A feasibility and acceptability of virtual reality as a pain relief measure post primary and revision total knee replacement surgery in a hospital setting: quasi-experimental study

Abstract

Background: Effective post-operative pain management remains a significant global challenge, especially following joint replacement surgeries. Despite the increasing interest in non-pharmacological interventions, persistent post-surgical pain, opioid dependence, and patient recovery demands continue to drive the search for safer and more cost-effective alternatives. Virtual Reality (VR) has emerged as promising, non-invasive, and drug-free intervention, with increasing evidence supporting its use in managing acute and procedure-related pain. However, its application in patients undergoing total knee replacement (TKR) or revision total knee replacement (RTKR) has not yet been evaluated. Methods: A single-centre, quasi-experimental feasibility study was conducted over 12 weeks in a UK specialist orthopaedic hospital. Adults undergoing TKR or RTKR were recruited and consented pre-operatively. Beginning 24 h post-surgery, participants were offered up to three VR sessions using the DR.VR system. Each session lasted approximately 7.5 min and included immersive, patient-selected experiences. Pain and anxiety levels were assessed pre- and post-session using validated scales. Acceptability was measured via participant questionnaires following each session. Results: Of 145 eligible patients, 57 were screened, 42 received study information, and 23 consented to participate: 56.5% female; 43.48%males; mean 69.23, ± 11.64 years. Three withdrew, and 20 participants completed at least one VR session with a retention rate of 87%. In total, 44 sessions were completed. Pain reduction was reported by 81.4% and anxiety reduction by 77.3% of participants post-session. Acceptability was high: 95% enjoyed the experience, 85% felt distracted from pain, and 90% would recommend VR for post-surgical use. No adverse effects were reported. Participant feedback suggested longer session durations and higher-quality content could further enhance the intervention. Conclusion: This study demonstrates that VR for managing post-operative pain and anxiety in TKR and RTKR patients is a feasible and acceptable non-pharmacological strategy. Findings support its potential as a safe, user-friendly adjunct to standard care. However, further large-scale, multi-centre trials are needed to evaluate efficacy, optimise protocols, and support routine implementation in post-operative settings. Trial registration: Ethical approval was obtained from Health Research Authority (HRA) and Health and Care Research Wales (HCRW), UK on 27 January 2022 (21/NW/0359).