2026年3月 保髋进展 JCR Q3-4 区

BACKGROUND: Graf's introduction of hip ultrasonography (US) in the 1980s coincided with a major change in developmental hip dysplasia (DDH) screening and diagnostic practice, with a gradual reduction in reliance on examination- and radiograph-only strategies. METHODS: A natural language processing pipeline and non-negative matrix factorization (NLP-NMF) were applied to Scopus-indexed DDH publications, extracting topics and weights across 4 epochs (pre-1980, 1980-1984, 1985-1989, 1980-2024) anchored to the 1980 US milestone. Topic co-occurrence networks, weight distributions, and segmented regression summarized thematic shifts and tested for a 1980 breakpoint. RESULTS: In the post-1980 corpus, a distinct diagnostic imaging theme emerged and strengthened, while surgery declined and anatomy remained influential. In 1985-1989, joint anatomy dominated (39.1%), followed by diagnosis (18.6%), pediatric orthopedics (15.3%), surgery (13.7%), and conservative treatment (13.4%). Across 1980-2024, clinical evaluation accounted for 31.5% of publications, followed by anatomy (19.6%), genetic anomaly (16.7%), diagnostic imaging (16.6%), and surgery (15.6%). Within diagnostic imaging, US carried a high weight (0.948), underscoring its central role. Segmented regression identified a structural breakpoint around 1980, temporally coincident with the period in which hip US entered clinical practice and diffused across the field. CONCLUSION: The NLP-NMF analysis of 4 decades of DDH literature shows a sustained pivot toward imagingsupported,n clinically anchored evaluation and growing attention to etiologic and syndromic/anomaly contexts alongside anatomical determinants, with potential implications for earlier detection, risk-aligned follow-up, and more targeted use of operative management.   Cite this article as: Taşkin R, Yılar S, Budak İ, Uğur F. Ultrasonography and the reorientation of developmental hip dysplasia research: an NLP-NMF trend analysis (1980-2024). Eurasian J Med. 2026, 58 (2), 1249, doi:10.5152/eurasianjmed.2026.251249.

BACKGROUND: Hip arthroscopy (HAS) is widely used to treat femoroacetabular impingement syndrome (FAIS), and many patients rely on online resources for medical information. Large language models (LLMs) such as ChatGPT have shown potential as supplementary educational tools in orthopedics; however, existing evaluations are limited to earlier model generations with variable accuracy and completeness. This study aimed to evaluate the accuracy, clarity, relevance, and completeness of ChatGPT-5 responses to common patient questions regarding FAIS and HAS. METHODS: ChatGPT-5 was used to generate 25 frequently asked patient questions and corresponding answers related to hip preservation. Two fellowship-trained hip preservation surgeons independently evaluated each response using a five-point Likert scale across four predefined domains: relevance, accuracy, clarity, and completeness. Descriptive statistics were calculated as mean ± standard deviation for each domain. Inter-rater reliability was assessed using a two-way random-effects intraclass correlation coefficient with absolute agreement (ICC [2, 1]) and complemented by exact agreement percentages. RESULTS: All responses received excellent scores, with mean values ranging from 4.84 ± 0.27 (completeness) to 5.00 ± 0.00 (relevance). Accuracy (4.97 ± 0.08) and clarity (4.91 ± 0.17) were near-perfect. ICC values demonstrated moderate to excellent agreement (0.70-0.81), complemented by high exact agreement rates (84-100%). No answer contained factually incorrect, misleading, or unsafe information. Minor reductions in completeness were attributable to occasional brevity rather than substantive omissions. CONCLUSION: ChatGPT-5 generated highly accurate, clear, and clinically appropriate patient-oriented explanations regarding FAIS and HAS, showing clear improvement compared with earlier ChatGPT versions. Although ChatGPT-5 represents a marked advancement in AI-based patient education, its use should be regarded as a complementary educational tool rather than a replacement for professional orthopedic counseling.

INTRODUCTION: Subchondral insufficiency fracture (SIF) of the femoral head typically occurs in older adults with compromised bone quality and often progresses to rapidly destructive coxarthropathy. However, the etiology of SIF remains poorly understood. We examined associations among spinopelvic alignment, pelvic tilt, and microdamage accumulation in the femoral head in patients with SIF compared with osteoarthritis (OA) secondary to hip dysplasia and cadaveric controls. MATERIALS AND METHODS: We analyzed eight SIF patients, ten OA patients, and nine cadaveric controls. All patients underwent total hip arthroplasty. Radiological evaluation included lumbar lordosis angle (LLA), sacral slope (SS), and pelvic tilt angles (PA) in standing and supine positions. Histomorphological assessment focused on a 5 × 5-mm cancellous bone area beneath the joint surface. RESULTS: The SIF group exhibited significantly lower LLA and SS, as well as a greater difference between standing and supine PA compared with the OA group, indicating increased posterior pelvic tilt. Histomorphologic analysis revealed reduced trabecular bone volume and greater crack length in SIF compared with OA. Crack surface density was significantly higher in both SIF and OA groups than in controls. CONCLUSION: SIF patients demonstrated greater posterior pelvic tilt and lower LLA compared with OA. Histologically, SIF showed lower trabecular bone volume and longer microcracks. These data suggest the nature of the microdamage, not just the amount of the microdamage, is important to skeletal fragility. Our findings underscore the importance of assessing both spinopelvic alignment and bone quality when evaluating patients at risk for SIF.

PURPOSE: To assess correlation of pre-operative symptoms, labral damage and chondrolabral junction pathology on MRI with intra-operative findings in patients undergoing hip arthroscopy for femoroacetabular impingement (FAI). METHODS: Consecutive patients with FAI treated surgically were included. Data were collected on patient demographics and preoperative clinical outcome measures. Three radiologists performed retrospective independent reviews of pre-operative MRIs in 96 hips. The presence of cartilage fraying, chondrolabral separation, labral tear pattern (intrasubstance, linear, complex), chondral flap, cartilage delamination, and ligamentum teres (LT) pathology (degeneration/partial or complete tear) were recorded on preoperative MRI and intraoperatively during arthroscopy. Inter-reader and inter-method agreement were measured using weighted-Cohen's or Fleiss'-kappa, or Kendall's coefficient. Associations between MRI and arthroscopic findings and preoperative modified-Harris-Hip-Score (mHHS) and Non-Arthritic-Hip-Score (NAHS) were assessed using Mann-Whitney-U or Kruskal-Wallis test. RESULTS: All readers detected lower rates of chondrolabral separation, cartilage delamination, and chondral flap, and higher rates of LT tear on MRI compared to arthroscopy. Linear tears were the most common tear pattern detected by readers on MRI (29%-50%) and arthroscopy (71%). The inter-reader agreement was moderate for LT findings and fair for remaining MRI variables. Between MRI and arthroscopy, there was moderate agreement for labral fraying for one reader (k = 0.303, 95% CI[0.106-0.501], p = 0.004) and fair agreement for labral tear pattern for one reader (k = 0.187, 95% CI[0.037-0.337], p = 0.006). There was poor-to-no agreement between MRI and arthroscopy for the remaining MRI variables for all readers (p = 0.05). Preoperative mHHS and NAHS scores demonstrated no significant association with preoperative MR or intraoperative findings (p > 0.05). CONCLUSION: MRI labral and chondrolabral findings in patients with FAI underestimated the intraoperative pathology identified during hip arthroscopy and were not associated with preoperative patient reported outcome measures. LEVEL OF EVIDENCE: III (retrospective case series).

BACKGROUND: Graf's introduction of hip ultrasonography (US) in the 1980s coincided with a major change in developmental hip dysplasia (DDH) screening and diagnostic practice, with a gradual reduction in reliance on examination- and radiograph-only strategies. METHODS: A natural language processing pipeline and non-negative matrix factorization (NLP-NMF) were applied to Scopus-indexed DDH publications, extracting topics and weights across 4 epochs (pre-1980, 1980-1984, 1985-1989, 1980-2024) anchored to the 1980 US milestone. Topic co-occurrence networks, weight distributions, and segmented regression summarized thematic shifts and tested for a 1980 breakpoint. RESULTS: In the post-1980 corpus, a distinct diagnostic imaging theme emerged and strengthened, while surgery declined and anatomy remained influential. In 1985-1989, joint anatomy dominated (39.1%), followed by diagnosis (18.6%), pediatric orthopedics (15.3%), surgery (13.7%), and conservative treatment (13.4%). Across 1980-2024, clinical evaluation accounted for 31.5% of publications, followed by anatomy (19.6%), genetic anomaly (16.7%), diagnostic imaging (16.6%), and surgery (15.6%). Within diagnostic imaging, US carried a high weight (0.948), underscoring its central role. Segmented regression identified a structural breakpoint around 1980, temporally coincident with the period in which hip US entered clinical practice and diffused across the field. CONCLUSION: The NLP-NMF analysis of 4 decades of DDH literature shows a sustained pivot toward imagingsupported,n clinically anchored evaluation and growing attention to etiologic and syndromic/anomaly contexts alongside anatomical determinants, with potential implications for earlier detection, risk-aligned follow-up, and more targeted use of operative management.   Cite this article as: Taşkin R, Yılar S, Budak İ, Uğur F. Ultrasonography and the reorientation of developmental hip dysplasia research: an NLP-NMF trend analysis (1980-2024). Eurasian J Med. 2026, 58 (2), 1249, doi:10.5152/eurasianjmed.2026.251249.

INTRODUCTION: acetabular dysplasia in adults represents a therapeutic challenge due to progressive joint instability, pain, and functional limitation. This article presents a case series using acetabuloplasty with autologous femoral head graft, combined with total hip arthroplasty, as a treatment option for adult patients with severe acetabular dysplasia and osteoarthritis. MATERIAL AND METHODS: a prospective case series was carried out between 2023 and 2024 at Cancun General Hospital. Five adult patients diagnosed with advanced hip dysplasia (Crowe II-IV) and Tönnis grade IV coxarthrosis were included. All patients underwent cemented dual-mobility total hip arthroplasty combined with acetabuloplasty using the autologous femoral head as graft material. Demographic characteristics, surgical approach and outcomes at 12-month follow-up are reported. RESULTS: the five patients (three females and two males, mean age 57 years) showed significant functional improvement. All patients achieved standing and assisted walking at four weeks, independent walking at 8-10 weeks, and restoration of functional mobility arcs. Harris hip score improved from < 70 preoperatively to > 90 points at final follow-up. CONCLUSIONS: acetabuloplasty with autologous femoral head graft combined with dual-mobility total hip arthroplasty is a reliable procedure, providing joint stability, early rehabilitation and improved quality of life. Although limited by sample size, this case series supports the utility of this technique as a valid therapeutic option in adult hip dysplasia with osteoarthritis. INTRODUCCIÓN: la displasia acetabular del adulto constituye un desafío terapéutico importante en ortopedia, pues conlleva inestabilidad articular progresiva, dolor crónico y limitación funcional que derivan en artrosis avanzada. El presente artículo expone la experiencia con el uso de acetabuloplastía mediante injerto autólogo de cabeza femoral, asociada con artroplastía total de cadera, como opción de tratamiento en pacientes adultos con displasia acetabular y artrosis severa. MATERIAL Y MÉTODOS: se realizó un estudio observacional tipo serie de casos entre 2023 y 2024 en el Hospital General de Cancún. Se incluyeron cinco pacientes adultos con diagnóstico de displasia acetabular avanzada (Crowe II-IV) y coxartrosis grado IV. Todos fueron tratados con artroplastía total de cadera cementada de doble movilidad, complementada con acetabuloplastía empleando injerto autólogo de la cabeza femoral. Se describen características demográficas, técnicas quirúrgicas empleadas y evolución clínica durante 12 meses de seguimiento. RESULTADOS: los cinco pacientes (tres mujeres y dos hombres, edad promedio 57 años, rango 52-63) presentaron mejoría funcional significativa. Se registró bipedestación y deambulación asistida con andadera a las cuatro semanas, deambulación independiente a las 8-10 semanas y recuperación de arcos de movilidad adecuados: flexión 90-100°, extensión 10-15°, abducción 30-35°, rotación interna 20-25° y rotación externa 30-35°. La puntuación en la escala de Harris modificada mejoró de < 70 puntos en el preoperatorio a > 90 puntos en el postoperatorio. CONCLUSIONES: la acetabuloplastía con injerto autólogo de cabeza femoral, asociada con prótesis total de cadera de doble movilidad, representa una técnica quirúrgica confiable, con potencial de ofrecer estabilidad, restaurar arcos de movilidad y mejorar la calidad de vida. Este estudio, aunque limitado por el número de casos, aporta evidencia clínica favorable.