Purpose Clinical practice guideline development requires title and abstract screening of many records. Large language models (LLMs) may reduce the number of records requiring manual screening, but their ability to retain studies identified during full-text assessment remains uncertain. Methods We retrospectively evaluated an LLM-assisted three-layer screening cascade using 904 English-language records from chapter 4 (conservative management) of a completed clinical practice guideline for hip osteoarthritis. The cascade used GPT-4o mini to assess study design, population, and question-specific intervention and outcome criteria. After full-text assessment, the guideline panel selected 64 record-question pairs, which served as the reference standard. Uncertain records were retained for manual review. The full cascade was run independently five times. The primary outcomes were the reduction in records requiring manual screening and sensitivity against the reference standard. Results Across the five runs, a median of 420 of 904 records (46.5%) were automatically excluded from all eight questions, leaving a median of 484 records (53.5%) for review on at least one question. For individual questions, 40–272 records remained for manual screening. The cascade retained 60 of 64 reference standard record-question pairs in each run, yielding a sensitivity of 93.8% (95% confidence interval, 85.0%–97.5%). The four pairs not retained comprised two safety studies, one biomechanical study, and one systematic review mainly addressing knee osteoarthritis. Conclusions In chapter 4 of a completed hip osteoarthritis guideline, an LLM-assisted cascade reduced the number of records requiring manual title and abstract screening while retaining 60 of 64 selected pairs. Its applicability to other chapters and guidelines, and to evidence beyond direct intervention effectiveness studies, remains to be evaluated.
Purpose To evaluate the effects of different artificial bone pore architectures on early bone union after medial open-wedge high tibial osteotomy (OWHTO). Methods This retrospective historical control study included 25 patients (30 knees) with varus knee osteoarthritis, who underwent OWHTO using beta-tricalcium phosphate (β-TCP) bone substitutes between January 2019 and August 2024. Patients were allocated to the spherical porous or unidirectional porous (UD) β-TCP groups, according to the pore architecture of the implanted bone substitute. As UD β-TCP was introduced at our institution in December 2022, group allocation was determined based on the surgical period. Radiographic correction loss was evaluated based on the medial proximal tibial angle and the percentage of the mechanical axis. Coronal and sagittal computed tomography (CT) scans were performed to assess bone healing, including bone union rates and CT attenuation values. Result Correction was not lost in either group. Coronal CT revealed significant bone resorption and formation in the UD group. Sagittal CT showed a significantly higher rate of bone union in the UD group than in the spherical porous group (47.2% ± 18.2% vs. 28.5% ± 21.7%; p = 0.008). The CT attenuation values were also significantly lower in the UD group (1312.6 ± 241.0 vs. 1512.4 ± 144.9 Hounsfield units; p = 0.025). Conclusions As assessed on CT, artificial bone with a UD structure was associated with earlier bone healing after OWHTO, without correction loss.
Purpose Preoperative deep vein thrombosis (DVT) is a major concern in patients undergoing total knee arthroplasty (TKA) because existing thrombi may progress perioperatively, increasing the risk of venous thromboembolism. This study evaluated the prevalence of preoperative DVT and identified associated clinical and laboratory risk factors in patients scheduled for primary TKA. Methods This retrospective observational study included 565 consecutive patients undergoing primary TKA. Patients with a history of DVT or undergoing simultaneous bilateral TKA were excluded. All patients underwent preoperative duplex ultrasonography for DVT screening. Demographic characteristics, comorbidities, and laboratory findings were compared between patients with and without DVT. Variables that were significant in univariate analyses were entered into a multivariable logistic regression model. Receiver operating characteristic curve analyses were used to determine optimal cutoff values. Results Preoperative DVT was detected in 40 patients (7.1%). Compared with those without DVT, patients with DVT were significantly older, had lower body mass index (BMI), had a higher prevalence of rheumatoid arthritis (RA), had lower serum albumin levels, and had higher D-dimer levels. Multivariable analysis identified older age [odds ratio (OR), 1.066; p = 0.018], lower BMI (OR, 0.800; p < 0.001), RA (OR, 3.242; p = 0.014), and higher D-dimer levels (OR, 1.177; p = 0.049) as independent factors associated with preoperative DVT. Optimal cutoff values were 72.5 years for age, 22.8 kg/m2 for BMI, and 0.85 μg/mL for D-dimer. Conclusions Preoperative DVT was identified in 7.1% of patients undergoing TKA. Older age, lower BMI, RA, and elevated D-dimer levels were independently associated with DVT and may help identify patients who could benefit from targeted preoperative screening and risk stratification.
Purpose The Shenton line is a qualitative radiographic sign of superior femoral head subluxation in adult hip dysplasia, but binary assessment may miss subtle subluxation. This study aimed to quantify the Shenton line sign using Shenton line distance (SLD) and determine a reference interval-based threshold for SLD positivity. Methods We retrospectively reviewed 211 Crowe type I dysplastic hips and 143 control hips. SLD was defined as the vertical distance between the inferior femoral head-neck junction and the interteardrop line on supine anteroposterior pelvic radiographs. The upper limit of the nonparametric 95% reference interval in controls defined the threshold. Positive classification rates and observer agreement were compared with those of classic Shenton line breakage. Results Median SLD was higher in dysplastic hips than in controls (0.3 mm vs. −6.1 mm, p < 0.001) and increased stepwise from controls to borderline and frank dysplasia. The upper reference limit was 0.0 mm, defining SLD positivity as ≥0 mm. SLD ≥0 mm was present in 61% of dysplastic hips (39% borderline; 73% frank), compared with 25% for classic Shenton line breakage (11% borderline; 33% frank). SLD ≥0 mm had a higher positive classification rate (61% vs. 25%) and greater intra- and interobserver agreement than classic Shenton line breakage (κ = 0.93 and 0.89 vs. 0.71 and 0.66, respectively). Conclusions SLD provides a simple quantitative radiographic measure of superior femoral head subluxation in adult hip dysplasia. The reference interval-based threshold of SLD ≥0 mm may complement acetabular coverage measurements for assessing subtle superior subluxation.
Purpose Although the clinical presentation of hip dysplasia has changed over recent decades, long-term temporal trends in patients undergoing periacetabular osteotomy remain poorly characterized. This study aimed to determine temporal trends among patients undergoing transposition osteotomy of the acetabulum (TOA) at a single center in Japan. Methods We retrospectively reviewed patients with symptomatic hip dysplasia who underwent TOA from 1998 to 2023. Demographic variables and preoperative radiographic parameters, including the Tönnis osteoarthritis grade and lateral center-edge angle, were evaluated. Temporal trends were assessed using the Cochran–Armitage trend test for categorical variables and the Mann–Kendall trend test for continuous variables. Results Overall, 715 patients (958 hips) were included. No significant temporal trends were observed in age or sex distribution, whereas body mass index showed a modest increasing trend (p = 0.016). The proportion of hips with a history of treatment for congenital hip dislocation decreased over time (p < 0.001). Radiographically, the proportion of hips with Tönnis grade 0 increased, whereas the proportions with grades 1 and 2 decreased over the study period (p < 0.001). The lateral center-edge angle showed an increasing trend, indicating a reduction in severe dysplasia and an increase in mild and borderline dysplasia (p < 0.001). Conclusions Over 25 years, patients undergoing TOA at our institution shifted toward earlier-stage osteoarthritis and milder hip dysplasia. These trends may reflect changes in disease presentation, patient selection, and institutional practice. Recognizing these trends is essential for interpreting historical outcomes and refining contemporary patient selection and surgical strategy.
