Background: Metallic orthopedic implants face persistent clinical challenges that have proved resistant to incremental conventional development. Machine learning and artificial intelligence offer a complementary paradigm for navigating the high-dimensional design spaces governing implant performance, yet the literature remains fragmented across disciplinary silos with no comprehensive synthesis spanning the full development pipeline. Methods: A structured database search of PubMed/MEDLINE, Embase, and Cochrane (executed May 2026), supplemented by hand-searching of reference lists, identified 33 primary studies organized across five sequential domains: alloy composition discovery, additive manufacturing process–property optimization, lattice and porous structure design, surface engineering and coatings, and corrosion and wear prediction. Results: Across all five domains, machine learning approaches, including random forests, convolutional neural networks, Bayesian optimization, generative adversarial networks, physics-informed neural networks, and autonomous multi-agent platforms, have accelerated property prediction and design space exploration beyond experimental or simulation-based methods. Shared barriers to translation include small, heterogeneous datasets, reliance on internal rather than external validation, limited interpretability, and the absence of regulatory frameworks for AI-assisted device design. Representative performance included modulus predictions within ~4 GPa of first-principles values, ML-designed alloys reaching ~42.7 GPa (versus 103–120 GPa for Ti-6Al-4V), property prediction R² often above 0.90 (up to 0.96–0.9991), 98.3% corrosion severity classification accuracy, and acceleration from a roughly fivefold reduction in finite element simulations to surrogates compressing days into minutes. Conclusions: Addressing these limitations will require open standardized databases linking materials parameters to registry-level clinical outcomes, prospective clinical validation studies, and coordinated engagement between researchers, industry, and regulatory agencies.