AI in Orthopaedics: The Wisdom of “Should We?” Versus “Can We?”

Abstract

Artificial intelligence (AI) is rapidly transitioning from theoretical promise to daily reality in medicine, with orthopaedic surgery representing one of its most active and visible frontiers. The convergence of abundant clinical data, growing computational power, and advances in machine learning algorithms positions orthopaedics at the forefront of this digital transformation. This article critically examines the positive impacts and theoretical disruptions that may accompany AI-driven changes in orthopaedics, addressing the central questions facing the field: How can AI be harnessed in everyday practice? What changes lie ahead, and why is surgeon leadership essential? Will AI replace the orthopaedic surgeon? In addition to reviewing the current applications of AI, this article presents original findings from the 2025 American Orthopaedic Association (AOA) Annual Leadership Meeting poll exploring surgeon attitudes toward AI. Most respondents expressed curiosity or excitement about AI’s potential, with 77% identifying workflow and administrative efficiency as the greatest opportunity and 86% indicating that they would gladly delegate charting and documentation to AI. However, only 35% felt comfortable or expert in their understanding of AI in health care, underscoring the need for surgeon-led education and oversight. AI can be successfully applied in orthopaedics as a decision aid for treatment risk stratification, diagnostic imaging interpretation, and workflow optimization, enhancing efficiency rather than replacing clinical expertise. Yet AI models can exhibit overconfidence, lack transparency regarding training data, propagate bias when applied outside their original context, and occasionally produce hallucinated content. Incorporating clinician-in-the-loop review, expert adjudication of edge cases, and continuous feedback is essential to improving reliability and reducing hallucinations as these systems are integrated into practice. Orthopaedic surgeons must play a central role in guiding the ethical and effective adoption of AI, championing both clinical rigor and patient partnership. With proactive leadership, multidisciplinary collaboration, and an unwavering commitment to patient-centered care, the use of AI can enhance the art and science of orthopaedic surgery. Ultimately, AI will transform orthopaedics not by replacing surgeons, but by augmenting our clinical judgment, improving efficiency, and supporting patient-centered care.

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