Hip Fracture in Elderly: Physiotherapy Post-Surgery

Hip Fractures in the Elderly: A Critical Clinical Event

A hip fracture in an older adult is a significant medical event. It often occurs due to a combination of osteoporosis (weakened bones) and a fall. Because of the serious risks associated with prolonged bed rest in older adults—such as pneumonia, deep vein thrombosis (DVT), muscle wasting, and pressure ulcers—surgery is usually performed within 24 to 48 hours of the injury.

Following surgery, hip fracture elderly physiotherapy is essential. Structured physical therapy helps patients safely transition from bed rest back to standing and walking, restoring strength, mobility, and confidence. Early mobilization is key to a successful recovery and helps reduce the risk of long-term complications.

Surgical Approaches and Post-Op Precautions

The surgical method used to repair the fracture determines the physical precautions that must be followed during early rehabilitation. The two main types of surgery are replacement (arthroplasty) and fixation (using screws or plates):

| Surgical Method | Description | Key Physical Precautions (First 6-12 Weeks) | | :--- | :--- | :--- | | Hemiarthroplasty or Total Hip Replacement | Replacing the damaged femoral head (and socket, in total replacement) with a metal or ceramic prosthesis. | Posterior Approach: Avoid bending the hip past 90 degrees, crossing the legs, or turning the toes inward.<br>Anterior Approach: Avoid hyperextending the hip or turning the foot outward. | | Open Reduction Internal Fixation (ORIF) | Stabilizing the bone fragments using surgical screws, plates, or an intramedullary nail. | Precautions depend on bone quality. Weight-bearing may be restricted (e.g., toe-touch weight-bearing) for several weeks to allow the bone to heal. |

Phases of Post-Surgical Physiotherapy

Rehabilitation is structured in phases to support tissue healing while progressively building strength and mobility:

Phase 1 (Days 1 - 5): Acute Care and Early Mobilization

The goal during the first few days is to prevent complications and begin simple movements:

• Circulatory and Respiratory Exercises: Ankle pumps and deep breathing exercises are started immediately to improve blood flow and keep the lungs clear.
• Bed Mobility: Training the patient to roll and transition to sitting without exceeding hip precautions.
• First Steps: Standing and taking a few steps using a walker, under the guidance of a physical therapist, usually within 24 hours of surgery.

Phase 2 (Weeks 2 - 6): Subacute Rehabilitation and Strength Building

Once discharged from the acute care hospital, therapy focuses on functional strength and walking quality:

• Active Range of Motion: Exercises like heel slides and hip abduction (within safe limits) to improve joint flexibility.
• Strengthening: Building strength in the quadriceps, hamstrings, and gluteal muscles using resistance bands and body weight.
• Gait Training: Graduating from a walker to crutches or a cane, focusing on a normal walking pattern and heel-to-toe contact.

Phase 3 (Weeks 6 - 12+): Advanced Balance and Fall Prevention

In the final phase of recovery, the focus shifts to restoring independence and preventing future falls:

• Balance Training: Exercises like standing on one leg, tandem walking (heel-to-toe), and stepping over small obstacles.
• Proprioceptive Training: Exercises on uneven surfaces to improve the body's awareness of its position.
• Functional Activities: Practicing rising from low chairs, climbing stairs, and carrying objects safely.

Home Safety Guidelines for Caregivers

Caregivers play a vital role in supporting recovery and preventing falls at home:

1. Rearrange Furniture: Clear wide walking paths to accommodate a walker or cane.
2. Remove Tripping Hazards: Take away loose rugs, electrical cords, and clutter from walking areas.
3. Install Assistive Devices: Place a raised toilet seat, a shower chair, and secure grab bars in the bathroom.
4. Ensure Proper Footwear: Make sure the patient wears supportive, non-slip shoes both indoors and outdoors.
5. Supervise Exercises: Help the patient complete their home exercise program safely, ensuring they follow all surgical precautions.