Distraction Techniques for Postoperative Pain After Total Knee Arthroplasty: A Randomized Controlled Trial

Total knee arthroplasty is a common orthopedic procedure that can be associated with significant postoperative pain. In addition to standard pharmacological analgesia, non-pharmacological approaches such as distraction techniques may help reduce perceived pain by redirecting attention away from nociceptive stimuli. This single-center, parallel-group randomized controlled trial will be conducted in the Orthopedics and Traumatology Clinic of Osmaniye State Hospital in Türkiye. Eligible adults (≥18 years) undergoing total knee arthroplasty will be randomized using a stratified block randomization approach based on baseline pain severity (VAS 0-3, 4-6, 7-10) to ensure balanced allocation across groups. The intervention arms include (1) VR headset distraction, (2) use of a squishy (squeeze toy) as a tactile distraction method, and (3) poetry reading as a cognitive distraction method. The control group receives usual postoperative care without a structured distraction intervention. All groups follow the same postoperative analgesia protocol. The primary outcome is postoperative pain intensity measured by VAS at 24 hours after surgery.

Inclusion criteria

• Age 18 years or older
• Undergoing total knee arthroplasty
• Hospitalized in the postoperative period at Osmaniye State Hospital
• Able to communicate and complete pain assessment (Visual Analog Scale)
• Provides written informed consent
• Managed under the same postoperative analgesia protocol and operated by the same surgeon (as per study protocol)

Exclusion criteria

• Severe cognitive impairment or inability to provide valid pain assessment
• Postoperative complications that may interfere with participation or pain assessment
• Contraindication to the assigned distraction method (e.g., intolerance to wearing a VR headset, severe nausea/dizziness, claustrophobia)
• Refusal or withdrawal of consent