Hip Fracture Surgery and Recovery: A Guide for Elderly Patients

Hip fractures are the most serious fall injury in elderly patients. A hip fracture in a patient over 75 typically requires surgery and leads to a significant change in the patient's level of function and independence. Families often face difficult decisions about surgery timing, operative approach, and rehabilitation intensity. Understanding hip fracture treatment helps families navigate this crisis and optimize their parent's recovery.

For general guidance on preparing for any surgical procedure, see our guide to preparing for specialist appointments. This guide covers how to gather medical history, coordinate care, and prepare for surgery day.

Types of Hip Fractures

Hip fractures are classified by location:

Femoral neck fracture (subcapital fracture): The fracture occurs in the bone of the hip joint itself. These fractures can damage blood supply to the bone, leading to non-union or avascular necrosis. Treatment typically involves hip replacement rather than internal fixation.

Intertrochanteric fracture: The fracture occurs below the hip joint in the region between the major trochanters (bony prominences). Blood supply is usually preserved. Internal fixation with plates and screws is the usual treatment.

Subtrochanteric fracture: The fracture is below the intertrochanteric region. More unstable than intertrochanteric fractures, requiring stronger fixation.

Pathological fracture: The fracture occurs through abnormal bone due to cancer, osteoporosis, or other disease. Treatment depends on the underlying condition.

Your parent's surgeon has ordered X-rays to determine fracture type and location, which guides treatment.

Why Hip Fracture Surgery Cannot Be Delayed

Unlike some surgical emergencies, hip fracture surgery should be performed within 24-48 hours of injury:

• Delayed surgery increases risk of serious complications (blood clots, pneumonia, prolonged bed rest causing deconditioning)
• Early surgery allows early mobilization, reducing pneumonia and blood clot risk
• Delayed surgery increases post-operative pain and difficulty with rehabilitation
• For these reasons, most surgeons recommend surgery as soon as the patient is medically optimized (typically within 24-48 hours)

Pre-Operative Assessment for Hip Fracture

When a hip fracture is diagnosed, urgent assessment occurs:

Orthopedic assessment: The surgeon evaluates the fracture on X-ray and CT, determines operative approach, and estimates surgery timing.

Medical optimization: Attention to acute issues:

• Severe pain is managed
• If the patient has a full stomach (ate recently), fasting occurs before surgery
• Dehydration is corrected
• Cardiac and respiratory status are assessed

Cardiac clearance: If your parent has heart disease, ECG and cardiac assessment occur to ensure they can tolerate surgery and anesthesia.

Blood work: Complete blood count, clotting studies, kidney function, and blood glucose are checked.

Anesthesia consultation: The anesthesiologist assesses anesthetic risk, reviews medications and allergies, and discusses approach.

Typically, surgery occurs within 24 hours of fracture diagnosis once medical optimization is complete.

Surgical Approaches to Hip Fracture Repair

The surgeon chooses an approach based on fracture type:

Internal fixation with plates and screws: Most common for intertrochanteric and subtrochanteric fractures. The surgeon makes an incision, realigns the fracture, and secures it with metal plates and screws. The bone is expected to heal within 12-16 weeks.

Total hip replacement (arthroplasty): Used for femoral neck fractures, especially in patients over 75. The surgeon replaces the fractured hip joint with an artificial prosthesis. This has advantages in elderly: eliminates pain from the fracture, allows immediate full-weight-bearing, and avoids problems from non-union or avascular necrosis.

Hemiarthroplasty: Replacement of just the femoral head (not the acetabulum or hip socket), used for some femoral neck fractures.

The Hip Fracture Surgery: What Happens

Positioning and preparation: Your parent is positioned on the operating table (typically supine or lateral depending on approach). Monitoring equipment is placed. Anesthesia is administered (usually general, occasionally spinal).

Surgical incision: The surgeon makes an incision (typically 4-6 inches) along the hip. Muscles and tissues are carefully separated.

Fracture reduction: The fractured bone fragments are carefully realigned.

Fixation or replacement: If internal fixation, plates and screws are placed. If arthroplasty, the prosthesis is implanted.

Closure: The incision is closed with sutures or staples. A drain may be placed to prevent fluid buildup.

The surgery typically takes 1-2 hours.

Hospital Stay After Hip Fracture Surgery

Most patients stay 4-7 days post-operatively:

Day 0 (surgery day): Recovery from anesthesia in recovery room. Pain is managed. Antibiotics are given to prevent infection.

Day 1: Physiotherapy begins. Your parent starts standing and walking with assistance. Weight-bearing depends on fracture type and fixation strength (full weight-bearing usually allowed after hip replacement; partial weight-bearing after plate fixation, progressing to full weight-bearing).

Days 2-3: Walking progresses. Physiotherapy intensifies. Pain is managed.

Days 4-7: Walking improves. Discharge planning begins. Your parent is assessed for ability to care for themselves at home or need for rehabilitation facility.

Post-Operative Pain Management

Pain after hip fracture surgery is significant:

• IV opioid medications in immediate post-operative period
• Transition to oral pain medications by day 2-3
• Pain decreases significantly over weeks 2-4
• Most patients require opioid pain medications for 4-6 weeks
• NSAIDs and paracetamol are used adjunctively
• Physical therapy causes pain; adequate pain management supports rehabilitation

Physiotherapy: Critical for Recovery

Successful hip fracture recovery depends critically on physiotherapy. Your parent must commit to aggressive rehabilitation:

In-hospital physiotherapy (days 1-7): Standing with support, walking with walker or crutches, stair practice, chair transfers.

Post-discharge physiotherapy (weeks 1-12): Most patients require intensive physiotherapy, ideally at a rehabilitation facility or with home physiotherapy 3-5 times weekly.

Progressive goals:

• Weeks 1-2: Walking with walker, standing transfers
• Weeks 3-4: Walking with walker progressing to cane, toilet transfers
• Weeks 5-8: Walking with cane then independently, stair climbing, light household activities
• Weeks 9-12: Most activities resume, preparing for return to baseline function

Complications from poor rehabilitation: Patients who do not participate in aggressive physiotherapy develop:

• Permanent loss of mobility and independence
• Chronic pain
• Falls and re-fracture
• Psychological depression from loss of function

For this reason, families must prioritize and support intensive rehabilitation.

When to Use a Rehabilitation Facility vs. Home

After hospital discharge, rehabilitation can occur at:

Rehabilitation facility: 24-hour specialized care, intensive physiotherapy (usually 2-3 sessions daily), nursing care. Advantages: intensive therapy, close monitoring. Disadvantages: cost, less familiar environment, loss of home independence.

Home with home physiotherapy: Patient returns home, physiotherapist visits 3-5 times weekly. Advantages: home environment, independence, lower cost. Disadvantages: less intensive therapy, requires responsible caregiver, less monitoring.

Family support: Your parent's recovery is aided by:

• A responsible adult present 24/7
• Household modifications (elevated toilet seats, grab bars, walkers, canes)
• Encouragement and motivation for physiotherapy
• Pain management
• Monitoring for complications

Fracture Healing and Return to Full Activity

Healing timeline:

• Weeks 1-6: Early callus formation, bone begins to bridge
• Weeks 6-12: Consolidation, increasing bone strength
• Months 3-6: Complete bone healing expected
• Months 6-12: Remodeling continues; strength improves further

Return to activities:

• Weeks 1-6: Walker, protected weight-bearing if needed
• Weeks 7-12: Cane, most daily activities
• Months 4-6: Most recreational activities, no high-impact sports
• Months 6-12: Full activities as tolerated, including hiking, travel, golf

X-ray follow-up: X-rays at 6 weeks and 12 weeks confirm fracture healing. If healing is delayed, additional support or surgery may be needed.

Potential Complications Post-Operatively

Early complications (in hospital):

• Blood clots (DVT/PE): risk with immobility; prevented by early mobilization, compression stockings, anticoagulation
• Pneumonia: risk with immobility and anesthesia; prevented by early mobilization and breathing exercises
• Delirium: common in elderly post-operatively; usually resolves with time

Late complications (after hospital discharge):

• Non-union: fracture fails to heal; requires additional surgery
• Avascular necrosis: blood supply to bone is lost, leading to collapse (risk with femoral neck fractures)
• Hardware failure: plates or screws break or loosen
• Infection: wound or deep infection; rare but serious

When to seek care:

• Fever, wound infection signs
• Severe pain not controlled by medication
• Swelling, redness, or drainage from incision
• Inability to bear weight after weeks of progress
• Falls or new injury

Preventing Future Hip Fractures

After one hip fracture, risk of second fracture is high. Prevention includes:

• Calcium and vitamin D supplementation
• Osteoporosis treatment (medication if indicated)
• Physical therapy to maintain strength and balance
• Fall prevention: remove hazards, improve lighting, use walkers
• Vision and hearing assessment and correction
• Medication review (some medications increase fall risk)

Psychological Impact of Hip Fracture

Hip fractures are life-changing events. Many elderly patients experience:

• Loss of independence and confidence
• Depression and anxiety
• Fear of falling again
• Grief over loss of mobility

Families can help:

• Provide emotional support and reassurance
• Encourage gradual return to activities
• Celebrate rehabilitation milestones
• Discuss fears with physiotherapist and doctor
• Consider counseling if depression develops

Long-Term Outcomes After Hip Fracture

Outcomes vary based on:

• Pre-fracture function and health
• Fracture type and operative approach
• Quality of rehabilitation
• Home support
• Motivation

Most elderly patients:

• Recover good mobility over 3-6 months
• Return to independent living
• Live many more years after hip fracture
• Some have permanent limitation but maintain quality of life

For detailed information on the critical first 48 hours after hospitalization and discharge, see our guide to post-hospital care in the first 48 hours. For families managing hip fracture care for elderly parents remotely, our Kochi companion service coordinates urgent surgery, provides in-hospital support, arranges post-operative rehabilitation, and monitors recovery progress.

This article is for informational purposes only. Hip fracture surgery decisions should be made with your parent's orthopedic surgeon. For our editorial standards, see our editorial policy.