ObjectiveIn this study, the effects of a virtual reality intervention before total knee arthroplasty on pain, anxiety, and vital signs were investigated. MethodsThis randomized controlled study with a pretest-posttest design was conducted with 130 patients included in experimental (n = 65) and control (n = 65) groups. Data were collected using a patient information form, the numeric rating scale (NRS), a vital signs form, and the state anxiety inventory. The patients in the experimental group watched a 20-minute video consisting of sea, forest, waterfall, and animal visuals using virtual reality goggles. Vital signs were recorded before and after the intervention. Vital signs were recorded on the same timeline in the control group, without any intervention. ResultsThe patients in the experimental group displayed lowered anxiety and pain levels and improvements in their vital signs, except for temperature. There were statistically significant differences between the experimental and control groups, except for temperature and diastolic blood pressure (p < .05). ConclusionThe virtual reality intervention reduced pain, anxiety, systolic and diastolic blood pressure, heart rate, and respiratory rate. It is recommended to be implemented before surgery.