Exercise interventions for postural stability in people after total hip arthroplasty for osteoarthritis: a systematic review

To synthesize the evidence for: (1) outcome measures and components of postural stability evaluated in people after total hip arthroplasty (THA) for osteoarthritis (OA), and (2) the effectiveness of exercise interventions delivered within the first three months post-THA for OA on short-term and long-term postural stability. MEDLINE, Embase, CENTRAL and CINAHL (inception to December 2024) were searched for randomized trials examining exercise interventions within three months post-THA for postural stability. Outcome measures and components of postural stability were identified using the Systems Framework for Postural Stability. Exercise intervention details were extracted using a modified TIDieR checklist, and trial quality was assessed with the PEDro scale. Of 16 trials, 15 were high quality (PEDro = 6-8), and one was low quality (PEDro = 4). The Timed Up and Go Test, assessing motor systems, anticipatory postural control, and dynamic stability was the most frequently used outcome measure (n = 9). Adding balance-challenging exercises to standard rehabilitation improved short-term postural stability more than standard rehabilitation alone. Long-term effects remain unclear. Limited number of outcome measures were used, assessing a few components of postural stability. Early postoperative exercise interventions improve postural stability, but greater clarity is needed to identify optimal assessments and exercise interventions.