Educational applications of virtual reality in orthopedic surgery: a scoping review of effectiveness and future directions

Virtual reality (VR) has emerged as a rapidly expanding modality in orthopedic surgical education. However, the evidence regarding its educational value, clinical transferability, and technological consistency remains heterogeneous. This scoping review aims to map the current landscape of VR applications in orthopedic surgical training and critically evaluate the level of evidence across educational outcomes. A structured scoping review was conducted to identify studies investigating VR-based orthopedic education. Data were synthesized narratively and categorized according to procedure type, simulation modality, trainee level, and Kirkpatrick educational outcomes. The literature demonstrates a marked increase in VR-related studies in recent years, with a predominance of arthroscopy-based applications, particularly in knee and shoulder surgery. Most systems were semi-immersive and primarily targeted orthopedic residents. Outcomes were largely limited to simulator-based skill acquisition (Kirkpatrick Level 2), with relatively few studies assessing transfer to clinical practice or patient outcomes. Immersive VR systems and higher-fidelity platforms showed promising results in skill acquisition and, in limited cases, skill transfer. However, substantial heterogeneity exists across technologies, validation methods, and outcome measures. VR is an effective tool for early-stage orthopedic skill acquisition, particularly in arthroscopic training. However, evidence supporting translation into clinical performance remains limited. Future research should focus on standardized validation frameworks, higher-level educational outcomes, and integration into real surgical practice.