Editorial Commentary: A Coffee's Worth of Time: Artificial Intelligence May Accelerate, Not Replace, Preoperative Planning for High Tibial Osteotomy.

Abstract

Artificial intelligence is advancing quickly in orthopaedic imaging, yet remarkably, few tools have entered daily surgical practice. The most convincing near-term use cases for orthopaedic surgeons are tasks that are repetitive, time-consuming, and prone to error; automated landmark detection with subsequent coronal-plane planning for high tibial osteotomy fits that description. Deep learning can localize the anatomical landmarks required for lower-limb alignment analysis and compute a correction angle in seconds, with reproducibility that approaches experienced readers, standardizing measurement and, at scale, letting surgeons iterate across large radiographic datasets and simulate osteotomies for research and training. Two limitations deserve equal attention. One is inherent to planning itself: a coronal, angle-based model cannot represent the 3-dimensional consequences of a posterosuperiorly ascending osteotomy on the axial or sagittal plane nor the intra-articular and ligamentous contributions to deformity. The other is specific to the tool: a system trained on selected, high-quality radiographs should be able to recognize when it should not analyze an image, for example, under insufficient radiographic quality because of malrotation or with retained hardware. Systems may still have a way to go prior to routine use; the distance from a promising prototype to a dependable instrument runs through increasing robustness in clinical reality, independent validation, and an awareness of what 2-dimensional planning cannot capture. Ultimately, the greatest potential will lie in translation from plan to execution, which is where artificial intelligence working with 3-dimensional data may lift osteotomy care to the next level. Until then, the efficiency gains reported in the present study may accelerate planning for high tibial osteotomy by roughly the time it takes to drink a coffee.