Non-pharmacological interventions to reduce postoperative anxiety in total hip arthroplasty: a systematic review

Total hip arthroplasty is the surgical treatment of choice to improve the quality of life of patients with advanced osteoarthritis. This treatment aims to increase functional capacity and reduce pain. However, anxiety is one of the most frequently described uncomfortable experiences associated with this surgery. Although there has been extensive study of techniques to treat preoperative anxiety, little is known about interventions targeted at reducing postoperative anxiety associated with the fear and uncertainty of adjusting to life changes after surgery.

To conduct a systematic review of the literature to identify the non-pharmacological interventions that have been performed to reduce postoperative anxiety in patients undergoing hip arthroplasty and their effectiveness.

A bibliographic search was conducted in Pubmed, Scopus, and Web of Science until April 2026. Search was based on the following selection criteria: randomized clinical trials, quasi-experimental pre-post studies with or without control groups. Study selection and data analysis were conducted according to the predefined eligibility criteria and analytical approach, and the reporting was conducted according to the PRISMA 2020 guidelines. Risk of bias was assessed using the Cochrane Risk of Bias tool (RoB 2) for randomized controlled trials and ROBINS-I for non-randomized studies.

Included studies assessed technology-assisted interventions (immersive virtual reality, telemedicine, and video-based health education), nursing-led educational or behavioral programs (including self-efficacy-enhancing and continuous nursing care models), multimodal rehabilitation-based approaches, and complementary therapies such as aromatherapy. Overall, the most consistent reductions in anxiety were observed in studies evaluating immersive virtual reality and self-efficacy-enhancing interventions. Nursing-led and continuous care models also reported improvements, although findings were more variable. Educational and eHealth-based approaches showed benefits primarily in the short term. Telemedicine and aromatherapy demonstrated limited or inconsistent effects on anxiety. Substantial heterogeneity in interventions, outcome measures, and follow-up periods precluded quantitative synthesis; therefore, a structured narrative synthesis was performed.

Multicomponent nursing-led and technology-assisted interventions, particularly immersive virtual reality and self-efficacy-based programs, show the most consistent evidence for reducing postoperative anxiety following THA. Educational and eHealth-based interventions demonstrate short-term benefits, whereas telemedicine and complementary approaches such as aromatherapy show more limited or inconsistent effects. However, the overall evidence base remains heterogeneous and methodologically variable. Future research should prioritise adequately powered, multicentre trials with standardised outcome measures and longer follow-up periods.