Precision in practice: a systematic review and meta-analysis of virtual reality efficacy for osteoarthritis-specific total knee arthroplasty rehabilitation

BACKGROUND: Virtual reality (VR) had gained traction as an innovative approach for post-total knee arthroplasty (TKA) rehabilitation in patients with knee osteoarthritis (KOA). However, evidence of its comparative efficacy against conventional methods remained fragmented. This study synthesized data from randomized controlled trials (RCTs) to evaluate VR's impact on pain, functional recovery, and quality of life in KOA patients post-TKA. METHODS: A systematic search was performed across PubMed, Embase, Web of Science, and Cochrane Central Register of Controlled Trials (inception to December 2024). RCTs comparing VR-based rehabilitation with standard care in KOA patients post-TKA were included. Data on pain (Visual Analogue Scale [VAS], Numerical Pain Rating Scale [NPRS]), functional outcomes (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC], Timed Up and Go [TUG], Range of Motion [ROM]), and quality of life (Short Form-36 [SF-36], EuroQol Five-Dimensional Questionnaire [EQ-5D]) were extracted. Risk of bias was assessed using the Cochrane Collaboration tool. Meta-analyses were conducted using RevMan 5.3, with mean differences (MD) or standardized MD and 95% confidence intervals (CI) calculated for continuous outcomes. Heterogeneity was quantified via the I² statistic. RESULTS: Ten RCTs (588 participants) were analyzed. VR interventions demonstrated transient advantages in WOMAC scores at one month (SMD: -1.40; 95% CI: -2.37 to -0.43; P < 0.01) and 3 months (SMD: -1.14; 95% CI: -2.29 to 0.00; P = 0.05), but no significant benefit was observed at 6 months. TUG performance improved short-term (SMD: -1.10; 95% CI: -2.06 to -0.14; P = 0.03), while ROM showed sustained gains (1-week SMD: 1.38; 95% CI: 0.84-1.92; P < 0.01). Pain outcomes varied: NPRS favored VR, whereas VAS results showed no short-term differences. Quality of life data were inconclusive due to limited reporting. Substantial heterogeneity (I² > 70%) was observed, which was attributed to variability in VR modalities, session duration, and rehabilitation settings. CONCLUSION: VR-based rehabilitation provided short-term improvements in functional mobility and joint flexibility for KOA patients post-TKA, but its long-term benefits remained uncertain. Methodological limitations, including high heterogeneity and inadequate blinding, necessitated cautious interpretation of the findings. Future trials should adopt standardized protocols, integrate gender-stratified analyses, and prioritize long-term follow-ups to optimize VR's clinical utility.