PURPOSE: To conduct a systematic review to determine the efficacy of head-mounted display (HMD) virtual reality (VR) in orthopaedic surgical training. METHODS: A thorough search was conducted on PubMed for articles published between January 2000 and August 2020. Studies were included if they (1) concerned orthopaedic surgery, (2) dealt with an HMD VR device, (3) the technology was being used for training purposes, and (4) was a randomized control trial (RCT). RESULTS: Eight articles met the inclusion criteria. Analysis of the 8 RCTs reveals 6 of the 8 demonstrating HMD VR to be a superior training method to traditional-based training modules. However, in the remaining 2 articles, authors found no significant difference between the VR group and controls, but showed at least equivalent ability to train novice surgeons. CONCLUSIONS: RCTs show promising evidence that HMD VR is an efficacious tool in surgical training for orthopaedic procedures, with most randomized clinical trials showing improvement in novice students/surgeons compared with controls. CLINICAL RELEVANCE: As VR technology advances, so must the research directed at determining the efficacy of such technologies at educating our novice surgeons. RCTs are already demonstrating the role HMD VR can play in the education of novice orthopaedic surgeons.