Objective <p>This study aimed to systematically search and synthesize qualitative research data regarding the facilitators and barriers affecting rehabilitation exercise adherence in patients following Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA).​</p> Methods <p>Relevant qualitative studies were retrieved from both English and Chinese databases, including PubMed, EMBASE, CINAHL, Web of Science, Cochrane Library, CNKI, Wanfang Database, VIP Database, and China Biology Medicine database. The search period spanned from the establishment of each database to September 1, 2025. The PICO framework was adopted to develop the search strategy. Two researchers independently conducted literature screening, data extraction, and quality assessment. The quality of the included studies was evaluated using the qualitative research appraisal criteria proposed by the Joanna Briggs Institute (JBI). Data synthesis was conducted in accordance with the thematic synthesis method proposed by Thomas &amp; Harden (2008).</p> Results <p>A total of 19 studies were included, involving 205 TKA patients, 111 THA patients, and 17 healthcare providers. The study results were derived from these 19 qualitative studies and obtained using the thematic synthesis method. From these studies, 78 original findings were extracted, categorized into 10 new categories, and further synthesized into 2 meta-themes:​Facilitators to rehabilitation exercise adherence for THA/TKA patients: Self-motivation and rehabilitation goals, effective rehabilitation strategies, establishment of doctor-patient trust, and multidimensional support networks.​Barriers to rehabilitation exercise adherence for THA/TKA patients: Physical symptoms and functional limitations, fear of movement, cognitive biases, lack of rehabilitation-related knowledge, psychological stress and negative emotions, and socio-environmental constraints.​These two meta-themes reflect the interactive and multi-level characteristics of the factors affecting rehabilitation exercise adherence, revealing the relationship between individual subjective factors, medical and health service factors, and social environmental factors in the process of patients' rehabilitation exercise.</p> Conclusion <p>The evidence-based findings of this study derived from thematic synthesis reveal the multi-dimensional factors influencing rehabilitation exercise adherence in patients after THA/TKA. These findings provide a basis for understanding the contradictions and demands in the process of patients' participation in rehabilitation exercises, and can serve as a reference for healthcare professionals to develop targeted intervention strategies. This helps optimize the management of patients' rehabilitation exercises, thereby promoting postoperative joint function recovery and accelerating the rehabilitation process.</p>