Application progress and thinking of generative artificial intelligence in orthopedics clinical practice_West China Medical Journal

Authors：

LI Peifang , CHEN Xi , ZHANG Lin ,  CHEN Jiali ,  NING Ning

Department of Orthopedic Surgery, West China Hospital, Sichuan University / West China School of Nursing, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

CHEN Jiali, Email: cjl85614115@163.com; NING Ning, Email: gkningning@126.com

Keywords：

Generative artificial intelligence; orthopedics; clinical decision support

DOI：

10.7507/1002-0179.202508103

Video：

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Generative artificial intelligence (AI) technology plays a significant role in enhancing data application capabilities, improving disease diagnosis and treatment plans, and advancing health management, drug development, genetic analysis, and precision medicine. However, due to the diagnostic complexity, treatment diversity, and high technical demands of orthopedic diseases, the application of generative AI in orthopedics is still in its early exploration stage. This paper, based on the experience of applying generative AI, summarizes the concept, working principles, progress of application in orthopedics, as well as the existing shortcomings and optimization strategies, aiming to provide valuable insights for the application of generative AI in orthopedics clinical practice.

Citation： LI Peifang, CHEN Xi, ZHANG Lin, CHEN Jiali, NING Ning. Application progress and thinking of generative artificial intelligence in orthopedics clinical practice. West China Medical Journal, 2025, 40(9): 1371-1375. doi: 10.7507/1002-0179.202508103 Copy

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2.	白洁, 周进祝. ChatGPT 生成式 AI 时代《医学统计学》教育的挑战与应对. 继续医学教育, 2024, 38(8): 136-139.
3.	颜见智, 何雨鑫, 骆子烨, 等. 生成式大语言模型在医疗领域的潜在典型应用与面临的挑战. 医学信息学杂志, 2023, 44(9): 23-31.
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6.	Wu C, Lin W, Zhang X, et al. PMC-LLaMA: toward building open-source language models for medicine. J Am Med Inform Assoc, 2024, 31(9): 1833-1843.
7.	吴腾. 生成式人工智能技术赋能智慧医疗建设的风险与规制. 医学与社会, 2025, 38(3): 9-16.
8.	刘泓泽, 王耀国, 唐圣晟, 等. 医学大语言模型的应用现状与发展趋势研究. 中国数字医学, 2024, 19(8): 1-7, 13.
9.	王芳, 朱学坤, 刘清民, 等. 生成式人工智能研究进展. 图书与情报, 2024(4): 45-64.
10.	王硕, 刘天语, 汪琛, 等. 试论生成式人工智能的医疗应用能力与风险边界. 医学与哲学, 2024, 45(12): 1-5.
11.	Chen Y, Esmaeilzadeh P. Generative AI in medical practice: in-depth exploration of privacy and security challenges. J Med Internet Res, 2024, 26: e53008.
12.	Zhu J, Jiang Y, Chen D, et al. High identification and positive-negative discrimination but limited detailed grading accuracy of ChatGPT-4o in knee osteoarthritis radiographs. Knee Surg Sports Traumatol Arthrosc, 2025, 33(5): 1911-1919.
13.	Temel MH, Erden Y, Bağcıer F. Evaluating artificial intelligence performance in medical image analysis: sensitivity, specificity, accuracy, and precision of ChatGPT-4o on Kellgren-Lawrence grading of knee X-ray radiographs. Knee, 2025, 55: 79-84.
14.	Pagano S, Holzapfel S, Kappenschneider T, et al. Arthrosis diagnosis and treatment recommendations in clinical practice: an exploratory investigation with the generative AI model GPT-4. J Orthop Traumatol, 2023, 24(1): 61.
15.	Du K, Li A, Zuo QH, et al. Comparing artificial intelligence-generated and clinician-created personalized self-management guidance for patients with knee osteoarthritis: blinded observational study. J Med Internet Res, 2025, 27: e67830.
16.	Gan W, Ouyang J, She G, et al. ChatGPT’s role in alleviating anxiety in total knee arthroplasty consent process: a randomized controlled trial pilot study. Int J Surg, 2025, 111(3): 2546-2557.
17.	You M, Chen X, Liu D, et al. ChatGPT-4 and wearable device assisted intelligent exercise therapy for co-existing sarcopenia and osteoarthritis (GAISO): a feasibility study and design for a randomized controlled PROBE non-inferiority trial. J Orthop Surg Res, 2024, 19(1): 635.
18.	肖仰华, 徐一丹. 大规模生成式语言模型在医疗领域的应用: 机遇与挑战. 医学信息学杂志, 2023, 44(9): 1-11.
19.	Duffourc M, Gerke S. Generative AI in health care and liability risks for physicians and safety concerns for patients. JAMA, 2023, 330(4): 313-314.
20.	杨淑琪, 朱政, 王佳清, 等. 基于证据的医疗生成式人工智能大语言模型的构建和应用进展. 护士进修杂志, 2025, 40(12): 1317-1325.
21.	Preiksaitis C, Rose C. Opportunities, challenges, and future directions of generative artificial intelligence in medical education: scoping review. JMIR Med Educ, 2023, 9: e48785.
22.	Lusetti F, Maimaris S, La Rosa GP, et al. Applications of generative artificial intelligence in inflammatory bowel disease: a systematic review. Dig Liver Dis, 2025: S1590-8658(25)00734-0.
23.	施亦龙, 许鑫. ChatGPT 机器回答与知乎人工回答的比较. 图书馆论坛, 2024, 44(1): 151-159.
24.	Carroll AN, Storms LA, Malempati C, et al. Generative artificial intelligence and prompt engineering: a primer for orthopaedic surgeons. JBJS Rev, 2024, 12(10): e24.00122.
25.	宋筱璇, 徐丹, 张紫蕴, 等. 提示词重构类型对 AI 生成内容效果的影响. 图书馆论坛, 2025, 45(4): 129-138.

1. 李佩芳, 陈佳丽, 宁宁, 等. ChatGPT 在医学领域的应用进展及思考. 华西医学, 2023, 38(10): 1456-1460.
2. 白洁, 周进祝. ChatGPT 生成式 AI 时代《医学统计学》教育的挑战与应对. 继续医学教育, 2024, 38(8): 136-139.
3. 颜见智, 何雨鑫, 骆子烨, 等. 生成式大语言模型在医疗领域的潜在典型应用与面临的挑战. 医学信息学杂志, 2023, 44(9): 23-31.
4. Singhal K, Azizi S, Tu T, et al. Large language models encode clinical knowledge. Nature, 2023, 620(7972): 172-180.
5. Peng C, Yang X, Chen A, et al. A study of generative large language model for medical research and healthcare. NPJ Digit Med, 2023, 6(1): 210.
6. Wu C, Lin W, Zhang X, et al. PMC-LLaMA: toward building open-source language models for medicine. J Am Med Inform Assoc, 2024, 31(9): 1833-1843.
7. 吴腾. 生成式人工智能技术赋能智慧医疗建设的风险与规制. 医学与社会, 2025, 38(3): 9-16.
8. 刘泓泽, 王耀国, 唐圣晟, 等. 医学大语言模型的应用现状与发展趋势研究. 中国数字医学, 2024, 19(8): 1-7, 13.
9. 王芳, 朱学坤, 刘清民, 等. 生成式人工智能研究进展. 图书与情报, 2024(4): 45-64.
10. 王硕, 刘天语, 汪琛, 等. 试论生成式人工智能的医疗应用能力与风险边界. 医学与哲学, 2024, 45(12): 1-5.
11. Chen Y, Esmaeilzadeh P. Generative AI in medical practice: in-depth exploration of privacy and security challenges. J Med Internet Res, 2024, 26: e53008.
12. Zhu J, Jiang Y, Chen D, et al. High identification and positive-negative discrimination but limited detailed grading accuracy of ChatGPT-4o in knee osteoarthritis radiographs. Knee Surg Sports Traumatol Arthrosc, 2025, 33(5): 1911-1919.
13. Temel MH, Erden Y, Bağcıer F. Evaluating artificial intelligence performance in medical image analysis: sensitivity, specificity, accuracy, and precision of ChatGPT-4o on Kellgren-Lawrence grading of knee X-ray radiographs. Knee, 2025, 55: 79-84.
14. Pagano S, Holzapfel S, Kappenschneider T, et al. Arthrosis diagnosis and treatment recommendations in clinical practice: an exploratory investigation with the generative AI model GPT-4. J Orthop Traumatol, 2023, 24(1): 61.
15. Du K, Li A, Zuo QH, et al. Comparing artificial intelligence-generated and clinician-created personalized self-management guidance for patients with knee osteoarthritis: blinded observational study. J Med Internet Res, 2025, 27: e67830.
16. Gan W, Ouyang J, She G, et al. ChatGPT’s role in alleviating anxiety in total knee arthroplasty consent process: a randomized controlled trial pilot study. Int J Surg, 2025, 111(3): 2546-2557.
17. You M, Chen X, Liu D, et al. ChatGPT-4 and wearable device assisted intelligent exercise therapy for co-existing sarcopenia and osteoarthritis (GAISO): a feasibility study and design for a randomized controlled PROBE non-inferiority trial. J Orthop Surg Res, 2024, 19(1): 635.
18. 肖仰华, 徐一丹. 大规模生成式语言模型在医疗领域的应用: 机遇与挑战. 医学信息学杂志, 2023, 44(9): 1-11.
19. Duffourc M, Gerke S. Generative AI in health care and liability risks for physicians and safety concerns for patients. JAMA, 2023, 330(4): 313-314.
20. 杨淑琪, 朱政, 王佳清, 等. 基于证据的医疗生成式人工智能大语言模型的构建和应用进展. 护士进修杂志, 2025, 40(12): 1317-1325.
21. Preiksaitis C, Rose C. Opportunities, challenges, and future directions of generative artificial intelligence in medical education: scoping review. JMIR Med Educ, 2023, 9: e48785.
22. Lusetti F, Maimaris S, La Rosa GP, et al. Applications of generative artificial intelligence in inflammatory bowel disease: a systematic review. Dig Liver Dis, 2025: S1590-8658(25)00734-0.
23. 施亦龙, 许鑫. ChatGPT 机器回答与知乎人工回答的比较. 图书馆论坛, 2024, 44(1): 151-159.
24. Carroll AN, Storms LA, Malempati C, et al. Generative artificial intelligence and prompt engineering: a primer for orthopaedic surgeons. JBJS Rev, 2024, 12(10): e24.00122.
25. 宋筱璇, 徐丹, 张紫蕴, 等. 提示词重构类型对 AI 生成内容效果的影响. 图书馆论坛, 2025, 45(4): 129-138.

West China Medical Journal

Application progress and thinking of generative artificial intelligence in orthopedics clinical practice

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