Can Virtual Reality Simulators for Orthopaedic Surgical Training Replace Traditional Training Methods?

In the wake of COVID-19, training orthopaedic surgical trainees via traditional training methods, namely bench-top training and cadaveric training is a challenge. Virtual Reality (VR) can be used as a safe training method without compromising patient safety and violating time restrictions. However, due to a lack of evidence for its benefits compared to the traditional methods, its adoption in orthopaedics has been greatly delayed. This review analyses current literature to assess the effectiveness of VR training simulators for orthopaedic surgical training. Methods: A systematic search of literature from 2014-2020 was carried out in full adherence to PRISMA guidelines. Ovid Medline, Ovid Embase, PubMed, and ERIC databases were used. Results: 14 studies, quantitatively assessing the efficacy of orthopaedic VR simulators were included. Thirteen out of fourteen studies showed that using VR training compared to traditional training methods effectively improved technical skills, patient safety, and efficiency of procedures. Only one study where VR training was compared with cadaveric training found the latter to be a superior method. Three studies demonstrated transfer validity from simulation training to intra-operative performance, however, they did not employ the use of objective in-theatre metrics. Conclusion: This literature review showed that VR training results in quantitative improvements in surgical performance and can bridge the gap from knowing to doing. However, a limited number of studies comparing cadaveric training to VR training and a lack of objective assessment, necessitates the need for further research to warrant an evidence-based implementation of VR training into the orthopaedic surgical curricula.