Abstract
Hip osteoarthritis is a common cause of pain and disability, and total hip arthroplasty (THA) is an effective treatment for advanced disease. Despite surgical success, many patients experience prolonged postoperative deficits, and conventional rehabilitation does not always restore full function. Virtual reality-based rehabilitation (VR-R) has recently emerged as a potential tool to enhance recovery through increased engagement and non-pharmacological pain modulation. We aim to comprehensively evaluate the effectiveness of VR-R after THA in improving functional recovery, reducing pain and opioid use, and enhancing overall rehabilitation outcomes. We systematically searched the following databases: PubMed, Scopus, Web of Science, Cochrane Library, and Embase until November 14, 2025. The quality of the included randomized clinical trials (RCTs) was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool. Statistical analysis was performed using the RevMan tool (v. 5; The Cochrane Collaboration, London, UK), with mean difference (MD) or standardized MD (SMD) for continuous data. Heterogeneity was evaluated using the I² statistic, and random-effects models were used when I² exceeded 50%. This systematic review was prospectively registered on PROSPERO (CRD420251268393). Seven studies met the inclusion criteria, comprising 397 patients. VR-R demonstrated a significant reduction in postoperative stress (SMD = -1.18; 95% confidence interval (CI): (-1.69, -0.67); p < 0.00001; I² = 0%). In contrast, no significant differences were observed between VR-R and conventional rehabilitation for pain (SMD = -0.87; p = 0.11), opioid consumption (SMD = -0.42; p = 0.40; I² = 87%), general mobility (SMD = 0.18; p = 0.32), or functional independence as measured by the Barthel index (MD = 8.00; p = 0.37). VR-R significantly reduces postoperative stress following THA but shows no significant benefits for pain, opioid consumption, mobility, or functional independence compared to standard care. Despite substantial heterogeneity across studies, VR-R represents a safe adjunctive tool for addressing psychological aspects of recovery. Standardized protocols and large-scale trials are needed to establish optimal implementation strategies.