Large language models’ performances regarding common patient questions about osteoarthritis: A comparative analysis of ChatGPT-3.5, ChatGPT-4.0, and perplexity

•This study evaluated the accuracy of three Large Language Models (LLMs)—ChatGPT-3.5, ChatGPT-4.0, and Perplexity—in answering common patient questions about osteoarthritis (OA). Orthopedic specialists rated the models, revealing that ChatGPT-4.0 significantly outperformed the others, with 64% of its responses rated as “excellent.” All models received high comprehensiveness scores, though challenges were noted in the “treatment and prevention” domain. These findings underscore the potential of LLMs to enhance patient education on OA while highlighting the need for improvements to address specific misconceptions. Large Language Models (LLMs) have gained much attention and, in part, have replaced common search engines as a popular channel for obtaining information due to their contextually relevant responses. Osteoarthritis (OA) is a common topic in skeletal muscle disorders, and patients often seek information about it online. Our study evaluated the ability of 3 LLMs (ChatGPT-3.5, ChatGPT-4.0, and Perplexity) to accurately answer common OA-related queries. We defined 6 themes (pathogenesis, risk factors, clinical presentation, diagnosis, treatment and prevention, and prognosis) based on a generalization of 25 frequently asked questions about OA. Three consultant-level orthopedic specialists independently rated the LLMs' replies on a 4-point accuracy scale. The final ratings for each response were determined using a majority consensus approach. Responses classified as “satisfactory” were evaluated for comprehensiveness on a 5-point scale. ChatGPT-4.0 demonstrated superior accuracy, with 64% of responses rated as “excellent”, compared to 40% for ChatGPT-3.5 and 28% for Perplexity (Pearson's chi-squared test with Fisher's exact test, all p < 0.001). All 3 LLM-chatbots had high mean comprehensiveness ratings (Perplexity = 3.88; ChatGPT-4.0 = 4.56; ChatGPT-3.5 = 3.96, out of a maximum score of 5). The LLM-chatbots performed reliably across domains, except for “treatment and prevention” However, ChatGPT-4.0 still outperformed ChatGPT-3.5 and Perplexity, garnering 53.8% “excellent” ratings (Pearson's chi-squared test with Fisher's exact test, all p < 0.001). Our findings underscore the potential of LLMs, specifically ChatGPT-4.0 and Perplexity, to deliver accurate and thorough responses to OA-related queries. Targeted correction of specific misconceptions to improve the accuracy of LLMs remains crucial. [Display omitted]