Objective: The integration of large language models (LLMs) into orthopedic surgical decision-making represents a growing area of research. This study aimed to compare the surgical recommendation capabilities of ChatGPT-4.0, ChatGPT-4o, and ChatGPT-5 models in simulated cases of hallux valgus deformity. Methods: A total of 50 simulated cases were constructed using fundamental clinical data related to hallux valgus pathology and were individually submitted to 3 models. For each case, a surgical recommendation and a brief rationale were obtained. The responses were compared based on content alignment, adequacy of justification, and consistency with established surgical algorithms. Additionally, textual outputs were evaluated using DISCERN and multiple readability indices. Results: All 3 models demonstrated overall algorithmic consistency. However, the ChatGPT-5 model provided the most context-aware and clinically consistent recommendations, followed by ChatGPT-4o and ChatGPT-4.0. Concordance rates with surgical algorithms were 70% for ChatGPT-4.0, 82% for ChatGPT-4o, and 90% for ChatGPT-5. DISCERN scores were 51, 56, and 62, respectively. ChatGPT-5 also achieved superior performance across readability metrics, including Flesch Reading Ease Score, Simple Measure of Gobbledygook, and Gunning-Fog Index, indicating improved textual clarity and reduced complexity. Conclusion: The ChatGPT-5 model demonstrated the highest contextual accuracy, consistency, and readability in surgical decision support for hallux valgus surgery, highlighting the progressive improvements of newer LLMs. Nonetheless, ChatGPT-4.0 and ChatGPT-4o also exhibited compatibility with surgical algorithms, indicating potential utility in generating patient education and informational content. Cite this article as: Karadamar ÖL, Aydilek A. Evaluation of surgical recommendation algorithms in hallux valgus cases using ChatGPT models: an artificial intelligence approach based on 50 simulated scenarios. Acta Orthop Traumatol Turc. 2026; 60(2), 0580, doi: 10.5152/j.aott.2026.25580.

Objective:The aim of this study was to compare the results of patients who underwent biceps tenotomy or tenodesis alongside rotator cuff rupture repair (RCRR), as well as to assess its relationship with alterations in subacromial volume. The hypothesis was that patients undergoing biceps tenodesis would experience greater improvements in outcome scores 2 years after the surgery and larger subacromial volumes as the long head of the biceps tendon maintains its tension.Methods:This is a retrospective study including patients who underwent an RCRR concomitant with a biceps procedure (88 tenotomy and 63 tenodesis) with a minimum of 2 years of follow-up between January 2015 and December 2022.Results:Preoperative subacromial volumes of the tenotomy and tenodesis groups were 3.89 cm3 and 3.87 cm3, respectively, which were similar (P = .287). Postoperative subacromial volume was 4.29 cm3 in the tenotomy group and 4.51 cm3 in the tenodesis group (P = .000). Preoperative, postoperative first year and postoperative final follow-up Constant scores were 43.3, 83.1 and 84.8, respectively, in the tenotomy group and 43.7, 86.9 and 89.0, respectively, in the tenodesis group. A statistically significant difference was found between the 2 groups in terms of postoperative Constant scores (P = .000 for both parameters). Volume changes and Constant score changes were significantly correlated (P = .012 and r = 0.513). Although preoperative Visual Analog Scale scores were comparable between the tenodesis and tenotomy groups (P = .076), the tenodesis group demonstrated significantly lower pain scores at both the 1-year follow-up and final evaluation (P = .002 and P = .007, respectively).Conclusion:In this study, biceps tenodesis was superior to tenotomy in terms of outcome scores. The results also revealed that subacromial volume increases significantly following biceps tenodesis compared to biceps tenotomy and has a moderate relationship with postoperative Constant scores, unlike Visual Analog Scale score.Level of Evidence:Level III, Therapeutic study.

Objective:The purpose of this study was to define the prevalence of os acromiale on magnetic resonance imaging (MRI) in patients presenting with shoulder pain, to document how often it coexists with rotator cuff tears, and to assess whether focused review detects this variant more reliably than routine radiology reporting.Methods:A retrospective review was conducted on 3697 shoulder MRI examinations obtained between 2020 and 2025 at a tertiary referral center. All studies were independently evaluated by 2 fellowship-trained shoulder surgeons and 1 musculoskeletal radiologist, focusing specifically on the presence, subtype, and coexistence of os acromiale with rotator cuff pathology. Interobserver reliability was assessed using Cohen’s kappa coefficient, and findings were compared with the original radiology reports.Results:Os acromiale was identified in 26 cases, corresponding to a prevalence of 0.7%. Only 11 cases were mentioned in the original radiology reports. Interobserver agreement between shoulder surgeons was almost perfect (κ = 0.98) and excellent between surgeons and the radiologist (κ = 0.92). Subtypes included 12 preacromion, 13 mesoacromion, and 1 metaacromion. Rotator cuff tears were present in 20 of 26 patients with os acromiale (77%), including isolated supraspinatus tears (n = 9), combined supraspinatus–infraspinatus tears (n = 4), supraspinatus–subscapularis tears (n = 3), massive tears (n = 2), and cuff tear arthropathy (n = 2).Conclusion:Os acromiale was uncommon in this MRI-based cohort but frequently coexisted with full-thickness rotator cuff tears. Although causality cannot be inferred, this coexistence may carry clinical relevance. Notably, focused evaluation documented more cases than routine radiology reports, underscoring the added value of targeted assessment.Level of Evidence:Level IV, Diagnostic study.

Objective:This study aimed to clarify the contribution of psychological factors to pain adjustment in patients with Achilles tendinopathy. It specifically investigated the associations of psychological inflexibility, distress, and resilience with pain catastrophizing, and their indirect associations between pain intensity and pain disability.Methods:A total of 120 participants (65% female; mean age = 49.17 years, SD = 12.06) completed validated measures of visual analog scales for pain level, psychological distress, psychological inflexibility, resilience, pain disability index, and pain catastrophizing. Hierarchical regressions identified correlates of pain catastrophizing. Bootstrapped mediation analyses (5000 samples) tested indirect effects of psychological variables on the pain intensity–disability relationship.Results:Pain catastrophizing was most strongly associated with psychological inflexibility (β = 0.413, P < .001) and distress (β = 0.284, P < .001); resilience also showed a significant inverse association (β = −0.181, P = .021). Pain intensity had a weaker yet significant association with catastrophizing in both final steps. Mediation models revealed an indirect-only pattern of association between pain intensity and disability through both pain catastrophizing and psychological inflexibility, as the direct effects were not statistically significant (c′ = 0.044, 95% CI [−0.092, 0.180]; 0.143, 95% CI [−0.014, 0.301], respectively). Resilience partially mediated this relationship (c’ = 0.207, 95% CI [0.044, 0.370]), while distress was not a significant mediator.Conclusion:Psychological processes, particularly catastrophizing and inflexibility, are strongly associated with the extent to which pain is linked to disability. These findings support the integration of psychological assessment into routine musculoskeletal rehabilitation in orthopedic practice. Addressing emotional processes and promoting psychological flexibility may improve treatment outcomes and prevent long-term disability.Level of Evidence:Level III, cross-sectional study.

Cite this article as: Yalçınkaya M, Akan K et al. Raising the bar: the EBOT-TK Turkish Oral Exam milestone and AOTT’s commitment to orthopaedic education. Acta Orthop Traumatol Turc., 2025;59(6):334-336.

Objective:Cerebral palsy (CP) is a prevalent neurological disorder affecting 2-3 per 1000 live births globally. A common orthopedic consequence in CP is hip dislocation, with an incidence ranging from 15% to 30%. This study aimed to assess physiotherapists’ (PTs) awareness and knowledge of hip dislocation in CP and identify knowledge gaps in this field.Methods:A cross-sectional survey was administered to PT working in healthcare institutions across Türkiye. The online anonymous survey, hosted on Google Forms, received responses from 128 PTs. It included questions related to the diagnosis, treatment approaches, and clinical experience concerning hip dislocation/subluxation. The survey consisted of 3 types of questions: demographic questions, yes/no knowledge questions, and opinion-suggestion questions.Results: The majority of PTs participating in this study work with pediatric patients. Physiotherapists had basic knowledge about hip dislocation although we observed significant gaps in areas related to routine screening programs and advanced treatment modalities. PTs incorrectly answered 3 out of 8 knowledge-based questions. The majority emphasized the importance of early diagnosis and treatment and expressed a need for more education and awareness programs.Conclusion:Physiotherapist provided important opinion-suggestion insights. The findings indicate a need for improved education and training for PT concerning hip dislocation in children with CP. We believe that the most appropriate screening method for Türkiye is to establish a screening program with a multidisciplinary structure formed between pediatric orthopedists, physical medicine and rehabilitation specialists (PM&R), PT, and family physicians (FPs).Level of Evidence: N/A

Objective:This study aimed to evaluate the association between preoperative anticoagulant use and time to surgery, hospital length of stay, and 30-day postoperative complications in elderly patients with proximal femur fractures.Methods:This study included 572 patients with low-energy proximal femur fractures who required surgical treatment. Patients were categorized into two groups based on anticoagulation therapy use. The following data was collected and compered between the groups: time from hospitalization to surgery, hospital length of stay, percent changes in hemoglobin and other post-operative complications: death, cardiac complications, sepsis, deep venous thrombosis, pneumonia, urinary tract infection, surgical site infection, pressure ulcers, acute kidney injury and delirium. Multivariate regression analysis was performed to analyze possible confounders.Results:The median age of study participants was 83 years. 78.2% being female. Anticoagulation therapy was used by 19.9% of patients, predominantly non-vitamin K oral anticoagulants. Patients receiving anticoagulants experienced significantly longer hospital stays (median 9 vs. 7 days; P < .05) and surgical delays (median 3 vs. 2 days; P < .0001) compared to those without anticoagulation. Complication rates and hemoglobin level changes did not differ significantly among the groups (P > .05). Multivariate analysis identified age, time to surgery, and hospital length of stay as independent predictors of 30-day postoperative complications, with age and hospital stay also significantly associated with 30-day mortality.Conclusion:Anticoagulation therapy did not directly increase 30-day postoperative complications or mortality but was associated with surgical delays and prolonged hospital stays, which negatively impacted outcomes. Delayed surgery and extended hospitalization emerged as key risk factors. These findings underscore the clinical importance of minimizing surgical delays in anticoagulated patients to improve postoperative outcomes.Level of Evidence: Level II, Prognostic study.

Objective:To evaluate the accuracy, applicability, comprehensiveness, and communication quality of responses generated by ChatGPT and Google Gemini in adolescent idiopathic scoliosis (AIS)-related scenarios, with the aim of assessing their potential utility as tools in patient management.Methods:Six case-based questions reflecting common patient concerns related to adolescent idiopathic scoliosis were developed by orthopedic specialists. Responses generated by ChatGPT and Google Gemini were independently evaluated by 61 orthopedic surgeons using a standardized rubric assessing accuracy, applicability, comprehensiveness, and communication clarity, each rated on a 1-5 Likert scale. Comparative analyses between platforms were performed using the Mann-Whitney U and Wilcoxon signed-rank tests. Additionally, open-ended feedback was collected to explore participants’ perspectives on the potential and limitations of AI-based consultations.Results:ChatGPT outperformed Google Gemini in terms of accuracy (P = .013) in postoperative care scenarios. The results for applicability (P = .119), comprehensiveness (P = .619), and communication (P = .240) were not statistically significant. Orthopedic specialists rated both AI models significantly higher than residents in accuracy, applicability, and comprehensiveness. Most evaluators acknowledged the potential of AI to reduce physician workload and support patient guidance; however, concerns were raised regarding reliability, ethical implications, and the current limitations of AI in ensuring patient safety. Conclusion:ChatGPT and Google Gemini demonstrated moderate accuracy and communication quality in adolescent idiopathic scoliosis–related scenarios, with ChatGPT showing a modest advantage. Although both models show promising results as supportive tools for patient education and preliminary consultations, their current limitations in accuracy and comprehensiveness restrict their clinical reliability. Multidisciplinary collaboration is crucial to ensure effective applications of AI in orthopedic practice.Level of Evidence:Level III, Diagnostic Study.

Objective:This study aimed to evaluate the clinical outcomes of preserving and repairing the bursal tissue—rather than excising it—during total hip arthroplasty (THA), and to assess the additional effect of administering a steroid injection into the repaired bursa.Methods:Patients who underwent total hip arthroplasty (THA) via a posterior approach were retrospectively reviewed and divided into three groups based on the intraoperative bursal tissue management technique. The first group (PB) included patients who received an intraoperative injection of corticosteroid (40 mg methylprednisolone) and local anesthetic (bupivacaine 5 mg/mL) into the preserved bursa. The second group (BR) consisted of patients who underwent bursal repair without injection. The third group (BE) comprised patients who underwent total excision of the bursa. Clinical outcomes were assessed using the Harris Hip Score (HHS), the Visual Analogue Scale (VAS) for pain during daily activities, and VAS for pain while lying on the ipsilateral hip at 6 and 24 months postoperatively. Results:A total of 41 patients (27 females, 14 males) who underwent THA were included in the study. No statistically significant differences were observed between the groups in lateral trochanteric VAS scores during daily activities at both 6 and 24 months postoperatively (P > .05). However, a significant difference was found in VAS scores assessed while lying on the operated side at 6 months, favoring the PB group (P < .001). Additionally, Harris Hip Score (HHS) values were significantly higher in the PB group compared to the other groups at both 6 months (P < .001) and 24 months (P = .006).Conclusion:Intraoperative corticosteroid and local anesthetic injection, in addition to bursa repair, may improve early postoperative outcomes and pain relief in patients undergoing THA using the posterior approach, without increasing infection risk.Level of Evidence:Level IV, Therapeutic Study.

Objective:This study aimed to identify the factors influencing the decisions of orthopedic and plastic surgery residents in Türkiye regarding their pursuit of a subspecialty in hand surgery, as well as to evaluate the challenges faced during hand surgery training.Methods:A national survey was conducted among residents in orthopedic and trauma surgery (n = 92), plastic surgery (n = 84), and hand surgery (n = 12). The survey, developed from literature reviews and previous studies, was distributed online, and responses were collected via Google Forms. Orthopedic and plastic surgery residents responded using a 4-point Likert scale, while hand surgery residents answered multiple-choice questions. The collected data were analyzed to determine factors influencing career choices, training adequacy, and the challenges faced by residents.Results:The analysis revealed a negative correlation between the high volume of emergency hand surgery cases and residents’ inclination toward the subspecialty (r = −0.217, P < .05). Theoretical training was significantly linked to enhanced hand surgery knowledge and skills (r = 0.213, P < .05), whereas the lack of adequate training infrastructure negatively affected residents’ experience (r = 0.390, P < .05). Financial concerns and heavy workloads were identified as major challenges, with 33.3% of hand surgery subspecialty residents considering quitting their program. The study also highlighted a lack of continuity in training, insufficient exposure to elective hand surgery cases, and limited access to international educational opportunities.Conclusion:The findings indicate a need to enhance both the theoretical and practical aspects of hand surgery training in Türkiye. By addressing financial and workload-related concerns, improving clinical exposure, and expanding access to microsurgical tools and training resources, it may be possible to increase interest in the subspecialty and ensure a sustainable workforce of hand surgeons in the future.Level of Evidence:N/A.