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Review
. 2025 May 30:15563316251340303.
doi: 10.1177/15563316251340303. Online ahead of print.

Bioethical Considerations of Deploying Artificial Intelligence in Clinical Orthopedic Settings: A Narrative Review

Lulla V Kiwinda  1 , Sophia D Kocher  1 , Anna R Bryniarski  1 , Christian A Pean  1   2
Affiliations
Review

Bioethical Considerations of Deploying Artificial Intelligence in Clinical Orthopedic Settings: A Narrative Review

Lulla V Kiwinda et al. HSS J. .

Abstract

Artificial intelligence (AI) has emerged in orthopedics with the potential to improve diagnostic accuracy, optimize surgical workflows, and support personalized care. We conducted a narrative review exploring the bioethical considerations of AI use in the orthopedic clinical setting, focusing on 4 core principles-autonomy, beneficence, nonmaleficence, and justice-to provide orthopedists with a practical framework for AI's implementation. We utilized the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework to conduct a comprehensive PubMed search; 89 articles were evaluated and 23 met our inclusion criteria. Across these studies, bioethical considerations for the clinical implementation of AI tools consistently emerged, most commonly concerning privacy, bias, transparency, informed consent, and regulation. We offer recommendations for strengthening privacy safeguards, adopting bias mitigation strategies, improving transparency through explainable AI tools, and establishing clear regulatory frameworks with lifecycle evaluation.

Keywords: AI; artificial intelligence; bioethics; ethical considerations; machine learning; orthopedics.

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Conflict of interest statement

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Christian A. Pean, MD, reports relationships with Arthrex Inc, Heraeus Medical LLC, Smith+Nephew Inc., ENCORE MEDICAL, LP, TriCoast Surgical Solutions LLC, Stryker Corporation, and Zimmer Biomet Holdings, Inc.; he is also co-founder and CEO of an AI company, RevelAi Health. The other authors report no potential conflicts of interest.

Figures

Fig. 1.
Fig. 1.
PRISMA flow diagram. PRISMA Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Fig. 2.
Fig. 2.
Framing of commonly cited ethical concerns within the core bioethical principles.
See this image and copyright information in PMC

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