Artificial Intelligence in Orthopaedics: Clinical Performance, Limitations, and Translational Readiness—A Review

Abstract

Background/Objectives: Musculoskeletal disorders and their surgical treatment significantly affect global disability, healthcare utilization, and costs. Artificial intelligence (AI) is a key enabler of data-driven musculoskeletal care. Their applications include diagnostic imaging, surgical planning, risk prediction, rehabilitation, and digital health ecosystems. This narrative review synthesizes current evidence on the use of AI in orthopaedics and musculoskeletal care across five areas: diagnostic imaging, surgical planning and intraoperative augmentation, predictive analytics and patient-reported outcomes, rehabilitation intelligence and teleorthopaedics, and system-level management. An additional task is to identify translational gaps and priorities for safe, ethical, and equitable implementation of AI. Methods: A structured narrative review was conducted using targeted searches in PubMed, Scopus, and Web of Science supplemented by semantic and citation-based explorations in Semantic Scholar, OpenAlex, and Google Scholar. The main search period was January 2019 to December 2025. The retrieved peer-reviewed articles were analyzed for clinical relevance to human musculoskeletal care, quantitative outcomes, and the translational implications of the results. From the broader pool of eligible publications, 40 clinically relevant studies were selected for detailed synthesis covering imaging, surgical planning, predictive modeling, rehabilitation, and system-level applications. Owing to the significant heterogeneity in the model architectures, datasets, and endpoints, the results were organized into five predefined thematic areas. Results: The most mature evidence is for AI-assisted detection of bone fractures on radiographs, identification of implants, and use of sizing templates in preoperative planning for arthroplasty, where deep learning systems have achieved expert-level diagnostic performance (e.g., fracture detection sensitivity of approximately 90% and specificity of approximately 92% and implant identification accuracy of 97–99%) and improved the accuracy of preoperative planning compared to conventional templating. AI-based planning increases the likelihood of reducing intraoperative corrections, shortening surgery time, reducing blood loss, and improving the final functional outcomes. Predictive models can support the stratification of risk for complications, rehospitalizations, and patient-reported outcomes, although external validation remains limited and is often single-center at this stage of research. Emerging applications in rehabilitation and teleorthopaedics, including sensor-based monitoring and learning systems integrated with Patient-Reported Outcome Measures (PROMs), are conceptually promising, but are mainly limited to feasibility or pilot studies. Conclusions: AI is beginning to influence musculoskeletal care, moving beyond pattern recognition toward integrated, patient-centered decision support throughout the perioperative and rehabilitation periods. Its widespread use remains constrained by limited multicenter validation, dataset bias, algorithmic opacity, and immature regulatory and governance frameworks. Future work should prioritize prospective multicenter impact studies, repeatable revalidation of local models, integration of PROM and teleorthopedic data with health learning systems, and adaptation to changing regulatory requirements to enable safe, ethical, effective, and equitable implementation in routine orthopedic practice.

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