Objective:To determine the difference in physical activity levels before and up to one year after unilateral primary total hip replacement.Data sources:A search was performed on 13 July 2016. Studies were eligible for inclusion if they presented preoperative and up to one year postoperative measures of physical activity for patients who had undergone unilateral primary total hip replacement.Review methods:Any article that used a measure of physical activity pre and up to one year post-unilateral primary total hip replacement. Data was synthesised using a meta-analysis with 95% confidence intervals (CI), if appropriate. The Critical Appraisal Skills Programme cohort study checklist was used to assess the quality of evidence.Results:From 6024 citations, 17 studies were selected: Nine studies were analysed in a meta-analysis and eight studies were analysed qualitatively. The quality of the evidence was ‘low’ to ‘moderate’. There was no statistically significant difference in physical activity pre- to post-total hip replacement when assessed using: movement-related activity (mean difference (MD): −0.08; 95% CI: 1.60, 1.44; I²= 0%; n = 77), percentage of 24-hours spent walking (MD: −0.21; 95% CI: −1.36, 0.93; I²= 12%; n = 65), 6-minute walk test (MD: −60.85; 95% CI: −122.41, 0.72; I²= 84%; n = 113) or the cardiopulmonary exercise test (MD: −0.24; 95% CI: −1.36, 0.87; I²= 0%; n = 76).Conclusion:There is no statistically significant difference in physical activity levels before and up to one year after unilateral primary total hip replacement. However, the low to moderate methodological quality of the included articles should be taken into consideration when drawing conclusions.