A hip fracture changes a life overnight. Most patients are over 70, recovering at home with family help, trying to get back to walking the dog or playing with the grandkids. The first six weeks are non-negotiable. Get them right and most patients return to their pre-fracture function. Get them wrong and you spend years catching up.
Two different surgeries, two different recoveries
Almost all hip fractures involve the upper part of the femur. The neck of femur, the intertrochanteric region, or the subtrochanteric region. These are different injury patterns and they get different operations.
Hemiarthroplasty (partial hip replacement) replaces the head of the femur with a prosthesis but leaves the natural hip socket alone. Most commonly used for displaced neck of femur fractures. ORIF (Open Reduction Internal Fixation) holds the bone with screws, a plate, or a long nail. Used for intertrochanteric and non-displaced neck of femur fractures. There's a third option, full Total Hip Replacement, used in younger or higher-demand patients with hip fractures. We cover that recovery in a separate post. Know which operation you had. The hip precautions, weight-bearing protocol and risks are different.
Why early mobilisation is the single biggest predictor of recovery
Hip fracture recovery research is remarkably consistent on one point. How quickly you get up and walking after surgery predicts outcomes more than almost anything else. Most patients are weight-bearing as tolerated from day one. Hospital stay is typically five to seven days. A patient who doesn't walk in the first 24 to 48 hours after surgery has dramatically worse outcomes. If you're feeling unwell, in pain, or scared, say so. Then ask the ward physio to come back. The bed is the enemy.
What the timeline looks like
- Day 1 to 3: Walking 5 to 10 metres with a frame and physio assistance. Transfer training, in and out of bed, chair, toilet. Pain management and complication prevention (DVT, chest infection).
- Week 1 to 2: Walking 20 to 100 metres with a frame. Stairs with a rail and support. Some patients transition to elbow crutches.
- Week 2 to 6: Frame to crutches to walking stick, sometimes within weeks. Hip and glute strengthening. Sit-to-stand without using the arms is a key milestone. Hip precautions still apply if you had a posterior approach hemiarthroplasty.
- Week 6 to 12: Walking without an aid indoors, then outdoors on flat surfaces. Outdoor walking on uneven surfaces with gradual exposure. Glute strengthening to address the Trendelenburg gait pattern that often persists.
- Month 3 to 6: Return to community life. Strength training. Fall prevention. Goal-based rehab. What does YOUR full life look like? Bowls, mosque, shops, grandkids.
The second fall is the biggest risk
The single biggest risk after a hip fracture is another fall. The fear of falling itself contributes to that risk. Patients who avoid outdoor walking because they're scared end up weaker, less balanced and more likely to fall the next time they have to.
The fix isn't to avoid the situations that scare you. It's graded exposure to them, with a physio there to manage the load. Indoor floors, then outdoor pavements, then slopes, then uneven ground, then dual-task work like walking while carrying or walking while talking. By discharge, the nervous system has been trained on the surfaces you actually live on.
The strength gap after a hip fracture doesn't close on its own. Older adults need MORE strength training after a hip fracture, not less. Light bands aren't enough.
Common mistakes (patients and families)
Five patterns we see. First, treating the fracture as a permanent loss of independence. Most patients return to pre-fracture function with structured rehab, but they need rehab, not just rest. Second, stopping at six weeks because they "feel fine." The strength deficit takes months to close. Third, avoiding outdoor walking out of fear. Avoidance makes the fall risk worse, not better. Fourth, families doing too much. The instinct to help with everything strips the patient of the loading their body needs to recover. Fifth, skipping strength work. Loaded resistance training is one of the most evidence-based interventions for restoring independence after hip fracture, at any age.
How we structure hip fracture rehab
We typically see hip fracture patients twice a week through the first six weeks, then weekly through month three, then fortnightly through month six. We work alongside community physio teams, GPs and surgical rooms, and will liaise directly with them with your permission. We accept EPC/Medicare referrals from your GP, DVA referrals, and HICAPS on-the-spot for all major private health funds. Home visits available in select cases, call to discuss. Book a 60-minute initial within the first two weeks of leaving hospital if you can. Bring a family member if it helps.