Journal of Surgical Simulation 2021; 8: 18 - 28

Published: 14 July 2021


Review article

Virtual reality simulation in orthopaedic surgical training during periods of restricted clinical hours: a systematic review

Bisola Salaja, Aoife Feeley, Iain Feeley, Eoin Sheehanb and Khalid Merghani
Corresponding author: Bisola Salaja, University of Limerick School of Medicine, Castletroy, Limerick, Ireland. Email:


Background: The public health response to the coronavirus pandemic has imposed limitations on orthopaedic surgeons’ scheduled care practice, with a consequential reduction in training time for residents within the specialty. A potentially viable option for maintenance of operative competency is the use of virtual reality (VR) surgical simulation. This review looks at the effectiveness of VR as a pedagogical method of learning for orthopaedic trainees.

Question: Can VR be a viable method of learning and skill retention for orthopaedic trainees during periods of reduced operative time? Methods: A systematic search using Google Scholar, EMBASE and PubMed was conducted in July 2020.

Results: Following the PRISMA guidelines, the initial search revealed 779 studies. Thirty-five full-text articles were analysed by two reviewers and a final total of 29 articles were included in this review. The levels of evidence ranged from one to four with variable quality. A thematic analysis revealed three broad categories: quality and validity of VR teaching simulations studies (n = 8); learning curves and subject performance papers (n = 14); usefulness of VR simulators in orthopaedics reviews (n = 7).

Conclusion: We demonstrated that VR has the capacity to help trainees maintain their technical skills, enhance their precision and retain rudimentary competency during this pandemic. Additional developments are necessary to ensure its safety as a training tool. Although there are limited orthopaedic-specific VR simulators, surgical trainees can benefit from VR-based training when paired with other forms of orthopaedic education, such as cadaveric laboratories and simulation suites.


virtual reality; orthopaedic training; simulations; COVID-19