Network analysis reveals the path to recover whole-body coordination after arthroplasty for unilateral total hip osteoarthritis

Hip arthroplasty or hip replacement surgery for total osteoarthritis aims to restore mobility, not just in the replaced joint but also in reintegration into whole-body movement. Traditional biomechanical approaches can address joint-specific movement outcomes but risk overlooking broader neuromuscular adaptations emerging before and after surgery. We use network analysis to examine how movement coordination reorganizes in unilateral total hip osteoarthritis (HOA) patients before and after total hip arthroplasty (THA) surgery (ClinicalTrials.gov Identifier: NCT01907503. Registered July 25, 2013). Local, global, and integrative properties of movement networks reveal how osteoarthritis disrupts coordination and the extent of post-surgical recovery. Pre-surgery movement patterns exhibit severely compromised whole-body coordination by various network metrics: localized compensations, fragmented coordination, asymmetrical movements, altered synergies between key segments, and increased reliance on the unaffected limb. These asymmetries persist post-surgery, particularly in the contralateral limb, suggesting a compensatory neural reorganization of pre-surgery motor control that extends beyond surgery and slows full restoration of bilateral coordination. THA can balance local connectivity and improve whole-body integration, but the persistence of elevated participation coefficients in both limbs indicates lingering motor adaptations and altered control strategies. Framed within an exercise-as-medicine perspective, these findings highlight the rehabilitative value of network-analytical frameworks. They enable tracking of functional recovery and guide targeted, progressive exercise aimed at whole-body reintegration and inter-limb coordination. By quantifying the balance among local adaptations, global coordination, and asymmetry, this approach yields actionable insights into post-surgical motor reorganization for clinical decision-making and personalized exercise rehabilitation planning.