The global contributions and emerging trends of extended reality-driven transformation in orthopedic surgical education: a bibliometric study

Extended reality (XR) technologies have made remarkable progress and been widely applied in orthopedic surgical education, offering a valuable and innovative pathway for traditional surgical training paradigms. Current reviews have not yet systematically synthesized the multimodal XR application landscape and emerging artificial intelligence (AI)-enabled adaptive tutoring technologies, making a comprehensive bibliometric analysis necessary to delineate the global research status and evolutionary trajectory of this field. Based on the Web of Science Core Collection, this study retrieved relevant literature published from 2000 to 2025 and screened 420 eligible publications following the PRISMA 2020 Guidelines. Multiple analytical tools were employed to investigate publication trends, geographical distribution, collaboration networks, research hotspots, and citation bursts. The field has undergone three developmental stages: initial exploration, steady growth, and explosive expansion. The USA, the UK, and China dominate the global research output with noticeable regional disparities, and McGill University ranks first in publication volume. Research foci have shifted from conventional virtual reality and augmented reality simulators toward the integration of AI with XR technologies, with AI demonstrating the strongest citation burst from 2020 to 2025. Technological advancement and post-pandemic demand for remote education have jointly driven the rapid growth of this field, and global research presents distinct developmental patterns between developed and emerging economies. Future research may further deepen the integrated application of AI and XR technologies, and expand cross-border academic collaboration to facilitate the inclusive and high-quality development of technological outcomes in this domain.