To explore the use of virtual reality (VR) headsets in rehabilitation after total knee arthroplasty (TKA), and to investigate participants' feelings about wearing VR headsets and seek their suggestions for improvement.

A prospective cross-sectional study was conducted on 50 patients who were hospitalized and recovered from dysfunction after TKA at Peking University Third Hospital from June to October 2022, including 16 males and 34 females with a mean age of (66.86±8.96) years. Using quantitative research methods, the patients were evaluated manually or with head-mounted VR devices after surgery. The range of motion (ROM), straight leg raise exercise duration, and pain during exercise and rest were measured, and the differences between manual assessment and VR assessment were analyzed. Additionally, semi-structured interviews were conducted with 11 selected participants, and the interview results were analyzed by thematic framework analysis.

In the quantitative study, there were no significant differences between the manual measurement and and VR assessment with regard to the maximum knee flexion ROM, maximum extension ROM, numerical rating scale (NRS) score, resting state NRS, and straight leg raise exercise duration (P＞0.05 for all). The intraclass correlation coefficients (ICCs) for the maximum flexion ROM of the knee (ICC=0.839, 95% confidence interval (CI): 0.732-0.905, P＜0.001), maximum extension ROM of the knee (ICC=0.970, 95% CI: 0.946-0.983, P＜0.001), movement state NRS (ICC=0.944, 95% CI: 0.901-0.969, P＜0.001), resting state NRS (ICC=0.968, 95% CI: 0.942-0.982, P＜0.001), and straight leg raise exercise duration (ICC=0.968, 95% CI: 0.938-0.984, P＜0.001) showed high consistency between the two methods. The analysis of the semi-structured interview content from the qualitative study revealed three themes: perceived ease of use, including device defects, learning difficulty, and acceptance; perceived usefulness, including operability, factors that affect the fit experience, and device functions; and improvement suggestions, including multifunctionality, labeling the target angle, enriching virtual background environments, and training programs.

VR headsets can serve as an auxiliary rehabilitation therapy tool for post-TKA recovery. In rehabilitation assessments, there is no significant difference between VR devices and rehabilitation professionals in terms of knee joint ROM, NRS, and straight leg raise exercise duration. Compared with other attitude detection devices, head-mounted VR devices have the characteristics of easy portability and real-time feedback.