OBJECTIVE: Compare the effectiveness of integrating virtual reality systems, Nintendo Wii and Microsoft Kinect, integrated with conventional physiotherapy versus conventional physiotherapy alone, in improving lower limb physical function in people over 60 years of age undergoing total hip arthroplasty. DESIGN: Randomised, single-blind clinical trial. Setting San Borja Arriaran Clinical Hospital, Santiago, Chile. Participants 111 individuals over 60 years of age, divided into three groups (n = 37 each). INTERVENTIONS: For six weeks, the control group received conventional physiotherapy. The Wii and Kinect groups received the same physiotherapy programme plus 15 min of exercise using virtual reality platforms. Outcome measures The primary outcome was the function subscale of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcomes included WOMAC pain, Berg Balance Scale, Six-Minute Walk Test, and weight-bearing. RESULTS: All groups improved. For WOMAC function, the Wii group surpassed the Kinect group (mean difference 40.48 points; p < 0.001; minimum clinically important difference MCID 11.9 points) but not the control group. The Wii group also led in balance (Berg Balance Scale mean difference 19.41 points; p < 0.001; MCID 11.5 points). The Kinect group was superior in the Six-Minute Walk Test (mean difference 133.10 metres; p = 0.001) and WOMAC pain reduction (mean difference 11.45 points; p < 0.003) exceeding the MCID of 2.2 points. No significant changes were observed in weight-bearing. CONCLUSION: Virtual reality combined with physiotherapy improves clinically meaningful outcomes following hip arthroplasty. The Wii favours balance, while Kinect enhances pain and gait, supporting personalised rehabilitation. TRIAL REGISTRATION: This research was registered in the Clinical Trials Registry of Australia and New Zealand (ACTRN12618001252202).

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