Early rehabilitation using virtual reality-based therapy can enhance hip function and self-perception of improvement following total hip arthroplasty: A systematic review and meta-analysis

• VRBT, combined with physiotherapy, could be effective in early rehabilitation after THA. • Physical exercises using VRBT, especially NIVR devices, suggest to be effective in increasing function and reduce disability. • Cognitive exercises using VRBT improves cognitive function and increase the subjective perception of improvement. • Passive immersive VRBT did not seem to be effective in reducing pain intensity after THA. To investigate the effectiveness of virtual reality-based therapy (VRBT) after total hip arthroplasty (THA). PubMed, SCOPUS, WOS, PEDro and CINAHL were consulted for results up to April 2024. Randomized controlled trials (RCTs) that assessed the effectiveness of VRBT (physical and cognitive videogames) in patients after THA were included. Pooled effect was assessed using standardized mean difference (SMD). This systematic review included 5 RCTs with 287 patients. Meta-analyses showed that VRBT, specifically non-immersive virtual reality (NIVR), combined with physiotherapy can be effective in reducing hip disability (SMD=-0.46; P = 0.018) and increasing hip function (SMD = 0.6; P = 0.002) after THA. The qualitative synthesis suggested that cognitive exercises using NIVR can improve disability, physical function, cognitive abilities and subjective perception of improvement. In contrast, passive immersive VRBT did not seem to have an impact on pain and hip function. Combining VRBT (mainly NIVR) with physiotherapy could be effective in early rehabilitation after THA.