Artificial intelligence in orthopedics: current applications, challenges, and future directions

BACKGROUND: Artificial intelligence research in orthopedics has grown rapidly, yet a substantial gap remains between technical development and clinical translation. This narrative review summarizes current applications of artificial intelligence in orthopedic practice and highlights barriers to implementation. MAIN BODY: Current work converges on three domains: machine learning for structured perioperative risk prediction, deep learning for standardized musculoskeletal imaging, and large language models for workflow and decision support. Applications such as automated fracture detection, Kellgren-Lawrence grading for osteoarthritis, and transfusion risk modeling are approaching clinical maturity. However, routine adoption is limited by algorithmic opacity, performance degradation in new clinical environments, and poor fit within existing workflows. We argue that progress should shift from increasing model complexity toward rigorous evaluation, including external validation on independent cohorts. In addition, probability calibration and uncertainty estimation are important for trustworthy risk communication. Future directions may include multimodal "digital twin" approaches that integrate electronic medical records, imaging phenotypes, and intraoperative data into patient-specific trajectories. CONCLUSIONS: The clinical impact of artificial intelligence in orthopedics will depend on life-cycle governance and demonstrated net benefit, prioritizing reliability and implementation science over retrospective benchmark performance.