Objective <p>To understand the authentic early postoperative ambulation experiences of older patients with kinesiophobia following total hip arthroplasty, with the aim of developing early rehabilitation intervention programs for this group.</p> Methods <p>This qualitative study employed purposive sampling to recruit 23 patients with kinesiophobia following total hip arthroplasty. Data were collected through semi-structured interviews, and the transcribed texts were analyzed, categorized, and thematically refined using framework analysis.</p> Results <p>Patients assessed early postoperative ambulation through two main dimensions: threats and responses, which were further categorized into seven themes. The threat assessment included perceived severity (pain and risk of re-injury), susceptibility, internal rewards (self-satisfaction and internal burden), and external rewards (social support and external burden). The response assessment included response efficacy (questioning the effectiveness of activities and being influenced by other patients’ experiences), self-efficacy (lack of trust in their physical condition, negative impact of social support, and lack of accurate understanding of rehabilitation information), and response cost (overcoming inertia, requiring more family support and medical resources).</p> Conclusion <p>It is essential to improve patients’ judgment on the severity and susceptibility of early ambulation, provide as much support as possible, enhance response efficacy and self-efficacy, reduce response costs, and increase motivation and compliance for early ambulation to improve health outcomes for patients.</p>