###### Abstract  
Virtual reality-based rehabilitation (VRBR) is being used in rehabilitation after total knee arthroplasty (TKA). This meta-analysis assesses the effect of immediate and/or maintained effect of VRBR (alone or in combination with conventional therapy (CT) in TKA recovery. To perform this meta-analysis, we searched in PubMed, SCOPUS, WOS, CINAHL, and PEDro until 5 February 2023. We included randomized controlled trials that assessed the effect of VRBR in improving knee pain and function, dynamic balance, range of motion (ROM), and strength, among others, after TKA. The pooled effect was calculated with [PERSON]'s standardized mean difference (SMD) with a 95% confidence interval (95% CI). Twelve studies, providing data from 997 participants (69.9 \(\pm\) 8.1 years old), were included. At post-immediate assessment, VRBR is effective in improving knee pain (SMD = \(-\)0.36; 95% CI \(-\)0.56 to \(-\)0.17), knee function (SMD = \(-\)0.51; 95% CI \(-\)0.75 to \(-\)0.27), dynamic balance (SMD = \(-\)0.59; 95% CI \(-\)1.02 to \(-\)0.15), knee flexion ROM (SMD = 0.4; 95% CI 0.17 to 0.62), and extension strength (SMD = 0.43; 95% CI 0.19 to 0.68). Our findings showed that immersive and non-immersive VRBR is effective to be used after TKA, and the effect on knee pain and function may be maintained over 3 or 6 months. A high level of satisfaction and adherence to VRBR was reported. Keywords:total knee arthroplasty; total knee replacement; virtual reality; videogames; knee pain; knee function; balance; rehabilitation; physiotherapy; meta-analysis +
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conservative treatments fail to alleviate symptoms [7]. The aim of TKA is to improve knee pain and function, knee strength, and range of motion (ROM), which can be translated into an improvement in the quality of life when the most conservative methods, such as pharmacology and physiotherapy, fail [8]. Between 5 and 40% of patients that receive TKA present discomfort after the surgery, where knee pain is the most disabling, so it is necessary to develop effective protocols in this phase [9]. Early rehabilitation after TKA is essential to guarantee the optimal recovery of the patients, and it aims to reduce knee pain and increase strength, mobility, and function of the knee and all lower extremity [10]. Pharmacotherapy and conventional therapy (CT), such as physiotherapy, are the main treatments used in this early rehabilitation [11]. Drugs to reduce knee pain and inflammation are the main pharmacotherapy option more used after TKA; however, there are adverse effects such as vomiting or addiction due to its continued use [12]. The physiotherapy treatment consists of passive and active mobilizations immediately after the surgery, cryotherapy, and exercises that promote the functionality and strength of the knee joint [13]. However, sometimes the classical physiotherapy approach, involving passive and analytic exercises that do not favor the participation of the patient in their rehabilitation, is considered monotonous and low motivating by the patients; and their high socio-economic cost does not allow all patients to continue with the same treatment [14]. On the other hand, in recent years, virtual reality and telerabhilitation have been postulated as effective therapeutic tools in the management of different musculoskeletal disorders such as low back pain [15], shoulder pain [16], spondyloarthos [17] and cervical post-surgery rehabilitation [18], among others. A previous systematic review suggested that the inclusion of virtual rehabilitation devices in classical physiotherapy treatments could increase the recovery of patients [19]. Virtual reality-based early rehabilitation (VRBR) is based on the use of virtual reality devices that allow the patient to be introduced into a virtual environment that feels similar to real-world using a computer, virtual reality glasses, or a game station, allowing interaction with this virtual environment and their objects through your own hands or joystick [20; 21].