BACKGROUND: An increasing body of evidence suggests that home-based exercise (HBE) therapy has significant therapeutic effects on knee osteoarthritis (KOA) and hip osteoarthritis (HipOA), and it has advantages such as cost savings, strong operability, and good compliance compared with hospitalization and exercise courses. OBJECTIVE: To evaluate the efficacy of HBE in the treatment of KOA and HipOA. METHODS: A systematic search was conducted in PubMed, Cochrane, Web of Science, and Embase to collect randomized controlled trials. The retrieval time was from database establishment until March 6, 2024. Stata 15.1 software was used for data analysis. RESULTS: A total of 16 randomized controlled trials involving 3,015participants were included, with 1,519 participants in the intervention group and 1,496 in the control group. The meta-analysis showed that, compared to the control group, HBE can significantly improve pain (SMD -0.38, 95% CI (-0.58 to -0.18); p = 0.001), joint function (SMD -0.60, 95% CI (-1.01 to -0.19); p = 0.004), balance ability (SMD -0.67, 95% CI (-1.00 to -0.34); p = 0.001), mobility (ADL) (SMD 0.51, 95% CI (0.19 to 0.82); p = 0.002) in patients with KOA and HipOA. There is no statistical difference in the improvement of joint stiffness (WMD -0.80, 95% CI (-1.61 to 0.01); p = 0.052). In addition, subgroup analysis showed that HBE significantly improved pain, joint function, and balance ability in KOA patients compared with the control group. HipOA patients showed significant improvement in pain and joint function; However, HBE only improved activity ability in patients with comorbidities of KOA and HipOA. CONCLUSION: HBE can effectively alleviate pain, improve joint function, and enhance physical function in patients with KOA and HipOA. However, more high-quality randomized controlled trials (RCTs) with large sample sizes and long-term interventions are needed to validate the efficacy of HBE due to limitations in the methodology and consistency of indicator outcomes in the included RCTs. REGISTRATION NUMBER: We've registered with PROSPERO, and the number is CRD42023443085.

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