Hip fracture surgery is usually performed as an emergency within 36 hours of admission. This guide covers what patients and families should expect from the operation and recovery.
ℹ️ You or your family member will be assessed by the orthopaedic and orthogeriatric teams. Blood tests, ECG, and chest X-ray are performed. The anaesthetic team will assess fitness for surgery.
The exact operation depends on the fracture type. Intracapsular fractures are typically treated with hemiarthroplasty (replacement of the femoral head). Extracapsular fractures are fixed with a dynamic hip screw or intramedullary nail. Surgery typically takes 45-90 minutes.
You will be asked not to eat or drink from midnight. Clear fluids may be permitted up to 2 hours before - your team will advise.
Nerve block (fascia iliaca block) is often performed in A&E or on the ward to reduce pain while awaiting surgery. This significantly reduces opioid requirements.
Any reversible medical conditions (anaemia, anticoagulation reversal, cardiac conditions) are addressed before surgery to minimise risk.
The NICE guideline recommends surgery within 36 hours of admission. Delay beyond this is associated with increased complications, pain, and mortality.
ℹ️ You will be given a specific arrival time. Do not eat or drink (other than clear water up to 2 hours before) from midnight the night before. Bring your medication list and any documents sent by the hospital.
You will be admitted to the ward or day surgery unit, change into a gown, and be seen by the nursing, anaesthetic, and surgical teams before theatre.
Your surgeon will confirm the procedure, mark the operative side, and you will sign a consent form before going to theatre.
You will meet the anaesthetist in the anaesthetic room. Once anaesthesia is established, the procedure will begin.
After surgery you will wake in the recovery room where nurses monitor your vital signs until you are stable and comfortable.
Most patients having arthroscopic or day-case procedures go home on the day of surgery. Those having joint replacement typically stay 1–2 nights. Before discharge, the team will check your pain is controlled, give you wound care instructions, and confirm your follow-up appointment.
You will be given oral pain relief before discharge. Take it regularly for the first 48 hours rather than waiting until pain is severe.
A nurse will check the wound before you leave and explain how to keep it clean and dry.
You will receive a letter for your GP and details of your next outpatient appointment - usually at 2 weeks for a wound check.
Arrange for a family member or friend to collect you. You must not drive on the day of surgery if you have had a general anaesthetic or sedation.
⚠️ Important: Any fever, increasing wound pain, redness, or discharge in the weeks after surgery should be assessed promptly. Chest pain, calf pain, or breathlessness may indicate blood clot and require emergency assessment.
Avoid getting the wound wet until it is fully healed - usually 10–14 days. Use a waterproof cover or cling film when showering.
Do not wait until pain is severe before taking medication. Regular simple analgesia (paracetamol, ibuprofen if appropriate) is more effective.
This is usually 2 weeks after surgery. Sutures or clips will be removed if used.
Seek urgent advice if you develop increasing redness, warmth, swelling, discharge from the wound, or a temperature above 38°C - these may indicate infection.
Nerve block, blood tests, ECG. Medical optimisation. Nil by mouth.
45-90 minutes under general or spinal anaesthetic. Most patients mobilise the following day.
A physiotherapist will get you standing on day 1. Full weight-bearing is usually permitted immediately.
Most patients are discharged to a rehabilitation ward, care home, or home with support within 5-7 days of surgery.
Most patients take 3-6 months to recover. Approximately 50% do not return to their pre-fracture mobility level.
The aim is to return to the level of mobility you had before the fall. Most patients achieve this, though some - particularly those who were already frail - may not fully recover. The rehabilitation team will work with you to maximise your independence.
Many patients benefit from a period of rehabilitation in a community rehabilitation unit before returning home. This depends on your home circumstances and mobility progress.
All patients should be assessed for osteoporosis after a hip fracture. Bone-strengthening medication (bisphosphonate) and vitamin D supplementation are started before discharge to reduce the risk of a second fracture.
The primary aim of hip fracture surgery is to restore mobility and independence as quickly as possible, with the minimum of pain. Surgery allows immediate weight-bearing and early mobilisation, which are critical for recovery and survival.
The specific operation depends on the fracture type. Hemiarthroplasty (replacement of the femoral head): the displaced femoral head is removed and replaced with a metal prosthesis, allowing immediate full weight-bearing. Takes 45-60 minutes. Dynamic hip screw (DHS): a lag screw and plate are used to fix the fracture from outside the hip joint. Takes 45-60 minutes. Intramedullary nail: a metal rod is inserted into the femoral canal and locked with screws. Takes 30-60 minutes.
Only considered in patients who were not ambulant before the fracture, those with very limited life expectancy, or when the risk of surgery is considered prohibitive. Non-operative management of displaced hip fractures results in prolonged pain, immobility, and very high mortality.
For medically fit patients who were independently mobile before fracture and have pre-existing hip arthritis, total hip replacement (rather than hemiarthroplasty) may provide better long-term outcomes.
Hip fracture in elderly patients carries significant mortality risk related to the patient's pre-existing health status. Surgery itself reduces mortality compared with non-operative management.
Wound or deep periprosthetic infection. May require further surgery.
Blood clot in leg veins or lungs. Anticoagulation is given after surgery.
The prosthetic femoral head can dislocate from the socket. May require manipulation under anaesthetic or revision surgery.
The screws or nail may cut out of the femoral head (cut-out), particularly in osteoporotic bone. May require revision to hemiarthroplasty.
Disruption of the blood supply to the femoral head during the fracture may lead to avascular necrosis. This is why replacement (hemiarthroplasty) is preferred to fixation for displaced intracapsular fractures in elderly patients.
Prolonged immobility after hip fracture is associated with pressure sores, chest infections, urinary tract infections, and delirium. Early surgery and mobilisation reduce these risks.
Managed with regular analgesia including nerve blocks.
Expected after hip fracture surgery.
Common in elderly patients after major surgery. Usually resolves within a few days. The orthogeriatric team manages this.
Non-operative management of a displaced hip fracture results in prolonged severe pain, inability to mobilise, and very high mortality. Surgery is almost always the correct treatment. It is recommended in all patients who are fit enough to undergo an anaesthetic, including those in poor health, as the benefits of surgery vastly outweigh the risks in all but the most extreme circumstances.