Hip Fracture: Causes, Treatment & Recovery

The most common causes of a broken hip are injury following a fall or in combination with osteoporosis.  95% of all hip fractures are caused by a fall. 

Falls are common in older people:

• Almost 1 in 3 people aged 65 and over will fall at least once a year
• 1 in 2 people aged 80 and over will fall once a year
• Around 1 in 20 falls results in a fracture requiring a hospital stay.  

The chances of falling are much higher for those who have already fallen once.  It is important to take any fall seriously in an older person and find ways to reduce their future risk. Head to our guides on Falls for more information. 

People living with osteoporosis are more likely to fracture a bone following a fall or injury.  For these individuals, relatively minor injuries can lead to serious breaks. 

People with osteoporosis are more likely to break their hips more than once.  Recent research suggests repeat hip fractures can affect 1 in 20 patients. 

For more information about osteoporosis including medicines and eating the right foods and taking supplements to keep bones as healthy as possible, visit the Royal Osteoporosis Society. 

Anyone who is 50 or over and experiences a fracture following a minor injury might be at risk from osteoporosis and should be referred to a fracture liaison service (FLS).  The FLS exists to prevent future fractures by assessing causes and advising on any necessary treatment.  The FLS site, features a range of helpful information and videos. 

We can all reduce our risks or fractures by eating foods which are good for healthy bones and taking regular exercise.    Stopping smoking and cutting back on alcohol can also make a difference. See the NHS website for information on  key food and exercise  

New routines, delirium, dementia and other factors can put some individuals at greater risk of falling whilst in hospital.  These falls can lead to a serious injury including a broken hip – read more here. 

Providing adequate pain relief is a clinical treatment priority for anyone with a suspected or diagnosed hip fracture.  

Increasingly, doctors are using special local anaesthetic “nerve blocks” to kill  pain in the early stages.  These are very effective and avoid the complications of many morphine based painkillers. 

Some discomfort is also natural after surgery and in the early stages of getting mobile again.  Pain levels tend to be low at rest but extra pain killers will be needed to help patients get up and start moving around.

The most appropriate treatment depends on the nature of the fracture but surgery is recommended for the majority of those affected by this injury.  Depending on the position and severity of the fracture, the operation might entail a hip joint replacement or special techniques to fix the break. 

Ideally, surgery should be performed as soon as possible after arriving at hospital  – either on the same or following day.

In some cases, however, the injured person might be too poorly to tolerate an anaesthetic or undergo surgery.  If this is the case the doctors might recommend delaying surgery until the patient is well enough.  

Those undergoing surgery can be given either a spinal or a general anaesthetic.

All patients should be supported to get up and moving again soon after surgery.  This is vital for short and long term recovery.

To enable this, and unless there are contraindications, patients should be offered a physiotherapy assessment and support to mobilise on the day after surgery and at least once a day subsequently.  In the first instance, simply getting out of bed can be a key first step toward longer term recovery.

Getting moving as soon as possible is also important to prevent other post surgical problems such as chest infections, blood clots or pressure sores.

After surgery patients might experience discomfort and feel a little weaker than usual when walking but this should improve over time.

A physiotherapist will provide an exercise programme that sets out a series of goals for the patient to achieve over the coming months – in and out of hospital. 

Carents can provide invaluable encouragement to those following a rehabilitation plan. The early stages can be uncomfortable and a full recovery relies on committing to a regular exercise programme.   Each sign of progress should be an excuse for lots of praise and celebration. 

Discharge from hospital will only happen if everyone involved is certain that the patient will be safe and able manage with essential tasks like bathing and dressing.  In some cases a special home care and support package might be needed.  Some patients might be discharged to a form of   “step down”  care to enable their recovery before they can return home safely.

For some older persons, a hospital stay or operation can trigger changes in their behaviour, thoughts or memory due to a condition called delirium.  Delirium is a temporary problem which affects people for varying lengths of time. 

Health care staff will be on high alert for any signs of delirium but if you think your loved one might be affected then you should let the medical or nursing staff know so that they can take appropriate action as soon as possible. 

NICE recommends that all those affected should be given printed and verbal information about their diagnosis, treatment and care.  

We have included links to some examples of this hospital information below in our Additional Information section. 

There is no set timescale for leaving hospital – it depends on the individual, their recovery path and the nature of support at home.   Some individuals might be discharged after 5 days but many will stay in hospital for longer. 

Again, everyone is different, but on average it takes between 6-12 weeks for a broken hip to heal and around 6 months for a full recovery.

Osteoporosis doesn't affect the healing process of bone, so it can still heal as normal after surgery.

• Driving – you should check with a GP to agree when this is advisable – certainly not within 6 weeks  
• Bathing – you should avoid getting the wound wet for around 2 weeks which means avoiding a bath for around three months.  A walk in shower might be feasible after 2 weeks but an occupational therapist will advise on safe bathing arrangements. 
• Surgical stockings – these help to prevent blood clots and, generally speaking, should be worn for six weeks after the operation. Do check with the medical team what is specifically recommended for the person you care about.
• Swelling – leg swelling is one of the commonest complications of the operation and can persist for up to a year.  Leg swelling an also occur with a clot or infection – these are serious, potentially life threatening problems so do not be complacent about swelling  - get it checked by a medical professional as an emergency.
• Travelling  - Simply getting in and out of a car can be tricky post surgery - check out our advice on car mobility aids.  You should ask a doctor about any flights and long haul flights are generally not recommended for at least 3 months post surgery.

A hip fracture can be a serious  - potentially fatal - injury especially for those living with other medical problems.  There are also some serious risks relating to undergoing, and recovering from, major surgery. 

Rehabilitation can also be more challenging for someone who is living with frailty and advanced medical conditions, so some older people can find that their health or mobility is permanently compromised.  This can have a profound impact on their ability to live independently and a significant proportion subsequently need residential care.