PURPOSE: To synthesize evidence on the effects of balance-based interventions in patients undergoing total knee (TKR) or hip replacement (THR) on self-reported functionality and balance outcomes. MATERIALS AND METHODS: A systematic review with meta-analysis evaluated the effects of balance-based interventions on self-reported functionality and balance, as well as on pain and quality of life. Databases (MEDLINE, Embase, Cochrane, PEDro, Scopus) were searched up to 15th February 2025. Methodological quality and risk of bias were assessed (PEDro scale and Cochrane tool). A standardized mean differences (SMD) meta-analysis was conducted with 95% CI. Certainty of evidence was cataloged with GRADE. RESULTS: Twenty studies with 1118 participants were included. Balance-based interventions showed greater self-reported functionality (SMD 95% 0.42 (0.03 to 1.12)) and significant improvements in dynamic, static, and global balance (SMD 95% 1.18 (0.40 to 1.96), 1.01 (0.31 to 1.72), 1.42 (0.1 to 2.73)) compared to controls for the immediate term. Evidence quality ranged from low to moderate. Similar trends were observed in the other outcomes. CONCLUSION: Balance and proprioceptive interventions may improve short-term balance and self-reported function in TKR and THR rehab when added to conventional care. However, their impact on health status and performance measures is inconsistent, and more high-quality research is needed to assess long-term effectiveness.

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