Przejdź do treściInteractive digital rehabilitation may improve short-term function in some people with knee osteoarthritis and after total knee arthroplasty, but the available evidence is too heterogeneous to treat it as a proven replacement for standard rehabilitation. A recent systematic review provides an encouraging signal while also showing how very different interventions can be grouped under the broad label of “virtual reality”.
Why is this study interesting?
Digital tools are increasingly used in rehabilitation, ranging from screen-based exercises with real-time feedback to immersive virtual-reality headsets. They may make home exercise easier to deliver, increase engagement and provide therapists with information about how tasks are performed. The clinically relevant question, however, is not simply whether patients enjoy the technology, but whether it improves pain and function more than conventional exercise or education.
The review by Kalinowski and colleagues, published on 8 September 2026 in the Journal of Medical Internet Research, evaluated extended-reality (XR) interventions in knee osteoarthritis and recovery after total knee arthroplasty. The authors used a broad XR definition that included both immersive virtual reality and interactive screen-based digital rehabilitation. That distinction is central to interpreting the findings.
Question and methodology
The authors performed a systematic review and meta-analyses using a prospectively registered PROSPERO protocol. Five databases were searched, with the search updated through December 2025. Twenty-one studies were included: 12 addressing non-operative management of knee osteoarthritis and 9 evaluating rehabilitation after total knee arthroplasty. Individual study sample sizes ranged from 36 to 306 participants.
The interventions varied substantially. Some used games or movement-tracking exercises displayed on a screen, others used more elaborate feedback systems, and only 6 of the 21 studies actually evaluated immersive virtual reality. No study directly compared immersive headsets with non-immersive digital rehabilitation.
Main findings
In knee osteoarthritis, interactive digital rehabilitation was associated with better function than control interventions. The pooled standardised effect was −0.59, but the 95% prediction interval included both possible benefit and no effect. Certainty of evidence was rated low. For pain at 6–8 weeks, the effect was small and near the threshold of statistical significance; the prediction interval again included no benefit.
After total knee arthroplasty, individual studies suggested possible functional improvement, but at 3–4 months there was no clear advantage for pain. The pooled effect was −0.12, with a wide confidence interval from −0.75 to 0.52. Most studies followed patients for only a short period, generally no longer than three months.
Clinical interpretation for an orthopaedic surgeon
The most reasonable interpretation is that digital rehabilitation can be a useful way to deliver and support exercise, particularly when it improves access, motivation or adherence. The review does not show that XR technology itself is responsible for the benefit. Better outcomes may instead reflect more repetitions, immediate feedback, gamification, greater contact with the rehabilitation team or simply more consistent participation.
The review also does not justify the claim that immersive virtual-reality headsets are more effective than a simpler app or screen-based exercise programme. Intervention categories were inconsistent, and no direct comparison between those approaches was available.
Important limitations
- Most trials were small, and 16 of 21 studies had follow-up shorter than 6 months.
- The XR label covered technologically and therapeutically different programmes.
- Some studies had risk of bias related to missing data and deviations from the planned intervention.
- Only 5 studies reported adverse events, so safety cannot be assessed with confidence.
- The review included English-language publications only, and individual meta-analyses contained relatively few studies.
What could this change in practice?
The review supports using well-designed digital tools as a possible adjunct to rehabilitation when they solve a specific problem—for example, limited access to therapy, difficulty monitoring exercises or poor adherence. Selection should be based on the functional goal, the patient’s abilities, supervision and safety rather than on the novelty of the technology.
The study does not show that XR improves long-term outcomes, reduces revision risk after arthroplasty or can replace individual physiotherapy assessment. It also does not establish superiority of immersive virtual reality over simpler forms of digital rehabilitation. Larger studies with clearly described interventions, longer follow-up and systematic adverse-event reporting are needed.
Source
Kalinowski C, et al. Extended Reality Interventions for Osteoarthritis of the Knee and Recovery After Total Knee Arthroplasty: Systematic Review and Meta-Analyses. J Med Internet Res. 2026;28:e84753. DOI: 10.2196/84753. PubMed · Full text.
Polish version · Research Updates, Literature and Evidence-Based Medicine
Content prepared by: Tomasz Poboży - orthopaedic surgeon.