Artificial intelligence in orthopaedics should be built with surgeons, not just for them!

Surgical artificial intelligence (AI) is typically validated on one patient population and then deployed unchanged into another, without surgeon input into its design. AI in orthopaedics should be built with surgeons, not simply for them: Surgeons should hold shared authority over the clinical question, data curation, validation, implementation, monitoring and retirement of any tool they use. Specialty-tuned models outperform general-purpose systems on some tasks, but the margin is modest and likely to narrow as generalist models improve. The more durable distinction is who controls the update loop-who can retrain a model on local outcomes, audit its failures and withdraw it when it drifts. Trial evidence shows that a clinician kept in that loop by design, not as an afterthought, outperforms working alone. What determines whether orthopaedic AI fulfils its promise is not model architecture, but who stays accountable to the surgeon at the bedside when the model needs to change.