Hip Fracture Recovery in the Elderly: Complete Rehabilitation Guide

Hip fractures in older adults are serious injuries requiring comprehensive rehabilitation. With the right approach, most people can regain mobility and independence. This guide covers everything you need to know about hip fracture recovery.

Understanding hip fractures in the elderly

Common types

• Intracapsular: Inside hip joint capsule
• Extracapsular: Outside joint capsule
• Femoral neck: Most common in elderly

Treatment options

• Hip pinning: Screws to hold fracture
• Partial hip replacement: Replace femoral head
• Total hip replacement: Replace entire joint

Hospital phase

First 24-48 hours

• Surgery usually within 24-48 hours
• Pain management
• Early mobilization crucial
• Sit out of bed day 1 post-op
• Standing with physiotherapist

Hospital stay (3-7 days typically)

• Daily physiotherapy
• Walking practice with frame
• Stair practice if needed
• Transfer training
• Discharge planning

Weight bearing status

Full weight bearing

Most common after surgery:

• Can put full weight through leg
• As much as comfortable
• Use walking aid for balance
• Progress as able

Partial weight bearing

Less common, if specified:

• Limited weight (e.g. 50%)
• Use crutches or frame
• Follow surgeon's instructions
• Usually 6 weeks

Recovery timeline

Weeks 1-2: Early recovery

• Home from hospital
• Walking with frame indoors
• Basic self-care with help
• Pain and fatigue significant
• Daily exercises essential

Weeks 3-6: Building strength

• Increased independence
• Progress to rollator or stick
• More self-care tasks
• Increased exercise intensity
• Short walks outside

Weeks 6-12: Continued improvement

• Walking with stick or unaided
• Most daily activities
• Stairs more confident
• Return to light activities

Months 3-12: Long-term recovery

• Continued strengthening
• Improved endurance
• Return to previous activities
• Some limitations may persist

Essential exercises

Bed exercises (start day 1 post-op)

Ankle pumps

• Point toes down, pull up
• 20 reps every hour
• Prevents blood clots

Knee bends

• Slide heel towards buttock
• 10 reps, 3 times daily
• Maintains knee movement

Static quads

• Tighten thigh muscle
• Hold 5 seconds
• 10 reps, 3 times daily

Straight leg raises

• Tighten thigh, lift leg
• Keep knee straight
• 10 reps, 3 times daily

Sitting exercises

Knee extensions

• Straighten knee fully
• Hold 5 seconds
• 10 reps each leg, 3 times daily

Hip marching

• Lift knee towards chest
• 10 reps each leg, 3 times daily

Standing exercises

Hip abduction

• Lift leg out to side
• Keep body upright
• 10 reps, twice daily

Hip extension

• Leg straight back behind
• Do not lean forward
• 10 reps, twice daily

Mini squats

• Small knee bends
• Hold support
• 10 reps, twice daily

Walking practice

Using a walking frame

1. Stand upright inside frame
2. Move frame forward
3. Step with operated leg
4. Bring other leg to meet it
5. Equal weight through both legs

Progressing to a stick

• When confident with frame
• Usually 2-6 weeks
• Stick in opposite hand
• Move stick with operated leg

Walking without aids

• When balance and strength adequate
• Usually 6-12 weeks
• May keep stick for outdoors
• Work on normal gait pattern

Managing stairs

Going up stairs

1. Good leg up first
2. Operated leg follows
3. Walking aid last
4. Use handrail

Going down stairs

1. Walking aid down first
2. Operated leg down
3. Good leg follows
4. Use handrail

Remember: "Up with the good, down with the bad"

Hip precautions

If you have a hip replacement

Follow these for 6-12 weeks:

• Do not bend hip past 90 degrees
• Do not cross legs
• Do not twist at hip
• Do not pivot on operated leg
• Keep knees apart

Safe positions

• Sit on high chairs
• Use raised toilet seat
• Sleep on back or unoperated side
• Pillow between knees

Preventing complications

Blood clots

• Take blood thinners as prescribed
• Do ankle pumps regularly
• Stay mobile
• Wear compression stockings
• Report calf pain or swelling

Chest infections

• Deep breathing exercises
• Sit upright regularly
• Stay mobile
• Report breathlessness

Deconditioning

• Get up and dressed daily
• Do exercises consistently
• Gradually increase activity
• Avoid prolonged bed rest

Nutrition for healing

Protein

• Essential for healing
• Include at every meal
• Meat, fish, eggs, dairy, beans
• Protein shakes if appetite poor

Calcium and vitamin D

• Important for bone health
• Dairy products
• Fortified foods
• Vitamin D supplement

Adequate calories

• Healing requires energy
• Do not diet during recovery
• Eat regular meals
• Nutritious snacks

Overcoming challenges

Pain management

• Take pain relief regularly
• Before exercises and activities
• Ice for swelling
• Pain should gradually improve

Fatigue

• Very common after hip fracture
• Rest between activities
• Gradually build stamina
• Improves over weeks

Fear and anxiety

• Normal after fracture
• Build confidence gradually
• Celebrate small wins
• Seek support if needed

The role of home physiotherapy

Fracture / Broken Bones Rehabilitation (18+) provides:

• Personalized exercise programme
• Progression guidance
• Walking and mobility practice
• Falls prevention strategies
• Support and motivation
• Liaison with hospital team

Preventing future fractures

Bone health

• Bone density scan
• Osteoporosis treatment if needed
• Calcium and vitamin D
• Weight-bearing exercise

Falls prevention

• Balance exercises
• Strength training
• Home safety review
• Appropriate footwear
• Vision and medication review

Realistic expectations

What to expect

• Most people regain independence
• May not return to exact previous level
• Walking aid may be needed long-term
• Some activities may be limited
• Quality of life can still be good

Factors affecting recovery

• Age and pre-fracture mobility
• Other health conditions
• Type of surgery
• Commitment to rehabilitation
• Support available

The bottom line

Successful hip fracture recovery requires:

• Early mobilization
• Daily exercises consistently
• Gradual increase in activity
• Good nutrition
• Pain management
• Falls prevention strategies
• Professional rehabilitation support
• Patience and persistence

Hip fractures are serious but most older adults can regain significant function with proper rehabilitation. The key is starting early, staying consistent with exercises, and having the right support at home.

About the author

Lizzie Thornton is a specialist community physiotherapist with over 15 years of experience in hip fracture rehabilitation. She is HCPC registered and a member of the Chartered Society of Physiotherapy. Lizzie provides home physiotherapy visits across Staffordshire Moorlands and Cheshire East, helping older adults recover from hip fractures and regain independence.

View Lizzie's profile