Extended reality and emerging artificial intelligence in orthopedic surgical training: a scoping review of educational outcomes

Abstract Immersive technologies have gained increasing relevance in orthopedic surgical education; however, the scope, outcomes, and maturity of extended reality (XR) and artificial intelligence (AI) applications remain heterogeneous. To map the educational applications, learner populations, outcome measures, and research gaps related to the use of XR and emerging AI tools in orthopedic surgical training. A scoping review was conducted following Joanna Briggs Institute methodology and reported according to PRISMA-ScR guidelines. PubMed, Scopus, and ScienceDirect were searched for English and Spanish studies published between 2015 and 2025. Fifty-four studies involving 3,066 participants were included. Virtual reality (VR) was the predominant modality (83.3%), followed by augmented reality (31.4%), while AI-based applications were infrequently reported. XR-based training was most commonly evaluated in trauma surgery, arthroscopy, and arthroplasty, primarily among medical students and residents. Most studies reported improvements in simulation-based technical performance metrics, whereas evidence on clinical outcomes, long-term skill retention, and cost-effectiveness was limited. XR—particularly VR—represents the most mature immersive technology in orthopedic surgical education. AI applications remain emergent and primarily supportive. Future research should prioritize standardized outcome measures, multicenter designs, and evaluation of long-term educational and clinical impact.