Artificial intelligence in orthopaedics: false hope or not? A narrative review along the line of Gartner’s hype cycle

Abstract

Artificial Intelligence (AI) in general, and Machine Learning (ML)-based applications in particular, have the potential to change the scope of healthcare, including orthopaedic surgery. The greatest benefit of ML is in its ability to learn from real-world clinical use and experience, and thereby its capability to improve its own performance. Many successful applications are known in orthopaedics, but have yet to be adopted and evaluated for accuracy and efficacy in patients’ care and doctors’ workflows. The recent hype around AI triggered hope for development of better risk stratification tools to personalize orthopaedics in all subsequent steps of care, from diagnosis to treatment. Computer vision applications for fracture recognition show promising results to support decision-making, overcome bias, process high-volume workloads without fatigue, and hold the promise of even outperforming doctors in certain tasks. In the near future, AI-derived applications are very likely to assist orthopaedic surgeons rather than replace us. ‘If the computer takes over the simple stuff, doctors will have more time again to practice the art of medicine’.76 Cite this article: EFORT Open Rev 2020;5:593-603. DOI: 10.1302/2058-5241.5.190092

What is Artificial Intelligence Surgery?

“…Part of the Gartner Hype cycle, described by a technology firm of the same name, the AI "hype cycle" goes through several general phases before true innovation can occur. It broadly includes: (1) a peak of inflated expectations; (2) machine learning, deep learning; (3) natural language processing; (4) computer vision; (5) a trough of disillusionment; and (6) a slope of enlightenment followed by a long plateau phase where the real work begins known as the "plateau of productivity" [Figure 1] [10] . By modifying surgeon's expectations, it is believed that the phase of enlightenment can be entered and the slope improved, which is why every device or innovation that provides any form of automation and improves patient care must be celebrated, studied, and if appropriate embraced.…”

“…It is feared that blind reliance on AI without quality data may lead to unintended biases and loss of empathy, which is fundamental to healing. Perhaps the clearest instance of the pitfalls of AI lies in [10] . facial recognition software, which has been shown to be susceptible to racial discrimination and could be particularly dangerous in plastic surgery [6] .…”

“…Artificial Intelligence Surgery Gartner Hype Cycle: NOTES = Natural Orifice Transluminal Endoscopic Surgery. Adapted from Gartner Hype Cycle for Artificial Intelligence, 2019 gartner.com/smarterwithgartner and modifications by Oosterhoff et al[10] .…”

Historical overview of hip arthroplasty: From humble beginnings to a high-tech future

“…However, the way we understand working with AI is dependent of Gartner's Hype Cycle and surgeon's learning curve. 28 Cemented hip arthroplasty is more likely to be limited to revision arthroplasty in the future, as their number (cemented) is decreasing yearly. Supporting this statement, based on a retrospective study on the German population, Klug et.…”

AI MSK clinical applications: spine imaging

“…AI enhancements are expected to have the potential to impact any industry, according to Gartner's latest Hype Cycle for Emerging Technologies from 2020 [21]. AI techniques are already being used both in research settings and for commercial purposes for different tasks of routine workflows in spine imaging.…”