sizes and extended follow up periods in the existing literature.

Emerging Innovations in Preoperative Planning and Motion Analysis in Orthopedic Surgery.

In recent years, preoperative planning has undergone significant advancements, with a dual focus: improving the accuracy of implant placement and enhancing the prediction of functional outcomes. These breakthroughs have been made possible through the development of advanced processing methods for 3D preoperative images. These methods not only offer novel visualization techniques but can also be seamlessly integrated into computer-aided design models. Additionally, the refinement of motion capture systems has played a pivotal role in this progress. These "markerless" systems are more straightforward to implement and facilitate easier data analysis. Simultaneously, the emergence of machine learning algorithms, utilizing artificial intelligence, has enabled the amalgamation of anatomical and functional data, leading to highly personalized preoperative plans for patients. The shift in preoperative planning from 2D towards 3D, from static to dynamic, is closely linked to technological advances, which will be described in this instructional review. Finally, the concept of 4D planning, encompassing periarticular soft tissues, will be introduced as a forward-looking development in the field of orthopedic surgery.

The 3D-Printed Custom Elbow Prosthesis for Salvage Treatment of Complex Intra-Articular Distal Humerus Fracture Malunion

Intra-articular fractures of the distal humerus are complex injuries that often require surgery with the goal of restoring elbow range-of-motion and function. Open reduction and internal fixation has been the preferred surgical modality; however, restoration of the medial and/or lateral columns can be complicated in fractures involving a major loss of the articular surface and bony structure. Over the past decade, 3-dimensional (3D) printing has made significant advances in the field of orthopedic surgery, specifically in guiding surgeon preoperative planning. Recently, the incorporation of 3D-printing has proven to provide a safe and reliable construct for the restoration of anatomy in complex trauma cases. We present a 47-year-old woman who sustained a complex, intra-articular distal humerus fracture with associated shearing of the capitellum that went onto malunion. Patient was treated with a patient-specific 3D-printed custom elbow prosthesis with excellent outcomes. Our goal was to shed light on the use of 3D-printing technology as a viable salvage option in treating complex, intra-articular distal humeral fractures associated with lateral condylar damage that subsequently went onto malunion.

Recognizing the Sex Disparity in Surgeons Performing Total Knee Arthroplasty

BackgroundThere is an unambiguous sex disparity in the field of orthopaedic surgery, with women making up only 7.4% of practicing orthopaedic surgeons in 2022. This study seeks to evaluate the sex distribution among orthopaedic surgeons engaged in primary total knee arthroplasty (TKA) between 2013 and 2020, as well as the procedural volume attributed to each provider. MethodsWe retrospectively queried the Medicare dataset to quantify all physicians reporting orthopaedic surgery as their specialty and performing primary TKA from 2013 to 2020. Healthcare Common Procedure Coding System codes for primary TKA procedures were used to extract associated utilization and billing provider information. Trend analyses were performed with 2-sided correlated Mann-Kendall tests to evaluate trends in the number of surgeons by sex and the women-to-men surgeon ratio. ResultsDuring the study period, 6,198 to 7,189 surgeons billed for primary TKA. Of this number, an average of 2% were women. The mean number of procedures billed for by men was 39.02/y (standard deviation: 34.54), and by women was 28.76/y (standard deviation: 20.62) (P < .001). There was no significant trend in the number of men or women surgeons who billed for primary TKA during the study period. Trend analysis of the women-to-men ratio demonstrated an increasing trend of statistical significance (P = .0187). ConclusionsThere was a significant upward trend in the women-to-men ratio of surgeons who billed for primary TKA. However, there remains a colossal gender gap, as women only made up 2.4% of surgeons who billed for the procedure. The current study raises awareness of the notable discrepancy in the average number of TKAs performed by women as compared to men. The orthopaedic community should aim to determine ways to increase the number of women arthroplasty surgeons along with the opportunities that women have to perform TKAs.

Enhancing Hip Arthroplasty Outcomes: The Multifaceted Advantages, Limitations, and Future Directions of 3D Printing Technology.

In the evolving field oforthopedic surgery, the integration of three-dimensional printing (3D printing) has emerged as a transformative technology, particularly in addressing the rising incidence of degenerative joint diseases. The integration of 3D printing technology in hip arthroplasty offers substantial advantages throughout the surgical process. In preoperative planning, 3D models enable meticulous assessments, aiding in accurate implant selection and precise surgical strategies. Intraoperatively, the technology contributes to precise prosthesis design, reducing operation duration, X-ray exposures, and blood loss. Beyond surgery, 3D printing revolutionizes medical equipment production, imaging, and implant design, showcasing benefits such as enhanced osseointegration and reduced stress shielding with titanium cups. Challenges include a higher risk of postoperative infection due to the porous surfaces of 3D-printed implants, technical complexities in the printing process, and the need for skilled manpower. Despite these challenges, the evolving nature of 3D printing technologies underscores the importance of relying on existing orthopedic surgical practices while emphasizing the need for standardized guidelines to fully harness its potential in improving patient care.

Feasibility and Usability of Augmented Reality Technology in the Orthopaedic Operating Room.

Augmented reality (AR)has gained popularity in various sectors,including gaming, entertainment, and healthcare. The desire for improved surgical navigation within orthopaedic surgery has led to the evaluation of the feasibility and usability of AR in the operating room (OR). However, the safe and effective use of ARtechnologyin the OR necessitates a proper understanding of its capabilities and limitations. This review aims to describe the fundamental elements of AR, highlight limitations for use within the field of orthopaedic surgery, and discuss potential areas for development. To date, studies have demonstrated evidence that AR technology can be used to enhance navigation and performance in orthopaedic procedures. General hardware and software limitations of the technology include the registration process, ergonomics, and battery life. Other limitations are related to the human response factors such as inattentional blindness,which may lead to the inability to see complications within the surgical field. Furthermore, the prolonged use of AR can causeeye strain and headache due to phenomena such as thevergence-convergence conflict. AR technology may prove to be abetter alternative to current orthopaedic surgery navigation systems. However, the current limitations should be mitigated to further improve the feasibility and usability of AR in the OR setting. It is important for both non-clinicians and clinicians to work in conjunction to guide the development of future iterations of AR technology and its implementation into the OR workflow.

Enriched mesoporous bioactive glass scaffolds as bone substitutes in critical diaphyseal bone defects in rabbits

In the field of orthopedic surgery, there is an increasing need for the development of bone replacement materials for the treatment of bone defects. One of the main focuses of biomaterials engineering are advanced bioceramics like mesoporous bioactive glasses (MBG´s). The present study compared the new bone formation after 12 weeks of implantation of MBG scaffolds with composition 82,5SiO2–10CaO–5P2O5-x 2.5SrO alone (MBGA), enriched with osteostatin, an osteoinductive peptide, (MBGO) or enriched with bone marrow aspirate (MBGB) in a long bone critical defect in radius bone of adult New Zealand rabbits. New bone formation from the MBG scaffold groups was compared to the gold standard defect filled with iliac crest autograft and to the unfilled defect. Radiographic follow-up was performed at 2, 6, and 12 weeks, and microCT and histologic examination were performed at 12 weeks. X-Ray study showed the highest bone formation scores in the group with the defect filled with autograft, followed by the MBGB group, in addition, the microCT study showed that bone within defect scores (BV/TV) were higher in the MBGO group. This difference could be explained by the higher density of newly formed bone in the osteostatin enriched MBG scaffold group. Therefore, MBG scaffold alone and enriched with osteostatin or bone marrow aspirate increase bone formation compared to defect unfilled, being higher in the osteostatin group. The present results showed the potential to treat critical bone defects by combining MBGs with osteogenic peptides such as osteostatin, with good prospects for translation into clinical practice. Statement of significanceTreatment of bone defects without the capacity for self-repair is a global problem in the field of Orthopedic Surgery, as evidenced by the fact that in the U.S alone it affects approximately 100,000 patients per year. The gold standard of treatment in these cases is the autograft, but its use has limitations both in the amount of graft to be obtained and in the morbidity produced in the donor site. In the field of materials engineering, there is a growing interest in the development of a bone substitute equivalent. Mesoporous bioactive glass (MBG´s) scaffolds with three-dimensional architecture have shown great potential for use as a bone substitutes. The osteostatin-enriched Sr-MBG used in this long bone defect in rabbit radius bone in vivo study showed an increase in bone formation close to autograft, which makes us think that it may be an option to consider as bone substitute.

A Comparison Between GPT-3.5, GPT-4, and GPT-4V: Can the Large Language Model (ChatGPT) Pass the Japanese Board of Orthopaedic Surgery Examination?

Introduction Recently, large-scale language models, such as ChatGPT (OpenAI, San Francisco, CA), have evolved. Thesemodels are designed to think and act like humans and possess a broad range of specialized knowledge. GPT-3.5 was reported to be at a level of passing the United States Medical Licensing Examination. Its capabilities continue to evolve, and in October 2023, GPT-4V became available as a model capable of image recognition. Therefore, it is important to know the current performance of these models because they will be soon incorporated into medical practice. We aimed to evaluate the performance of ChatGPT in the field of orthopedic surgery. Methods We used three years' worth of Japanese Board of Orthopaedic Surgery Examinations (JBOSE) conducted in 2021, 2022, and 2023. Questions and their multiple-choice answers were used in their original Japanese form, as was the official examination rubric. We inputted these questions into three versions of ChatGPT: GPT-3.5, GPT-4, and GPT-4V. For image-based questions, we inputted only textual statements for GPT-3.5 and GPT-4, and both image and textual statements for GPT-4V. As the minimum scoring rate acquired to pass is not officially disclosed, it was calculated using publicly available data. Results The estimated minimum scoring rate acquired to pass was calculated as 50.1% (43.7-53.8%). For GPT-4, even when answering all questions, including the image-based ones, the percentage of correct answers was 59% (55-61%) and GPT-4 was able to achieve the passing line. When excluding image-based questions, the score reached 67% (63-73%). For GPT-3.5, the percentage was limited to 30% (28-32%), and this version could not pass the examination. There was a significant difference in the performance between GPT-4 and GPT-3.5 (p < 0.001). For image-based questions, the percentage of correct answers was 25% in GPT-3.5, 38% in GPT-4, and 38% in GPT-4V. There was no significant difference in the performance for image-based questions between GPT-4 and GPT-4V. Conclusions ChatGPT had enough performance to pass the orthopedic specialist examination. After adding further training data such as images, ChatGPT is expected to be applied to the orthopedics field.

Electrical potentials in bone induced by ultrasound propagation

Bone with complex geometry is hard, heterogeneous and anisotropic tissue, which makes ultrasound diagnosis very difficult. Therefore, the simulation of wave propagation is often performed to understand the complicated wave propagation in bone, where we find solid-liquid coexisting conditions. In addition to the diagnosis, one of the recent topics of bone studies are ultrasound fracture healing. The low intensity pulsed ultrasound (LIPUS) is popular as a fracture treatment technique in the field of orthopedic surgery, although how bones detect high frequency ultrasound is still under discussion. In this study, we focus on the weak piezoelectricity of bone as one of the key properties for the LIPUS treatment. According to the piezoelectric finite difference time-domain (PE-FDTD) method, we have investigated ultrasound propagation and generation of electrical potentials in bone. First, we verified the PE-FDTD method by comparing the simulated electric fields with the experimental data obtained by an ultrasound receiver using bone as the piezoelectric element. Next, we have tried to understand the wave propagation and generation in a real bone model (the radius of a 66-year-old woman). The generation of electrical potentials in the cancellous bone was also studied by simulation and experiments. The use of human bone to fabricate a model was permitted by the ethical committee at Doshisha University.