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World J Orthop. Sep 18, 2021; 12(9): 685-699
Published online Sep 18, 2021. doi: 10.5312/wjo.v12.i9.685
Machine learning in orthopaedic surgery
Simon P Lalehzarian, Anirudh K Gowd, Joseph N Liu
Simon P Lalehzarian, The Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, United States
Anirudh K Gowd, Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Winston-Salem, NC 27157, United States
Joseph N Liu, USC Epstein Family Center for Sports Medicine, Keck Medicine of USC, Los Angeles, CA 90033, United States
Author contributions: All authors made significant contributions toward the preparation of this manuscript; Lalehzarian SP wrote the article, critically revised the article, and participated in the final approval of the version to be published; Gowd AK critically revised the article and participated in the final approval of the version to be published; Liu JN designed the work, critically revised the article, and was responsible for final approval of the version to be published.
Conflict-of-interest statement: All authors have no conflicts of interest to report.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Joseph N Liu, MD, Assistant Professor, USC Epstein Family Center for Sports Medicine, Keck Medicine of USC, 1520 San Pablo St #2000, Los Angeles, CA 90033, United States. joseph.liu@med.usc.edu
Received: March 17, 2021
Peer-review started: March 17, 2021
First decision: May 3, 2021
Revised: May 12, 2021
Accepted: August 5, 2021
Article in press: August 5, 2021
Published online: September 18, 2021
Abstract

Artificial intelligence and machine learning in orthopaedic surgery has gained mass interest over the last decade or so. In prior studies, researchers have demonstrated that machine learning in orthopaedics can be used for different applications such as fracture detection, bone tumor diagnosis, detecting hip implant mechanical loosening, and grading osteoarthritis. As time goes on, the utility of artificial intelligence and machine learning algorithms, such as deep learning, continues to grow and expand in orthopaedic surgery. The purpose of this review is to provide an understanding of the concepts of machine learning and a background of current and future orthopaedic applications of machine learning in risk assessment, outcomes assessment, imaging, and basic science fields. In most cases, machine learning has proven to be just as effective, if not more effective, than prior methods such as logistic regression in assessment and prediction. With the help of deep learning algorithms, such as artificial neural networks and convolutional neural networks, artificial intelligence in orthopaedics has been able to improve diagnostic accuracy and speed, flag the most critical and urgent patients for immediate attention, reduce the amount of human error, reduce the strain on medical professionals, and improve care. Because machine learning has shown diagnostic and prognostic uses in orthopaedic surgery, physicians should continue to research these techniques and be trained to use these methods effectively in order to improve orthopaedic treatment.

Keywords: Artificial intelligence, Machine learning, Supervised learning, Unsupervised learning, Deep learning, Orthopaedic surgery

Core Tip: With the mass interest artificial intelligence and machine learning have garnered in orthopaedic surgery, a literature review of recent studies is necessary. By demonstrating the utility of various machine learning algorithms across various subspecialties of orthopaedic surgery, researchers should encourage physicians to understand the benefits of machine learning techniques and learn how to effectively incorporate these elements into their own practice to improve patient care. This clinical review outlines the concepts of machine learning and summarizes current and future orthopaedic applications of machine learning in risk assessment, outcomes assessment, imaging, and basic science fields.