A broken hip, or hip fracture, is a serious break in the upper quarter of the femur. This injury typically occurs near the hip joint, where the femur connects to the pelvis. While it can result from high-impact trauma, it most often happens in older adults from a simple fall due to weakened bones. A hip fracture is a medical emergency that almost always requires immediate hospitalization and surgical intervention. The total healing time is highly individual, involving both the biological mending of the bone and a prolonged period of regaining strength and mobility.
Types of Hip Fractures and Initial Treatment
Hip fractures are broadly classified based on their location on the femur. The two primary categories are intracapsular and extracapsular fractures, referring to whether the break occurs inside or outside the joint capsule. Intracapsular fractures, such as those occurring at the femoral neck, are problematic because they can disrupt the blood supply to the ball of the joint. If the blood supply is compromised, a complication known as avascular necrosis can occur.
Extracapsular fractures, including intertrochanteric fractures, occur further down the femur outside the capsule, and typically maintain a better blood supply. This distinction is why most displaced intracapsular fractures are treated with a partial or total hip replacement (arthroplasty), which allows for quicker weight-bearing and mobilization. Extracapsular fractures are usually treated with internal fixation, where metal screws, plates, or rods stabilize the bone fragments while they mend. The goal of surgery is to stabilize the joint to allow for early movement and rehabilitation.
Key Stages of Physical Recovery
The first phase of recovery is the Acute Post-Operative period. The main focus during this time is effective pain management and immediate mobilization, often starting with sitting up in a chair within 24 hours of surgery. Early movement is pursued to prevent complications associated with prolonged bed rest, such as blood clots and pneumonia.
The Initial Rehabilitation phase spans from approximately Week 2 to Week 6, often continuing in an inpatient rehabilitation facility or at home with outpatient therapy. During this stage, the patient begins controlled weight-bearing as directed by the surgeon. For example, a hip replacement often permits faster weight-bearing than a fixation procedure. Physical therapists guide gait training and simple exercises designed to restore range of motion and initial muscle strength.
The Sub-Acute Healing phase generally covers Months 2 through 6, marking the period where the bone is undergoing the majority of its biological consolidation. This process typically takes between three to six months for the fracture site to achieve structural stability. The rehabilitation focus shifts toward achieving independent walking, often transitioning from a walker to a cane, and progressing to more challenging strength and balance exercises. While the bone is mostly mended by the six-month mark, full functional recovery still requires time.
Factors Influencing the Healing Timeline
Advanced age is a significant factor, as older adults generally have a slower biological healing response and may have less muscle mass and bone density (osteoporosis). Pre-existing health conditions, or comorbidities, can also slow recovery, particularly conditions like diabetes or vascular issues that impair blood flow and wound healing.
The specific surgical procedure is primary, with a hip replacement often allowing for a faster return to weight-bearing activities compared to internal fixation, where the bone must fully unite. Compliance with the physical therapy program is also influential, as consistent exercise maintains muscle mass and prevents stiffness. Adequate nutrition, specifically sufficient intake of Vitamin D and Calcium, supports the bone remodeling process.
The presence of complications can significantly delay the entire recovery process. These issues include surgical site infections, malunion (the bone healing in an incorrect position), or non-union (the bone failing to heal entirely). In intracapsular fractures, the risk of avascular necrosis remains a concern, which may necessitate further surgery and reset the recovery timeline.
Long-Term Rehabilitation and Full Functional Return
Even after the bone has achieved stability around the six-month mark, the long-term process of regaining full function continues. Full functional recovery, which involves returning to pre-fracture daily activities, can take anywhere from six months to a year or more. This extended period is necessary to rebuild the significant muscle strength that was lost due to the injury and subsequent period of reduced activity.
Outpatient physical therapy and occupational therapy remain important for addressing strength deficits, improving balance, and ensuring safe navigation of the home environment. Regaining full balance and gait function can take up to nine months after the fracture. For many patients, the goal shifts from simple walking to achieving a quality of life that includes independent mobility and reducing the significant fear of falling again. Continued, specialized exercise programs are often necessary to maximize strength and functional independence well into the second year of recovery.