After hip fracture surgery, the goal is to get out of bed and stand the DAY AFTER the operation, with a physiotherapist and a walking frame. Most operations are designed so the leg can take full weight straight away.
Recovery is slower than after a planned hip replacement.
Most of the gain comes in the first six months, and it can continue for up to a year. Roughly half of people get back to the way they walked before the fall. The rest usually need more help or a walking aid than before, which is why the first months of rehab matter so much.
If you’re reading this for a parent, you can make a real difference. This guide is written for both of you. The surgical team’s plan always comes first, so check anything here against what they tell you.
Which operation, and why
The surgeon chooses based on where the break is, whether the bone has shifted, and how active the person was before.
- Pins or screws: for a crack in the neck of the thighbone that hasn’t moved out of place. The person’s own hip is kept
- A plate and screw, or a rod down the thighbone: for breaks lower down, between the bony bumps at the top of the thigh
- A half hip replacement, called a hemiarthroplasty: for a displaced break in the neck of the thighbone. The ball is replaced, the natural socket stays. This is the most common choice for older, less active people
- A total hip replacement: both ball and socket are replaced. Often offered to people who walked independently outdoors before the fall and are otherwise fit
Ask which operation was done and whether there are any rules about bending the hip. After a replacement, some teams give hip precautions for the first weeks.
See hip replacement precautions.
The first days in hospital
- Surgery is usually within a day or two of arrival. A short delay is sometimes needed to get someone medically ready, for example to manage blood thinners
- Day 1 after surgery: sitting out of bed and standing with a frame, with a physio. Pain relief should be good enough to allow this. If it isn’t, say so
- Every day after that: walking practice, getting on and off the bed, chair and toilet. Short and frequent is the pattern
- Confusion is common. Sudden muddled thinking after surgery, called delirium, happens to many older people after a hip fracture. It usually clears as they recover, but it needs to be reported and treated
Every day in bed costs strength. Every short walk buys some back.
How family can help in hospital
- Bring glasses, hearing aids and dentures. Seeing and hearing properly helps prevent confusion, and dentures make eating easier
- Bring proper footwear: closed-back slippers or shoes with a grip. No backless slippers
- Visit, talk and orient: the date, where they are, news from home. Familiar faces help
- Encourage drinking and eating. Poor intake slows healing and adds to confusion
- Tell the team what normal looks like: how your parent walked, thought and managed before the fall. It shapes their goals
- Ask about bone health. A break from a simple fall usually means the bones are weak. Ask whether a bone-strengthening medicine is planned. It lowers the chance of another fracture
Recovery after hospital
- Weeks 1 to 6: walking with a frame, often moving to a stick. Exercises every day for the hip and thigh. Help with washing, dressing and meals is common at this stage
- Weeks 6 to 12: walking further, going outdoors, getting up from lower chairs, managing stairs
- Months 3 to 6: the biggest gains in walking and balance usually happen by now
- Months 6 to 12: slower progress, especially for shopping, housework and getting out and about
Exercise programs that continue for three to six months after discharge have been shown to help, so the work shouldn’t stop when the hospital physio finishes. If nothing is arranged, ask for community or outpatient physio.
The American Academy of Orthopaedic Surgeons has a useful overview of hip fractures, the operations and recovery.
Preventing the next fall
Another fall is one of the biggest risks after a hip fracture. These make a real difference:
- Balance and strength exercise: programs that include balance and everyday movement practice cut falls by about a QUARTER. They work best done regularly and kept up long term
- A home check: loose rugs gone, clear walkways, night lights on the way to the toilet, rails by the stairs, bath and toilet
- A medicine review: sleeping tablets, some blood pressure pills and several other drugs raise fall risk. Ask the doctor or pharmacist to check them
- Eyes and feet: an up-to-date eye test, and foot problems seen to
- A way to get help: a personal alarm or a phone they can reach from the floor
- Getting up slowly: sit on the edge of the bed for a moment before standing, especially at night
How it compares with a planned hip replacement
A planned replacement happens to someone prepared and usually fitter, with time to get ready. A fracture comes with a fall, a shock and often an older, frailer body. The same operation can therefore mean a slower, less predictable recovery.
For the planned route, see hip replacement recovery week by week.
Go to the emergency department if
- There’s chest pain or sudden shortness of breath
- They fall again and can’t put weight on the leg, or the leg looks shorter or turned
- The hip suddenly clunks and becomes very painful to move
Call the ward, surgeon or doctor today if
- New or sudden confusion, drowsiness or agitation appears at home
- The calf is painful, swollen or warm
- The wound is red, hot, spreading or leaking, or there’s a fever
- They stop eating or drinking, or stop passing much urine
Mention it at the next review if
- Walking has stopped improving for several weeks
- Pain is limiting exercise or sleep
- There’s no plan yet for bone health or falls prevention
The operation fixes the bone. Daily walking, strength work and preventing the next fall bring the person back.