Download PDF
J Knee Surg
DOI: 10.1055/s-0044-1782233
Original Article

Can ChatGPT Answer Patient Questions Regarding Total Knee Arthroplasty?

Aleksander P. Mika 
1   Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
,
Hillary E. Mulvey
1   Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
,
Stephen M. Engstrom
1   Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
,
Gregory G. Polkowski
1   Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
,
J. Ryan Martin
1   Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
,
Jacob M. Wilson
1   Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
› Author Affiliations Funding None.
› Further Information
    Permissions and Reprints

Abstract

The internet has introduced many resources frequently accessed by patients prior to orthopaedic visits. Recently, Chat Generative Pre-Trained Transformer, an artificial intelligence-based chat application, has become publicly and freely available. The interface uses deep learning technology to mimic human interaction and provide convincing answers to questions posed by users. With its rapidly expanding usership, it is reasonable to assume that patients will soon use this technology for preoperative education. Therefore, we sought to determine the accuracy of answers to frequently asked questions (FAQs) pertaining to total knee arthroplasty (TKA).

Ten FAQs were posed to the chatbot during a single online interaction with no follow-up questions or repetition. All 10 FAQs were analyzed for accuracy using an evidence-based approach. Answers were then rated as “excellent response not requiring clarification,” “satisfactory requiring minimal clarification,” satisfactory requiring moderate clarification,” or “unsatisfactory requiring substantial clarification.”

Of the 10 answers given by the chatbot, none received an “unsatisfactory” rating with the majority either requiring minimal (5) or moderate (4) clarification. While many answers required nuanced clarification, overall, answers tended to be unbiased and evidence-based, even when presented with controversial subjects.

The chatbot does an excellent job of providing basic, evidence-based answers to patient FAQs prior to TKA. These data were presented in a manner that will be easily comprehendible by most patients and may serve as a useful clinical adjunct in the future.

Keywords

artificial intelligence - machine learning - total knee arthroplasty - frequently asked questions - AI

Note

The study's investigation was performed at Vanderbilt University Medical Center, Nashville, TN.


IRB Statement

This study was exempted from the IRB approval process.




Publication History

Received: 14 December 2023

Accepted: 08 February 2024

Article published online:
05 March 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Open AI. Accessed January 1, 2023, Available at: https://openai.com/blog/chatgpt/
  • 2 Cocco AM, Zordan R, Taylor DM. et al. Dr Google in the ED: searching for online health information by adult emergency department patients. Med J Aust 2018; 209 (08) 342-347
    Google Scholar
  • 3 Van Riel N, Auwerx K, Debbaut P, Van Hees S, Schoenmakers B. The effect of Dr Google on doctor-patient encounters in primary care: a quantitative, observational, cross-sectional study. BJGP Open 2017; 1 (02) bjgpopen17-X100833
    Google Scholar
  • 4 Mika AP, Martin JR, Engstrom SM, Polkowski GG, Wilson JM. Assessing ChatGPT responses to common patient questions regarding total hip arthroplasty. J Bone Joint Surg Am 2023; 105 (19) 1519-1526
    Google Scholar
  • 5 Brophy RH, Fillingham YA. AAOS Clinical Practice Guideline Summary: Management of Osteoarthritis of the Knee (Nonarthroplasty), Third Edition. J Am Acad Orthop Surg 2022; 30 (09) e721-e729
    Google Scholar
  • 6 Marsland D, Mumith A, Barlow IW. Systematic review: the safety of intra-articular corticosteroid injection prior to total knee arthroplasty. Knee 2014; 21 (01) 6-11
    Google Scholar
  • 7 Wilson HA, Middleton R, Abram SGF. et al. Patient relevant outcomes of unicompartmental versus total knee replacement: systematic review and meta-analysis. BMJ 2019; 364: l352
    Google Scholar
  • 8 Zuiderbaan HA, van der List JP, Khamaisy S. et al. Unicompartmental knee arthroplasty versus total knee arthroplasty: which type of artificial joint do patients forget?. Knee Surg Sports Traumatol Arthrosc 2017; 25 (03) 681-686
    Google Scholar
  • 9 Jensen CB, Petersen PB, Jørgensen CC, Kehlet H, Troelsen A, Gromov K. Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement Collaborative Group. Length of stay and 90-day readmission/complication rates in unicompartmental versus total knee arthroplasty: a propensity-score-matched study of 10,494 procedures performed in a fast-track setup. J Bone Joint Surg Am 2021; 103 (12) 1063-1071
    Google Scholar
  • 10 Mohammad HR, Judge A, Murray DW. A matched comparison of the patient-reported outcome measures of 38,716 total and unicompartmental knee replacements: an analysis of linked data from the National Joint Registry of England, Northern Ireland and Isle of Man and England's National PROM Collection Programme. Acta Orthop 2021; 92 (06) 701-708
    Google Scholar
  • 11 Hunt LP, Blom AW, Matharu GS. et al. Patients receiving a primary unicompartmental knee replacement have a higher risk of revision but a lower risk of mortality than predicted had they received a total knee replacement: data from the National Joint Registry for England, Wales, Northern Ireland, and the Isle of Man. J Arthroplasty 2021; 36 (02) 471-477.e6
    Google Scholar
  • 12 Mohammad HR, Liddle AD, Judge A, Murray DW. A matched comparison of long-term outcomes of total and unicompartmental knee replacements in different ages based on national databases: analysis of data from the National Joint Registry for England, Wales, Northern Ireland, and the Isle of Man. J Arthroplasty 2022; 37 (02) 243-251
    Google Scholar
  • 13 Zhang J, Ndou WS, Ng N. et al. Robotic-arm assisted total knee arthroplasty is associated with improved accuracy and patient reported outcomes: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2022; 30 (08) 2677-2695
    Google Scholar
  • 14 Chin BZ, Tan SSH, Chua KCX, Budiono GR, Syn NL, O'Neill GK. Robot-assisted versus conventional total and unicompartmental knee arthroplasty: a meta-analysis of radiological and functional outcomes. J Knee Surg 2021; 34 (10) 1064-1075
    Google Scholar
  • 15 Kayani B, Konan S, Huq SS, Tahmassebi J, Haddad FS. Robotic-arm assisted total knee arthroplasty has a learning curve of seven cases for integration into the surgical workflow but no learning curve effect for accuracy of implant positioning. Knee Surg Sports Traumatol Arthrosc 2019; 27 (04) 1132-1141
    Google Scholar
  • 16 Marchand KB, Ehiorobo J, Mathew KK, Marchand RC, Mont MA. Learning curve of robotic-assisted total knee arthroplasty for a high-volume surgeon. J Knee Surg 2022; 35 (04) 409-415
    Google Scholar
  • 17 Naziri Q, Cusson BC, Chaudhri M, Shah NV, Sastry A. Making the transition from traditional to robotic-arm assisted TKA: what to expect? A single-surgeon comparative-analysis of the first-40 consecutive cases. J Orthop 2019; 16 (04) 364-368
    Google Scholar
  • 18 Sodhi N, Khlopas A, Piuzzi NS. et al. The learning curve associated with robotic total knee arthroplasty. J Knee Surg 2018; 31 (01) 17-21
    Google Scholar
  • 19 Kort N, Stirling P, Pilot P, Müller JH. Robot-assisted knee arthroplasty improves component positioning and alignment, but results are inconclusive on whether it improves clinical scores or reduces complications and revisions: a systematic overview of meta-analyses. Knee Surg Sports Traumatol Arthrosc 2022; 30 (08) 2639-2653
    Google Scholar
  • 20 Meneghini R, Gibson W, Halsey D, Padgett D, Berend K, Della Valle CJ. The American Association of Hip and Knee Surgeons, Hip Society, Knee Society, and American Academy of Orthopaedic Surgeons Position Statement on Outpatient Joint Replacement. J Arthroplasty 2018; 33 (12) 3599-3601
    Google Scholar
  • 21 Adelani MA, Barrack RL. Patient perceptions of the safety of outpatient total knee arthroplasty. J Arthroplasty 2019; 34 (03) 462-464
    Google Scholar
  • 22 Lovecchio F, Alvi H, Sahota S, Beal M, Manning D. Is outpatient arthroplasty as safe as fast-track inpatient arthroplasty? A propensity score matched analysis. J Arthroplasty 2016; 31 (9 Suppl) 197-201
    Google Scholar
  • 23 Keulen MHF, Schotanus MGM, van Haaren EH, van Hemert WLW, Heyligers IC, Boonen B. Rates and causes of 90-day complications and readmissions following outpatient hip and knee arthroplasty: a retrospective analysis of 525 patients in a single institution. J Arthroplasty 2021; 36 (03) 863-878
    Google Scholar
  • 24 Lan RH, Samuel LT, Grits D, Kamath AF. Contemporary outpatient arthroplasty is safe compared with inpatient surgery: a propensity score-matched analysis of 574,375 procedures. J Bone Joint Surg Am 2021; 103 (07) 593-600
    Google Scholar
  • 25 Bemelmans YFL, Keulen MHF, Heymans M, van Haaren EH, Boonen B, Schotanus MGM. Safety and efficacy of outpatient hip and knee arthroplasty: a systematic review with meta-analysis. Arch Orthop Trauma Surg 2022; 142 (08) 1775-1791
    Google Scholar
  • 26 Moore MG, Brigati DP, Crijns TJ, Vetter TR, Schultz WR, Bozic KJ. Enhanced selection of candidates for same-day and outpatient total knee arthroplasty. J Arthroplasty 2020; 35 (03) 628-632
    Google Scholar
  • 27 Sher A, Keswani A, Yao DH, Anderson M, Koenig K, Moucha CS. Predictors of same-day discharge in primary total joint arthroplasty patients and risk factors for post-discharge complications. J Arthroplasty 2017; 32 (9S): S150-S156 , 156.e1
    Google Scholar
  • 28 Courtney PM, Boniello AJ, Berger RA. Complications following outpatient total joint arthroplasty: an analysis of a national database. J Arthroplasty 2017; 32 (05) 1426-1430
    Google Scholar
  • 29 Meneghini RM, Ziemba-Davis M, Ishmael MK, Kuzma AL, Caccavallo P. Safe selection of outpatient joint arthroplasty patients with medical risk stratification: the “Outpatient Arthroplasty Risk Assessment Score”. J Arthroplasty 2017; 32 (08) 2325-2331
    Google Scholar
  • 30 Ziemba-Davis M, Caccavallo P, Meneghini RM. Outpatient Joint Arthroplasty-Patient Selection: Update on the Outpatient Arthroplasty Risk Assessment Score. J Arthroplasty 2019; 34 (7S): S40-S43
    Google Scholar
  • 31 Lopez CD, Ding J, Trofa DP, Cooper HJ, Geller JA, Hickernell TR. Machine learning model developed to aid in patient selection for outpatient total joint arthroplasty. Arthroplast Today 2021; 13: 13-23
    Google Scholar
  • 32 Wyles CC, Hevesi M, Osmon DR. et al. 2019 John Charnley Award: Increased risk of prosthetic joint infection following primary total knee and hip arthroplasty with the use of alternative antibiotics to cefazolin: the value of allergy testing for antibiotic prophylaxis. Bone Joint J 2019; 101-B (6_Supple_B): 9-15
    Google Scholar
  • 33 Bohl DD, Ondeck NT, Darrith B, Hannon CP, Fillingham YA, Della Valle CJ. Impact of operative time on adverse events following primary total joint arthroplasty. J Arthroplasty 2018; 33 (07) 2256-2262.e4
    Google Scholar
  • 34 Yang Z, Liu H, Xie X, Tan Z, Qin T, Kang P. The influence of diabetes mellitus on the post-operative outcome of elective primary total knee replacement: a systematic review and meta-analysis. Bone Joint J 2014; 96-B (12) 1637-1643
    Google Scholar
  • 35 Owen AR, Amundson AW, Larson DR. et al. Spinal versus general anaesthesia in contemporary primary total knee arthroplasties. Bone Joint J 2022; 104-B (11) 1209-1214
    Google Scholar
  • 36 Traven SA, Reeves RA, Sekar MG, Slone HS, Walton ZJ. New 5-Factor Modified Frailty Index predicts morbidity and mortality in primary hip and knee arthroplasty. J Arthroplasty 2019; 34 (01) 140-144
    Google Scholar
  • 37 Pulido L, Ghanem E, Joshi A, Purtill JJ, Parvizi J. Periprosthetic joint infection: the incidence, timing, and predisposing factors. Clin Orthop Relat Res 2008; 466 (07) 1710-1715
    Google Scholar
  • 38 Inabathula A, Dilley JE, Ziemba-Davis M. et al. Extended oral antibiotic prophylaxis in high-risk patients substantially reduces primary total hip and knee arthroplasty 90-day infection rate. J Bone Joint Surg Am 2018; 100 (24) 2103-2109
    Google Scholar
  • 39 Kheir MM, Dilley JE, Ziemba-Davis M, Meneghini RM. The AAHKS Clinical Research Award: extended oral antibiotics prevent periprosthetic joint infection in high-risk cases: 3855 patients with 1-year follow-up. J Arthroplasty 2021; 36 (7S): S18-S25
    Google Scholar
  • 40 Iannotti F, Prati P, Fidanza A. et al. Prevention of periprosthetic joint infection (PJI): a clinical practice protocol in high-risk patients. Trop Med Infect Dis 2020; 5 (04) 186
    Google Scholar
  • 41 Goodman SM, Springer BD, Chen AF. et al. 2022 American College of Rheumatology/American Association of Hip and Knee Surgeons Guideline for the perioperative management of antirheumatic medication in patients with rheumatic diseases undergoing elective total hip or total knee arthroplasty. Arthritis Care Res (Hoboken) 2022; 74 (09) 1399-1408
    Google Scholar
  • 42 Kong L, Cao J, Zhang Y, Ding W, Shen Y. Risk factors for periprosthetic joint infection following primary total hip or knee arthroplasty: a meta-analysis. Int Wound J 2017; 14 (03) 529-536
    Google Scholar
  • 43 Lizaur-Utrilla A, Martinez-Mendez D, Collados-Maestre I, Marco-Gómez L, Lopez-Prats FA. Elective total knee arthroplasty in patients with end-stage renal disease: is it a safe procedure?. J Arthroplasty 2016; 31 (10) 2152-2155
    Google Scholar
  • 44 Gu A, Malahias MA, Strigelli V, Nocon AA, Sculco TP, Sculco PK. Preoperative malnutrition negatively correlates with postoperative wound complications and infection after total joint arthroplasty: a systematic review and meta-analysis. J Arthroplasty 2019; 34 (05) 1013-1024
    Google Scholar
  • 45 Lin CA, Kuo AC, Takemoto S. Comorbidities and perioperative complications in HIV-positive patients undergoing primary total hip and knee arthroplasty. J Bone Joint Surg Am 2013; 95 (11) 1028-1036
    Google Scholar
  • 46 Kapadia BH, Johnson AJ, Daley JA, Issa K, Mont MA. Pre-admission cutaneous chlorhexidine preparation reduces surgical site infections in total hip arthroplasty. J Arthroplasty 2013; 28 (03) 490-493
    Google Scholar
  • 47 Shohat N, Parvizi J. Prevention of periprosthetic joint infection: examining the recent guidelines. J Arthroplasty 2017; 32 (07) 2040-2046
    Google Scholar
  • 48 Rao N, Cannella B, Crossett LS, Yates Jr AJ, McGough III R. A preoperative decolonization protocol for staphylococcus aureus prevents orthopaedic infections. Clin Orthop Relat Res 2008; 466 (06) 1343-1348
    Google Scholar
  • 49 Kowalski TJ, Kothari SN, Mathiason MA, Borgert AJ. Impact of hair removal on surgical site infection rates: a prospective randomized noninferiority trial. J Am Coll Surg 2016; 223 (05) 704-711
    Google Scholar
  • 50 Daines BK, Dennis DA, Amann S. Infection prevention in total knee arthroplasty. J Am Acad Orthop Surg 2015; 23 (06) 356-364
    Google Scholar
  • 51 Canovas F, Dagneaux L. Quality of life after total knee arthroplasty. Orthop Traumatol Surg Res 2018; 104 (1S): S41-S46
    Google Scholar
  • 52 Gunaratne R, Pratt DN, Banda J, Fick DP, Khan RJK, Robertson BW. Patient dissatisfaction following total knee arthroplasty: a systematic review of the literature. J Arthroplasty 2017; 32 (12) 3854-3860
    Google Scholar
  • 53 Kuperman EF, Schweizer M, Joy P, Gu X, Fang MM. The effects of advanced age on primary total knee arthroplasty: a meta-analysis and systematic review. BMC Geriatr 2016; 16: 41
    Google Scholar
  • 54 Maempel JF, Riddoch F, Calleja N, Brenkel IJ. Longer hospital stay, more complications, and increased mortality but substantially improved function after knee replacement in older patients. Acta Orthop 2015; 86 (04) 451-456
    Google Scholar
  • 55 Klit J, Jacobsen S, Rosenlund S, Sonne-Holm S, Troelsen A. Total knee arthroplasty in younger patients evaluated by alternative outcome measures. J Arthroplasty 2014; 29 (05) 912-917
    Google Scholar
  • 56 Cherian JJ, O'Connor MI, Robinson K, Jauregui JJ, Adleberg J, Mont MA. A prospective, longitudinal study of outcomes following total knee arthroplasty stratified by gender. J Arthroplasty 2015; 30 (08) 1372-1377
    Google Scholar
  • 57 Parratte S, Pesenti S, Argenson JN. Obesity in orthopedics and trauma surgery. Orthop Traumatol Surg Res 2014; 100 (1 Suppl) S91-S97
    Google Scholar
  • 58 Goodman SM, Johnson B, Zhang M. et al. Patients with rheumatoid arthritis have similar excellent outcomes after total knee replacement compared with patients with osteoarthritis. J Rheumatol 2016; 43 (01) 46-53
    Google Scholar
  • 59 Stone OD, Duckworth AD, Curran DP, Ballantyne JA, Brenkel IJ. Severe arthritis predicts greater improvements in function following total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2017; 25 (08) 2573-2579
    Google Scholar
  • 60 Katz JN, Barrett J, Mahomed NN, Baron JA, Wright RJ, Losina E. Association between hospital and surgeon procedure volume and the outcomes of total knee replacement. J Bone Joint Surg Am 2004; 86 (09) 1909-1916
    Google Scholar
  • 61 Katz JN, Mahomed NN, Baron JA. et al. Association of hospital and surgeon procedure volume with patient-centered outcomes of total knee replacement in a population-based cohort of patients age 65 years and older. Arthritis Rheum 2007; 56 (02) 568-574
    Google Scholar
  • 62 Lau RL, Perruccio AV, Gandhi R, Mahomed NN. The role of surgeon volume on patient outcome in total knee arthroplasty: a systematic review of the literature. BMC Musculoskelet Disord 2012; 13: 250
    Google Scholar
  • 63 Abdel MP, Morrey ME, Jensen MR, Morrey BF. Increased long-term survival of posterior cruciate-retaining versus posterior cruciate-stabilizing total knee replacements. J Bone Joint Surg Am 2011; 93 (22) 2072-2078
    Google Scholar
  • 64 Yapp LZ, Clement ND, Moran M, Clarke JV, Simpson AHRW, Scott CEH. The estimated lifetime risk of revision after primary knee arthroplasty is influenced by age, sex, and indication. Bone Joint J 2022; 104-B (12) 1313-1322
    Google Scholar
  • 65 Crawford DA, Adams JB, Hobbs GR, Berend KR, Lombardi Jr AV. Higher activity level following total knee arthroplasty is not deleterious to mid-term implant survivorship. J Arthroplasty 2020; 35 (01) 116-120
    Google Scholar
  • 66 Sharkey PF, Lichstein PM, Shen C, Tokarski AT, Parvizi J. Why are total knee arthroplasties failing today–has anything changed after 10 years?. J Arthroplasty 2014; 29 (09) 1774-1778
    Google Scholar
  • 67 Kagan R, Anderson MB, Christensen JC, Peters CL, Gililland JM, Pelt CE. The recovery curve for the patient-reported outcomes measurement information system patient-reported physical function and pain interference computerized adaptive tests after primary total knee arthroplasty. J Arthroplasty 2018; 33 (08) 2471-2474
    Google Scholar
  • 68 Kurtz SM, Lau E, Ong K, Zhao K, Kelly M, Bozic KJ. Future young patient demand for primary and revision joint replacement: national projections from 2010 to 2030. Clin Orthop Relat Res 2009; 467 (10) 2606-2612
    Google Scholar
  • 69 Van Leemput D, Neirynck J, Berger P, Vandenneucker H. Return to work after primary total knee arthroplasty under the age of 65 years: a systematic review. J Knee Surg 2022; 35 (11) 1249-1259
    Google Scholar
  • 70 Bhowmik-Stoker M, Mathew KK, Chen Z. et al. Return to work and driving after robotic arm-assisted total knee arthroplasty. Arthroplast Today 2022; 16: 219-223
    Google Scholar
  • 71 Witjes S, Gouttebarge V, Kuijer PP, van Geenen RC, Poolman RW, Kerkhoffs GM. Return to sports and physical activity after total and unicondylar knee arthroplasty: a systematic review and meta-analysis. Sports Med 2016; 46 (02) 269-292
    Google Scholar
  • 72 Bonnin M, Laurent JR, Parratte S, Zadegan F, Badet R, Bissery A. Can patients really do sport after TKA?. Knee Surg Sports Traumatol Arthrosc 2010; 18 (07) 853-862
    Google Scholar
  • 73 Buckley A, Duffy P, Korley R. Downhill skiing following total knee arthroplasty: a survey of Alberta orthopedic surgeons. Can J Surg 2021; 64 (04) E414-E418
    Google Scholar