What are the challenges in recovering from a hip fracture?

From the Guidelines

Hip fracture recovery is a complex process that requires a multidisciplinary approach, including protocol-driven, fast-track admission, multidisciplinary care, surgery within 48 hours, and high-quality communication between clinicians and allied health professionals, as well as early mobilization and measures to prevent secondary falls. Pain management is often difficult, requiring a combination of medications like acetaminophen (1000mg every 6 hours), NSAIDs when appropriate, and initially stronger opioids that gradually taper as healing progresses 1. Mobility limitations are substantial, with patients typically needing assistive devices like walkers or canes for 3-6 months, and a structured physical therapy program (2-3 sessions weekly for 8-12 weeks) focusing on strength, balance, and gait training. Complications are common, including blood clots (preventable with blood thinners like enoxaparin 40mg daily for 4-6 weeks), pressure sores, and pneumonia. Many patients, particularly older adults, experience significant functional decline, with only 40-60% regaining their previous independence level.

Recovery is further complicated by the psychological impact, including depression and fear of falling. Nutritional challenges are also present, with increased protein needs (1.2-1.5g/kg daily) to support bone healing, and oral nutritional supplements (ONS) are recommended to reduce complications and improve outcomes 1. The recovery timeline is lengthy, typically 3-6 months for basic healing, but full recovery may take a year or longer, especially in elderly patients with pre-existing conditions.

Some key considerations in hip fracture recovery include:

• Early surgery and mobilization to reduce complications and improve outcomes
• Multidisciplinary care, including orthogeriatricians, physical therapists, and nutritionists
• High-quality communication between clinicians and allied health professionals
• Measures to prevent secondary falls, such as removing tripping hazards and using assistive devices
• Nutritional support, including ONS, to reduce complications and improve outcomes
• Psychological support, including counseling and therapy, to address depression and fear of falling.

Overall, a comprehensive and multidisciplinary approach to hip fracture recovery is essential to improve outcomes and reduce complications 1.

From the Research

Hips Fracture Recovery Challenges

• Hip fracture is a significant public health problem affecting an estimated 1.6 million persons annually, with more than half of those who sustain a fracture either dying or not returning to functional abilities present before fracture required to function independently 2
• The consequences of hip fracture are significant, and recovery patterns can be complex, with target areas and timing for interventions suggested to optimize recovery 2
• Comprehensive rehabilitation is essential for promoting physical function recovery and minimizing complications in older patients with hip fractures, which can be achieved through a multidisciplinary approach 3

Rehabilitation and Recovery

• A multidisciplinary approach, progressive resistance exercises, and balance training are strongly recommended for rehabilitation after hip fracture surgery 3
• Early ambulation, weight-bearing exercises, activities of daily living training, community-level rehabilitation, management of comorbidities/complication prevention, and nutritional support are also suggested 3
• Patients consider recovery as a return to pre-fracture activities or "normal" enabling independence, and feelings of vulnerability are observed irrespective of the time since hip fracture 4

Predictors of Hip Fracture

• Predictors of hip fracture despite bisphosphonate use among frail older adults include age 75 years or older, female sex, white race, and body mass index = 18.5-24.9 5
• Independent ability to transfer and occasional urinary incontinence are also important predictors of hip fracture 5
• Bisphosphonate use is associated with a decreased risk of hip fracture in older men and women, with similar risk reductions in individuals older than 80 years 6