Rehabilitation is started as soon as possible after hip fracture surgery. The first goals may be to increase strength and to prevent atrophy on the unaffected side. Initially, only isometric exercise of the affected limb while it is fully extended is permitted. Placement of a pillow under the knee is contraindicated because it may lead to flexion contracture of the hip and knee.

Gradual mobilization of the affected limb usually results in full ambulation. Speed of rehabilitation depends partly on the type of surgery done. For example, after prosthetic hip replacement, rehabilitation usually progresses more rapidly, less rehabilitation is needed, and the functional outcome is better than after nail-and-plate or pin-and-plate fixation. Ideally, full weight bearing starts on the 2nd day after surgery. Ambulation exercises are started after 4 to 8 days (assuming that patients can bear their full weight and can balance), and stair-climbing exercises are started after about 11 days.

Patients are taught to do daily exercises to strengthen the trunk muscles and quadriceps of the affected leg. Prolonged lifting or pushing of heavy items, stooping, reaching, or jumping can be harmful. During ambulation, the amount of mechanical stress is about the same whether patients use 1 or 2 canes, but using 2 may interfere with certain activities of daily living (ADLs). Patients should not sit on a chair, particularly a low one, for a long period and should use the chair arm for support when standing up. While sitting, they should keep their legs uncrossed.

Occupational therapists teach patients how to modify ways of doing basic ADLs (BADLs) and instrumental ADLs (IADLs) safely after hip replacement, thus promoting healing and improving mobility. For example, patients may learn the following:

• To keep their hip correctly aligned
• To wash dishes and iron while sitting on a high stool
• To use a pillow to raise the seat of the car while transferring in and out
• To use long-handled devices (eg, reachers, shoe horns) to minimize bending over

This instruction may occur in the hospital, in longer-term rehabilitation settings, in the patient's home immediately after discharge, or in outpatient settings.

Last full review/revision February 2009 by Mathew H. M. Lee, MD; Alex Moroz, MD, FACP

Content last modified August 2010