A hip fracture is a major medical event with a recovery that plays out over months, not days. This page explains what happens in the first 48 hours, what surgery involves, the realistic recovery timeline, and the critical step that most Canadian patients miss: preventing the second fracture.
Nearly all hip fractures require surgery. There is no meaningful conservative management option for displaced hip fractures in adults — the fracture needs to be fixed or the joint needs to be replaced. The only question is what type of surgery and how quickly.
Canadian hospitals target surgery within 48 hours of admission for hip fractures. This target is met at most major acute care centres in BC, Ontario, Alberta, and Quebec. Surgery within 48 hours reduces complication rates — particularly blood clots, pneumonia, and delirium — compared to delayed surgical management.
Before surgery, the orthopaedic and medical teams assess overall health status, medications (anticoagulants need to be managed carefully), cardiac and pulmonary risk, and anesthesia choice. Most hip fracture patients have co-existing conditions; preoperative optimization may take 12–24 hours.
The type of surgery depends on where in the hip the fracture occurred and the quality of the surrounding bone. Family members often want to know which surgery happened and what it means for long-term outcomes.
| Fracture Location | Typical Surgery | Recovery Implication |
|---|---|---|
| Femoral neck (within the joint capsule) | Hemiarthroplasty (partial hip replacement) or total hip replacement | Earlier weight-bearing; higher dislocation risk in early weeks |
| Intertrochanteric (outside the capsule) | Internal fixation with nail or plate/screw | Bone heals around hardware; some weight-bearing restrictions initially |
| Subtrochanteric (below the trochanter) | Intramedullary nail fixation | Longer healing time; higher complication risk |
For displaced femoral neck fractures in healthy, mobile older adults, total hip replacement (rather than hemiarthroplasty) is increasingly preferred in Canadian centres — it produces better long-term functional outcomes, though it carries higher short-term surgical risk. Your surgeon will make this decision based on your pre-fracture mobility, bone quality, and overall health.
Physiotherapy starts the morning after surgery for most patients. The first goal is sitting up, then transferring to a chair. Early mobilization is not optional — it prevents blood clots and helps preserve muscle function. Pain management is optimized to make this possible.
Most Canadian patients stay 4–7 days in acute care. PT continues daily — goal is walking with a walker before discharge. Occupational therapy assesses home safety and equipment needs. Discharge planning begins the day of admission at most orthopaedic units.
Most patients go home or to a subacute rehabilitation facility. Home patients receive outpatient or community physiotherapy — frequency varies by province and region. Pain gradually decreases; mobility with a walker improves. Activities are limited: no driving, restricted bending angles for hip replacement patients.
Many patients transition from walker to cane. Stair climbing returns. Outpatient PT continues, focusing on strength, balance, and gait quality. Driving may resume around 6–8 weeks depending on surgical side and surgeon clearance.
Return to community walking, light household activities. Some patients return to driving and modified work. Formal physiotherapy often concludes around this time; home exercise programs continue.
Maximum functional recovery is typically achieved by 12 months. For younger, healthier patients, return to pre-fracture function is common. For frailer older adults, some functional decline compared to pre-fracture level is typical and expected.
Published mortality rates after hip fracture — 18–31% within one year — are accurate and families deserve to know them. However, context matters enormously: most deaths occur from pre-existing medical conditions that the fracture and hospitalization unmask or worsen, not from the fracture itself. Pneumonia, blood clots, cardiac events, and delirium are the primary causes.
Early surgery (within 48 hours), early mobilization (physio day 1 post-op), anticoagulation for DVT prevention, and comprehensive geriatric care during the hospital stay all reduce these risks substantially. Canadian academic medical centres with orthogeriatric programs — hospitals where orthopaedics and geriatric medicine collaborate on hip fracture patients — consistently show better outcomes than centres without such programs.
Age and pre-fracture function are the strongest predictors of outcome. A 68-year-old active person with a hip fracture has very different odds than a 91-year-old with multiple co-morbidities. The population statistics don't predict an individual outcome.
Post-acute rehabilitation for hip fracture varies by province. Most provinces offer a combination of inpatient rehabilitation (at the acute care hospital or a rehab facility) and community-based outpatient physiotherapy.
Inpatient rehab: Not all patients qualify. Assessment is based on rehabilitation potential, medical stability, and available beds. In Ontario, the Local Health Integration Networks (LHINs, now Ontario Health regions) coordinate transitions from acute care to rehab facilities. In BC, Vancouver Coastal Health and Interior Health both operate dedicated orthopaedic rehabilitation units. Alberta Health Services operates similar programs in major centres.
Home physiotherapy: Available in most provinces through provincial home care programs. Typically 1–3 visits per week for the first 4–6 weeks. Access the program through your hospital discharge planner or by calling provincial home care directly (e.g., 310-2300 in BC, 310-0000 in Alberta).
Outpatient PT: Once patients can be transported safely (usually 4–6 weeks), outpatient physiotherapy provides higher-intensity rehabilitation. Covered by provincial health plans only in specific circumstances; most outpatient PT is paid privately or through extended benefits.
Only about 20% of Canadians who suffer a fragility fracture — including hip fracture — are subsequently assessed and treated for the underlying osteoporosis. This is the "osteoporosis care gap," and it's a genuine public health failure. A hip fracture is an absolute indication to assess and treat osteoporosis, because the risk of a second fracture in the 12 months following the first is significantly elevated.
After a hip fracture, the risk of another fracture — including a second hip fracture or a vertebral fracture — is highest in the 12 months following the first event. Yet this is when most Canadian patients are focused on rehabilitation and not thinking about bone medication. Starting osteoporosis treatment before discharge or within weeks of the fracture is critical.
Many Canadian hospitals now operate Fracture Liaison Services (FLS) — dedicated programs that identify fragility fracture patients and initiate osteoporosis assessment and treatment before discharge. Hospitals with FLS programs include Sunnybrook Health Sciences Centre (Toronto), St. Michael's Hospital (Toronto), Vancouver General Hospital, and several Alberta Health Services sites. Ask your care team whether the hospital has an FLS program.
If you're not automatically assessed, ask your GP to initiate a DEXA scan and osteoporosis treatment after discharge. The conversation should happen within weeks, not months. For most patients, bisphosphonate therapy (alendronate or IV zoledronic acid) is the appropriate starting point. For patients who were on Prolia (denosumab) before their fracture, or who may be started on it after, understand that stopping Prolia without a transition plan carries its own fracture risk.
Hospitalized patients are often given calcium and vitamin D supplementation after hip fracture — this is appropriate and should continue after discharge. Osteoporosis Canada recommends 1,200mg of total calcium daily (diet plus supplements) and 800–2,000 IU vitamin D for most adults over 50. See the calcium guide and vitamin D page for specifics on dosing and form.
Many hip fracture patients are deficient in vitamin D at the time of fracture — low vitamin D compromises muscle strength and increases fall risk, contributing to the fracture. Replenishing vitamin D promptly supports both bone and muscle recovery.
After a first hip fracture, fall prevention becomes urgent. The same bone fragility that allowed the first fracture is still present, often more so if osteoporosis isn't treated. Your physiotherapist will address balance and gait during rehabilitation, but the home environment also needs assessment.
Fear of falling is common after hip fracture and can limit activity and independence more than the physical recovery. This fear is understandable but counterproductive if it leads to reduced mobility — deconditioning from inactivity accelerates further decline and increases fall risk.
Approximately one-third of hip fracture patients never return to their pre-fracture level of mobility and independence. This is most common in older, frailer patients with pre-existing cognitive impairment or multiple co-morbidities. For families supporting recovery, realistic expectations are more useful than optimism that doesn't match the clinical picture. Early conversations with the care team about prognosis are appropriate and necessary for planning.