Objective: To evaluate the value of a virtual monoenergetic image (VMI) combined with an orthopedic metal artifact reduction algorithm (O-MAR) for double-layer detector spectral CT to reduce orthopedic metal implant artifacts. Methods: A total of 44 patients with examination sites containing orthopedic metal implants undergoing spectral CT were included. CI (conventional image, CI), O-MAR images, VMI and VMI +O-MAR (100～200 keV, increments of 10 keV) were reconstructed. The region of interest was outlined within the and hyperdense and hypodense artifact areas and fat tissue in each group of images, and CT value, standard deviation (SD) were measured, and signal to noise ratio (SNR) and artifact index (AI) were calculated for statistical analysis. Two subjective evaluations of the bone and muscle soft tissue conditions around the metal implants were performed by a radiologist based on a 5-point Likert scale. Results: Compared with CI, O-MAR, 100-200 keV VMI, and VMI +O-MAR, AI decreased in the hyperdense artifact area (P < 0.05); whereas SNR increased in the hypodense artifact area and AI decreased (P < 0.05). In the same keV, VMI +O-MAR AI was lower than VMI in both artifact areas (P < 0.05). 100~200 keV VMI +O-MAR subjective scores were higher than VMI; At 140~160 keV, both image scores were greater than 3 points, and the image quality met the diagnostic requirements. Conclusion: Dual-layer detector spectral CT VMI + O-MAR can effectively reduce orthopedic metal implant artifacts, and the VMI+O-MAR algorithm at 140~160 keV is recommended for image reconstruction.