Broken Hip: Recovery Time & Walking in Young Adults and Elderly

How does the rehabilitation process go for a hip fracture, in elderly patients and young adults? And what is the recovery and healing time?

18% of women and 6% of men will have a hip fracture in their lifetime; in other words, a lot of people, especially among the elderly.

Hip fractures usually occur as a result of a fall, and surgery is often necessary. In the vast majority of cases, rehabilitation is required to regain the ability to perform daily tasks. Physical therapy sessions are prescribed.

These are the main aspects of managing a hip fracture.

I answer all the most frequent questions from patients and their families based on:

👩🏽‍⚕️ my experience as a physical therapist since 2009;
📚 extensive research in the international scientific literature.

Have more questions? Want to share an experience? Leave them in the comments, and I’ll be happy to respond 🙂.

What are the different types of hip fractures?

The femur is the hip bone that is most commonly fractured, particularly at its upper end (called the proximal end), specifically in its neck area. This is why it is called a femoral neck fracture or hip fracture.

However, there are other possible locations for a hip fracture. Here is a list of them, along with an explanatory diagram of the different locations of hip fractures at the upper end of the femur:

• Intracapsular fractures:
  • Femoral neck fracture, or fracture of the femoral neck, or subcapital hip fracture (these are the ones we will focus on here).
  • Femoral head fracture.
• Intertrochanteric hip fractures, pertrochanteric fracture of the femur. I talk about it in my blog post on the gamma nail after femur fracture.
  • Fracture of the Greater Trochanter / Greater trochanteric fracture
  • Fracture of the Lesser Trochanter
• Subtrochanteric fractures
• Acetabular fracture or fracture of the socket (the socket is the old name for the acetabulum) : right or left acetabulum
• Anterior superior labrum hip fracture.
• Hairline hip fractures
• Periprosthetic fractures

Rehabilitation after a femoral fracture is fairly similar regardless of the location of the fracture (whether in the femoral neck, trochanter or acetabulum). The approach to care is usually the same, regardless of the type of fracture:

• A hospital stay of a few days in an orthopedic and trauma ward.
• Surgical treatment or orthopedic treatment (i.e. partial immobilization or partial or total no weight bearing of the leg for a certain period of time).
• A stay in a rehabilitation and readjustment care center or a return home, in all cases with at least a few rehabilitation sessions via physiotherapy at the hospital, then at home, in a clinic or center.

How long does the femur surgery last and what does it involve?

The duration of the surgical procedure for a fracture of the proximal end of the femur depends on several parameters:

• The age, functional abilities, and medical history of the patient, including the presence of cognitive impairments.
• The severity and location of the fracture on the femur.
• The preferences and habits of the surgeons.

Based on these parameters, different types of materials can be used to stabilize the joint, such as:

• a total hip replacement (arthroplasty),
• osteosynthesis with screws or a plate,
• femoral nail with or without cement,
• hip fracture repair and internal fixation: hip pinning,
• or intramedullary nailing (gamma nail),
• among others.

The duration of the surgical procedure is at least 1 hour and can last up to about 3 hours, or even longer in the case of a complex fracture. On average, it lasts around 1 hour and 30 minutes.

The surgery for a femur fracture is performed under local anesthesia (spinal anesthesia) or general anesthesia. It often takes place on the day of the fall or the next day and is performed in an operating room.

Surgeons use specific materials and biomaterials that are inserted into the femur to consolidate the fractured area. After awakening from anesthesia, analgesics are usually administered via infusion to minimize postoperative pain.

After a stay in the recovery room, patients are transferred to a trauma unit where they remain for several days.

Compression stockings are usually prescribed (unless contraindicated) to reduce the risk of deep vein thrombosis.

What is broken hip treatment without surgery?

Most of the time, femoral fractures are treated with surgery. Sometimes, however, conservative treatment or orthopedic treatment (partial immobilization of the lower limb using a splint) may be chosen. In this case, the hip fracture is not operated on.

There are no clear and unanimous criteria for determining whether a fracture should be operated on or not.

This depends on the location of the fracture, as well as the autonomy of the elderly person or the ease of access to modern surgical equipment. It will be easier not to operate on someone:

• who was already unable to walk before the fracture,
• or whose life expectancy is very low due to other pathologies,
• or who is at risk of not tolerating the anesthesia associated with the operation.

In general, it is still preferable to operate on a hip fracture because:

• The hospital stay is shorter;
• Rehabilitation in the aftermath is simpler and faster;
• Recovery of functional abilities is better;
• There is less risk of deformity of the lower limb in the aftermath.

(Handoll 2008)

When the decision is made not to operate on a femoral fracture, the following care is administered:

• Pain treatment with oral medication or infusion;
• Possible partial immobilization of the lower limb using a splint and instructions to put as little weight as possible on the lower limb for 3 to 6 weeks, sometimes longer;
• A stay of several days or weeks in the hospital;
• Rehabilitation, either in the hospital or in a rehabilitation center, or at home.

I wrote a more comprehensive blog post on life expectancy after a hip fracture.

How long we stay in hospital after a hip fracture?

The length of hospital stay after hip fracture varies depending on the person’s age, the course of the procedure, the person’s recovery abilities, their living situation, and their support network.

The hospital stay for a femur fracture can be:

• About 3 days for a relatively young and healthy person who lives with a partner or children, has no cognitive impairments, had a straightforward operation without complications, and lives in a single-story house or easily accessible apartment.
• About 5-10 days for someone who lives alone or had some difficulties at home, has less accessible housing, is waiting for a place in a rehabilitation center, or had some complications such as bleeding requiring a transfusion.
• Several weeks for someone with cognitive impairments, significant loss of autonomy, and no available rehabilitation placement.

In studies conducted on the subject, the average length of hospital stay indicated is longer. It’s possible that it’s precisely the fewer people who stay in the hospital for an extremely long time that influence these averages:

• 🇬🇧 The average length of hospital stay for femur fracture is 23 days in the UK.
• 🇮🇹 The average length of hospital stay for femur fracture is 15 days in Italy.
• 🇺🇲 The average length of hospital stay for femur fracture is 6.5 days in the US.
• 🇫🇷 In France, in 1987, the average length of hospital stay for femur fracture in Picardy was 21.6 days. In France in 2009, it was on average 12.7 days.

What is the healing time after broken hip?

The healing time for the femur bone is approximately 6 weeks if everything goes well. That’s why a follow-up X-ray is usually done 6-8 weeks after hip surgery to ensure that the hardware is in place and that bony healing, a sign of good consolidation, has occurred.

Sometimes it takes several months for complete healing.

But often, you can resume all your activities before complete healing!

Hip fracture: Recovery time in young adults

The healing time remains roughly the same in young people after a broken femur: around 6 weeks. However, young people regain their autonomy to walk, do sports, and resume their daily activities more quickly.

Walking without crutches is often possible 1 to 2 months after the hip fracture, and running can be resumed a few months after the fracture.

Broken femur: Recovery time in elderly

We’ve seen that the average hospital stay in France for a femur fracture is currently about ten days. This is often followed by a stay in a rehabilitation center, also known as a convalescent home or rehabilitation center.

The stay after a femur fracture is usually several weeks in these places, typically between 4 and 10 weeks.

Once discharged, the recovery continues for several more weeks.

After a broken femur, elderly individuals typically take at least 2 to 3 months to regain their previous level of independence.

If physical therapy takes place at home, the recovery time is the same. It usually takes several weeks, and in the best-case scenario, it can take 3 months to recover the previous walking distance and speed.

A synthesis of studies looks at the time it takes to regain autonomy after a femur fracture (Dyer et al., 2016).

A study of hip fracture patients from the US in the 1980s found that most patients who recover their ability to perform IADL do so within the first 6 months.
The proportion who were fully independent was greater at 6 months post-discharge than at 2 months post-discharge.
Over the following 6-month period, approximately 20 % of patients improved further while a similar proportion declined to the same degree.

Dyer et al. 2016

See this blog post: Recovery time for hip replacement in elderly

Physical therapy after hip fracture in adults: what?

Whether the hip fracture is treated with surgery or not, rehabilitation is often necessary. Here’s what it involves and the answers to common questions about rehabilitation after a broken hip.

In case of surgery with a femur fracture, the resumption of walking and hip mobility should be done as early as possible after the intervention. Physiotherapists perform an assessment in the days following the surgery or fall, in order to personalize and adapt rehabilitation. This usually consists of:

• Monitoring the decrease in pain related to the operation or fracture and providing advice to limit its increase and promote its reduction;
• Recovering functional joint ranges of motion of the hip in flexion, abduction, extension, and rotation. This may not necessarily require manual mobilization but can be done through active exercises, including standing, which have the advantage of also engaging muscle strength and patient empowerment;
• In case of hip replacement surgery, learning movements to avoid hip prosthesis dislocation;
• Recovery of lower limb muscle strength;
• Maintenance of the cardiovascular system to prevent postoperative complications and promote a quicker return to daily activities;
• Possible re-learning of transfers, walking, climbing and descending stairs, and other daily activities, despite the discomfort related to the fracture;
• Gradual weaning off of walking aids;
• Implementation of measures to prevent another fall or limit its harmful consequences (adaptation of the environment, choice of walking aids, learning how to get up from the ground, etc.), and management of any post-fall syndrome.

Some studies are being conducted to determine whether certain rehabilitation techniques and principles are more effective than others: muscle strengthening with quadriceps electrostimulation, treadmill walking, electrotherapy for pain relief, home-based physiotherapy, rehabilitation at home lasting more than a year, rehabilitation started more than 2 months after the fracture, teleconsultations.

Currently, it is difficult to say whether it is more relevant or not to use a particular rehabilitation technique, or whether it is better to start rehabilitation in the hospital or after discharge.

However, there is a consensus that rehabilitation is important and necessary after a femur fracture.

(Handoll et al. 2011)

Home-based rehabilitation is also linked to a higher quality of life for people over 65 and better health. (Peeters et al. 2016)

Is it possible to walk after hip fracture?

It’s the surgeons who examine the X-rays after a femur fracture and determine whether or not the person can put weight on their fractured leg or whether they should avoid putting their foot on the ground for several weeks (at least 6 weeks, sometimes 2 or 3 months).

In any case, walking is possible with a femur fracture, and it’s even recommended.

• If weight-bearing is not possible, walking should be done without weight-bearing using the help of 2 crutches or a walker.
• If this is too difficult due to balance or strength issues, it’s recommended to simply stand up several times a day to maintain the habit of standing and maintain strength.

Read my more comprehensive article: Can you walk with a femur fracture?

In the case of hip replacement or a gamma nail, weight-bearing is possible most of the time. Due to pain, it’s often necessary to use a walking aid for at least the first few weeks: crutches, walker, or walking frame. As soon as the pain decreases, walking is possible without any assistance.

See this article on pain after hip replacement.

What is the life expectancy after a hip fracture?

The life expectancy after a femoral neck fracture is several years, regardless of age.

• For those under 50, whether male or female, life expectancy is only reduced by 4 and 6 years, respectively, compared to those of the same age who have not had a fracture.
• For men and women aged 51-60 at the time of the fracture, life expectancy is reduced on average by 7.5 years compared to those who have not had a femur fracture.
• For those aged 71-80 at the time of the fracture, the years of life lost compared to people of the same age without a femur fracture are about 5 years.
• For men and women over 80 at the time of the fracture, life expectancy is reduced on average by 3 years compared to those of the same age who have not had a femur fracture.

(Vestergaard 2009)