This study aims to explore the factors in a patient’s rehabilitation achievement after a total knee replacement (TKR) patient exercises, using a PCA-ANFIS emotion model-based game rehabilitation system, which combines virtual reality (VR) and motion capture technology. The researchers combine a principal component analysis (PCA) and an adaptive network-based fuzzy inference system (ANFIS) to present a predicting, artificial emotion model with a Plutchik emotional wheel in a 3D Gesture gamification rehabilitation system, and illustrate the value of the Plutchik emotional wheel. Also, this study tries to improve a rehabilitant’s self-efficacy, based on interesting games and the use of Kinect technology to capture a rehabilitant’s motion. This quasi-experimental design required two months to collect the PRS rehabilitation treatment data from the study’s participants, who were divided into experimental and control groups. The experimental group, rehabilitated with a PRS, filled out a questionnaire and evaluated whether the system operations and self-efficacy changes affected their rehabilitation achievement. These findings could be referenced for related researchers designing auxiliary tools and for helping physical therapists improve rehabilitants’ performance. Meanwhile, these findings recommend that patients have the operation in the early stages and that they form regular exercise habits for a better rehabilitation outcome.