Clinical Orthopaedics and Related Research®

, Volume 468, Issue 10, pp 2586–2591 | Cite as

Virtual Reality in Orthopaedics: Is It a Reality?

  • Jay D. MabreyEmail author
  • Karl D. Reinig
  • W. Dilworth Cannon
Symposium: ABJS Carl T. Brighton Workshop on Health Informatics



Virtual reality (VR) simulation has been a requirement for airline and military pilots for decades and is only now being integrated into surgical training programs. Thus far, orthopaedic training programs have been slow to adopt VR training.


We therefore asked (1) how VR has worked for other surgical specialties; (2) what VR solutions are available for orthopaedics; and (3) should VR simulation become part of the orthopaedic curriculum?


An informal literature review was performed, searching for orthopaedically-oriented VR surgical simulators and comparing this to the number of programs available for general surgery teaching programs. An in-depth review of a VR simulator for knee arthroscopy is also presented.

Where are we now?

The number of papers specific to orthopaedics and VR is limited. VR is used effectively in other specialties, especially general surgery. VR simulators are readily available for shoulder and knee arthroscopy but not as well incorporated into training curricula.

Where do we need to go?

VR technology is available today for training programs. Integration of VR into the orthopaedic curriculum will save time in the OR, reduce operative errors, and improve the resident’s overall educational experience. The public will expect their surgeons to train on these simulators.

How do we get there?

Orthopaedic training programs should take advantage of the commercially available VR simulators for orthopaedic procedures and incorporate them into their training curricula. This effort could be led by the American Academy of Orthopaedic Surgeons (AAOS) and the American Board of Orthopaedic Surgery (ABOS), two of the primary sponsors of a major study in the effectiveness of VR simulators for knee arthroscopy.


Anterior Cruciate Ligament Virtual Reality Virtual Reality Simulator Shoulder Arthroscopy Virtual Reality Training 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Ackerman MJ. The Visible Human Project: a resource for anatomical visualization. Stud Health Technol Inform. 1998;52 Pt 2:1030–1032.PubMedGoogle Scholar
  2. 2.
    Aggarwal R, Ward J, Balasundaram I, Sains P, Athanasiou T, Darzi A. Proving the effectiveness of virtual reality simulation for training in laparoscopic surgery. Ann Surg. 2007;246:771–779.CrossRefPubMedGoogle Scholar
  3. 3.
    Ahlberg G, Enochsson L, Gallagher AG, Hedman L, Hogman C, McClusky DA, III, Ramel S, Smith CD, Arvidsson D. Proficiency-based virtual reality training significantly reduces the error rate for residents during their first 10 laparoscopic cholecystectomies. Am J Surg. 2007;193:797–804.CrossRefPubMedGoogle Scholar
  4. 4.
    Bliss JP, Hanner-Bailey HS, Scerbo MW. Determining the efficacy of an immersive trainer for arthroscopy skills. Stud Health Technol Inform. 2005;111:54–56.PubMedGoogle Scholar
  5. 5.
    Bridges M, Diamond DL. The financial impact of teaching surgical residents in the operating room. Am J Surg. 1999;177:28–32.CrossRefPubMedGoogle Scholar
  6. 6.
    Burke K, Donohue P, Siemaszko C. US Airways airplane crashes in Hudson River - Hero pilot Chesley Sullenberger III saves all aboard. New York Daily News. January 16, 2009.
  7. 7.
    Cannon WD, Eckhoff DG, Garrett WE, Jr., Hunter RE, Sweeney HJ. Report of a group developing a virtual reality simulator for arthroscopic surgery of the knee joint. Clin Orthop Relat Res. 2006;442:21–29.CrossRefPubMedGoogle Scholar
  8. 8.
    Farnworth LR, Lemay DE, Wooldridge T, Mabrey JD, Blaschak MJ, DeCoster TA, Wascher DC, Schenck RC, Jr. A comparison of operative times in arthroscopic ACL reconstruction between orthopaedic faculty and residents: the financial impact of orthopaedic surgical training in the operating room. Iowa Orthop J. 2001;21:31–35.PubMedGoogle Scholar
  9. 9.
    Gallagher AG, Ritter EM, Champion H, Higgins G, Fried MP, Moses G, Smith CD, Satava RM. Virtual reality simulation for the operating room: proficiency-based training as a paradigm shift in surgical skills training. Ann Surg. 2005;241:364–372.CrossRefPubMedGoogle Scholar
  10. 10.
    Gatehouse SC, Izatt MT, Adam CJ, Harvey JR, Labrom RD, Askin GN. Perioperative aspects of endoscopic anterior scoliosis surgery: the learning curve for a consecutive series of 100 patients. J Spinal Disord Tech. 2007;20:317–323.CrossRefPubMedGoogle Scholar
  11. 11.
    Gomoll AH, O’Toole RV, Czarnecki J, Warner JJ. Surgical experience correlates with performance on a virtual reality simulator for shoulder arthroscopy. Am J Sports Med. 2007;35:883–888.CrossRefPubMedGoogle Scholar
  12. 12.
    Gonzalvo A, Fitt G, Liew S, de la Harpe D, Turner P, Ton L, Rogers MA, Wilde PH. The learning curve of pedicle screw placement: how many screws are enough? Spine (Phila Pa 1976). 2009;34:E761–765.Google Scholar
  13. 13.
    Grantcharov TP, Bardram L, Funch-Jensen P, Rosenberg J. Learning curves and impact of previous operative experience on performance on a virtual reality simulator to test laparoscopic surgical skills. Am J Surg. 2003;185:146–149.CrossRefPubMedGoogle Scholar
  14. 14.
    Gurusamy K, Aggarwal R, Palanivelu L, Davidson BR. Systematic review of randomized controlled trials on the effectiveness of virtual reality training for laparoscopic surgery. Br J Surg. 2008;95:1088–1097.CrossRefPubMedGoogle Scholar
  15. 15.
    Heng PA, Cheng CY, Wong TT, Wu W, Xu Y, Xie Y, Chui YP, Chan KM, Leung KS. Virtual reality techniques. Application to anatomic visualization and orthopaedics training. Clin Orthop Relat Res. 2006;442:5–12.CrossRefPubMedGoogle Scholar
  16. 16.
    Klein M. NICE, SULLY - NOW TRY IT ALL AGAIN. The New York Post. March 1, 2009.;jsessionid=5E3F2061AEAEA7DFFA8BEC1043EFDF44
  17. 17.
    Larsen CR, Soerensen JL, Grantcharov TP, Dalsgaard T, Schouenborg L, Ottosen C, Schroeder TV, Ottesen BS. Effect of virtual reality training on laparoscopic surgery: randomised controlled trial. BMJ. 2009;338:b1802.CrossRefPubMedGoogle Scholar
  18. 18.
    Laurance J. Surgeons should train on simulators, like pilots. The Independent. March 16, 2009.
  19. 19.
    McCarthy AD, Moody L, Waterworth AR, Bickerstaff DR. Passive haptics in a knee arthroscopy simulator: is it valid for core skills training? Clin Orthop Relat Res. 2006;442:13–20.CrossRefPubMedGoogle Scholar
  20. 20.
    Pedowitz RA, Esch J, Snyder S. Evaluation of a virtual reality simulator for arthroscopy skills development. Arthroscopy. 2002;18:E29.CrossRefPubMedGoogle Scholar
  21. 21.
    Rong LM, Xie PG, Shi DH, Dong JW, Liu B, Feng F, Cai DZ. Spinal surgeons’ learning curve for lumbar microendoscopic discectomy: a prospective study of our first 50 and latest 10 cases. Chin Med J (Engl). 2008;121:2148–2151.Google Scholar
  22. 22.
    Seymour NE, Gallagher AG, Roman SA, O’Brien MK, Bansal VK, Andersen DK, Satava RM. Virtual reality training improves operating room performance: results of a randomized, double-blinded study. Ann Surg. 2002;236:458–463; discussion 463–454.CrossRefPubMedGoogle Scholar
  23. 23.
    Srivastava S, Youngblood PL, Rawn C, Hariri S, Heinrichs WL, Ladd AL. Initial evaluation of a shoulder arthroscopy simulator: establishing construct validity. J Shoulder Elbow Surg. 2004;13:196–205.CrossRefPubMedGoogle Scholar
  24. 24.
    Stefanidis D, Korndorffer JR, Jr., Sierra R, Touchard C, Dunne JB, Scott DJ. Skill retention following proficiency-based laparoscopic simulator training. Surgery. 2005;138:165–170.CrossRefPubMedGoogle Scholar
  25. 25.
    Verdaasdonk EG, Dankelman J, Lange JF, Stassen LP. Transfer validity of laparoscopic knot-tying training on a VR simulator to a realistic environment: a randomized controlled trial. Surg Endosc. 2008;22:1636–1642.CrossRefPubMedGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2010

Authors and Affiliations

  • Jay D. Mabrey
    • 1
    Email author
  • Karl D. Reinig
    • 2
    • 3
  • W. Dilworth Cannon
    • 4
  1. 1.Department of OrthopaedicsBaylor University Medical CenterDallasUSA
  2. 2.Touch of Life TechnologiesAurora USA
  3. 3.University of Colorado Health Science CenterDenver USA
  4. 4.Department of OrthopaedicsUniversity of CaliforniaSan Francisco USA

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