Artificial Intelligence for the Orthopaedic Surgeon

An Overview of Potential Benefits, Limitations, and Clinical Applications

Eric C. Makhni, MD, MBA; Sonya Makhni, MD, MBA; Prem N. Ramkumar, MD, MBA

Disclosures

J Am Acad Orthop Surg. 2021;29(6):235-243. 

In This Article

Abstract and Introduction

Abstract

Artificial intelligence (AI), along with its subset technology machine learning, has transformed numerous industries through newfound efficiencies and supportive decision-making. These technologies have similarly begun to find application within United States healthcare, particularly orthopaedics. Although these modalities have the potential to similarly transform health care, there exist limitations that must also be recognized and understood. Unfortunately, most clinicians do not have an understanding of the fundamentals of AI and therefore may have challenges in contextualizing its impact in modern healthcare. The purpose of this review was to provide an overview of the key concepts of AI and machine learning with the orthopaedic surgeon in mind. The review further highlights the potential benefits and limitations of AI, along with an overview of its applications, in orthopaedics.

Introduction

The application of artificial intelligence (AI) in the field of medicine has been widely forecasted since John McCarthy first coined the term over 60 years ago. In his proposal in 1955, McCarthy originally envisioned AI as "the science and engineering of making intelligent machines."[1] He predicted that these machines would one day be capable of doing feats previously thought to be exclusive to the domain of human intelligence, such as abstract thought, advanced problem-solving, and iterative self-improvement. In fact, in 1976, Jerrold S. Maxmen,[2] a professor of psychiatry at Columbia University, predicted that AI would bring about the "postphysician era" by the 21st century,[3] describing the change as "possible, inevitable, and desirable.

"The true impact of AI on the future practice of medicine is still unknown. What is clear, however, is that AI has already begun to transform numerous industries in a variety of sectors. Some common examples include autonomous vehicles, online purchase recommendations, targeted advertising, and even forecasting of stock market fluctuations. However, the incorporation of AI in the healthcare sector has lagged behind that of other industries. Despite initial excitement over the possibilities of AI in the medical field, practical applications of AI have only recently begun to materialize.

Within the field of orthopaedic surgery, AI holds promise for several cutting-edge applications that can transform the quality of care rendered, accelerate the delivery of services, and improve the value rendered. The technology also has important limitations and vulnerabilities that must be understood to maintain (and improve on) the current healthcare quality standards. The purpose of this review was to provide a summary of AI and highlight its potential applications and limitations within the context of clinical orthopaedics. In particular, the review will summarize the key-related technical aspects and subtopics of AI. This framework may be beneficial to practitioners who wish to understand the role of this important technology in the context of healthcare quality and operations.

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