Erdem Aras Sezgin

Joint Diseases and Related Surgery (JDRS), the official journal of the Turkish Joint Diseases Foundation, is an international, peer-reviewed, immediate open access journal. All published articles in JDRS has been free for everyone, without embargo, since 1990.

Joint Diseases and Related Surgery (JDRS), the official journal of the Turkish Joint Diseases Foundation, is an international, peer-reviewed, immediate open access journal. All published articles in JDRS has been free for everyone, without embargo, since 1990.

Purpose: To assess whether large language models (LLMs) with advanced reasoning and live web search (LWS) provide recommendations concordant with evidence‐based clinical practice guidelines (CPGs) developed by the American Academy of Orthopaedic Surgeons (AAOS) for anterior cruciate ligament (ACL) and rotator cuff (RC) injury management. Methods: Recommendations from CPGs were extracted and developed into a total of 46 questions ( n = 15 for ACL, n = 31 for RC). Four configurations were evaluated: GPT‐5 Thinking, GPT‐5 Thinking Deep Research, Gemini 2.5 Pro, Gemini 2.5 Pro Deep Research. Concordance with CPGs, the primary endpoint, was independently evaluated by two orthopaedic surgeons. Citation integrity, the secondary endpoint, was evaluated against four criteria: 1—relevance, ensuring the citation was congruent with the response; 2—accuracy, confirming the citation metadata were correct; 3—existence, to rule out hallucinations; and 4—source quality, ensuring the cited source is from a peer‐reviewed journal. Blinding was performed by a third investigator, by anonymously randomising the order of LLM‐generated responses for each CPG recommendation. Results: All LLMs answered ACL questions concordantly (100% [15/15]; 95% confidence interval [CI]: 78.2%–100%). For RC questions, GPT‐5 Thinking and Gemini 2.5 Pro Deep Research each had one discordant answer (96.8% [30/31]; 95% CI: 83.3%–99.9%), whereas the other two configurations were fully concordant (100% [31/31]; 95% CI: 88.7%–100%). GPT‐5 Thinking achieved 96.8% (231/239; 95% CI: 93.6%–98.6%) citation integrity, improving to 100% (176/176; 95% CI: 97.9%–100%) with Deep Research. Gemini 2.5 Pro showed substantially lower baseline performance (64.6% [173/268]; 95% CI: 58.5%–70.3%) but improved to 98.6% (274/278; 95% CI: 96.4%–99.6%) with Deep Research. Inter‐rater agreement was perfect ( κ = 1.0) across all domains, except for citation relevance, which maintained strong agreement ( κ = 0.88). Conclusions: Contemporary LLMs with agentic capabilities can deliver clinically aligned answers concordant with CPGs on ACL and RC injuries, recovering from previous hallucinations. Built‐in LWS functions are particularly helpful in ensuring citation reliability. Although expert oversight remains imperative, Deep Research allows LLMs to be considered as a first‐pass clinical reasoning companion. Level of Evidence: NA.

Purpose: To compare the accuracy, readability and patient‐centeredness of responses generated by standard ChatGPT‐4o and its retrieval‐augmented ‘deep research’ mode for hip arthroscopy education, addressing the current uncertainty about the reliability of large language models in orthopaedic patient information. Methods: Thirty standardised patient questions were derived through structured searches of reputable orthopaedic health information websites. Both ChatGPT configurations independently generated responses. Two fellowship‐trained orthopaedic surgeons assessed each response independently, using 5‐point Likert scales (1 = poor, 5 = excellent) for accuracy, clarity, comprehensiveness and readability. Intra‐ and interrater reliabilities were calculated, and readability metrics were also evaluated using Flesch‐Kincaid Grade Level (FKGL) and Flesch Reading Ease Score (FRES). Results: Deep Research outperformed the standard model in accuracy (4.7 ± 0.4 vs. 4.0 ± 0.5; p = 0.012) and comprehensiveness (4.8 ± 0.3 vs. 3.9 ± 0.6; p < 0.001). The standard model performed better in clarity (4.6 ± 0.4 vs. 4.4 ± 0.5; p = 0.048). Readability Likert scores were comparable ( p = 0.729), but FKGL and FRES favoured the standard model (both p < 0.001). Interrater intraclass correlation coefficients (ICC) ranged from 0.57 to 0.83; intrarater ICCs from 0.63 to 0.79. Conclusion: Deep research provides superior scientific rigour, whereas the standard model offers better readability. A hybrid approach combining model strengths may maximise educational effectiveness, though clinical oversight remains essential to mitigate misinformation risks. The observed differences were modest in magnitude, aligning with previously reported accuracy–readability trade‐offs in LLMs. These results should be interpreted as exploratory and hypothesis‐generating. Level of Evidence: Level IV, cross‐sectional, comparative simulation study.

Purpose Management of blood transfusion in the peri-operative period of joint arthroplasties is often difficult and although associated risk factors and practice trends help ease this process, for shoulder arthroplasty, these aspects have not been explored as widely as other procedures. The purposes of the current study were to identify the incidence, risk factors and trends of blood transfusion in shoulder arthroplasty patients over a 25-year period in a single, high-volume centre. Methods We retrospectively reviewed all patients undergoing hemi-, total and reverse shoulder arthroplasties, including revision procedures, between 1997 and 2021. Overall rate of blood transfusion, procedure and patient related risk factors, and transfusion trends over time were evaluated. Results A total of 3,168 patients were included in the analysis and overall rate of blood transfusion was 1.8%. Multivariate analysis revealed revision procedure (p < 0.001), prior revision (p = 0.035), regional anaesthesia (p = 0.004), history of hypertension (p = 0.043), history of myocardial infarction (p = 0.004), history of renal insufficiency (p = 0.045), and alcohol abuse (p = 0.033) were independent risk factors for transfusion. Although transfusion rates were observed to be increased after 2007, from 0.6 to 0.8 to over 2%, this trend did not demonstrate statistical significance. Conclusion Revision procedures and regional anaesthesia as well as hypertension, myocardial infarction, renal insufficiency and alcohol abuse can be regarded as independent risk factors for blood transfusion in shoulder arthroplasty. It is imperative to implement advanced blood conservation protocols for patients with these risk factors.

Joint Diseases and Related Surgery (JDRS), the official journal of the Turkish Joint Diseases Foundation, is an international, peer-reviewed, immediate open access journal. All published articles in JDRS has been free for everyone, without embargo, since 1990.

Joint Diseases and Related Surgery (JDRS), the official journal of the Turkish Joint Diseases Foundation, is an international, peer-reviewed, immediate open access journal. All published articles in JDRS has been free for everyone, without embargo, since 1990.