Hip Fracture Recovery at Home: The Weeks After Surgery

Not a planned operation

A broken hip is not the same as a planned hip replacement

If you have been reading about hip replacements, put those timings to one side. Both operations involve the same joint and little else about them is alike. Knowing the difference stops you planning a fortnight of help when the recovery is longer than that.

	A planned hip replacement	A broken hip
How it starts	A date booked months ahead	A fall, an ambulance and an X-ray. NICE says the operation should be done on the day of admission or the day after
Who it happens to	Somebody worn down by a painful joint who was managing at home	Usually an older person, often one already unsteady or needing help
Time to get ready	Weeks to order equipment and arrange help	None. It is all arranged while your relative is on the ward
The operation itself	The worn joint is replaced	The bone is fixed, or half or all of the joint is replaced, depending on where the break is
Time in hospital	The NHS says generally fit people go home around 1 to 3 days later	The NHS says a stay of around 1 to 4 weeks is usual
Getting back to normal	A return to work at about 6 weeks, and months for the rest	The NHS says a person may never get back the same strength and movement, and may need a stick or a frame

How it starts

A planned hip replacement: A date booked months ahead
A broken hip: A fall, an ambulance and an X-ray. NICE says the operation should be done on the day of admission or the day after

Who it happens to

A planned hip replacement: Somebody worn down by a painful joint who was managing at home
A broken hip: Usually an older person, often one already unsteady or needing help

Time to get ready

A planned hip replacement: Weeks to order equipment and arrange help
A broken hip: None. It is all arranged while your relative is on the ward

The operation itself

A planned hip replacement: The worn joint is replaced
A broken hip: The bone is fixed, or half or all of the joint is replaced, depending on where the break is

Time in hospital

A planned hip replacement: The NHS says generally fit people go home around 1 to 3 days later
A broken hip: The NHS says a stay of around 1 to 4 weeks is usual

Getting back to normal

A planned hip replacement: A return to work at about 6 weeks, and months for the rest
A broken hip: The NHS says a person may never get back the same strength and movement, and may need a stick or a frame

Timings from the NHS pages on hip replacement and on hip fracture, and from NICE clinical guideline CG124 on hip fracture management.

The other difference is why the fall happened. A hip that broke because somebody tripped on a rug is one problem. A hip that broke because somebody has been getting dizzy standing up, or is on medicines that make them unsteady, is another, and it will still be there when they come home. Read after a fall: the checklist alongside this page, and the mobility and falls care guide on making another fall less likely. If the operation was planned, recovery at home after a hip replacement is the page for that.

What the surgeon does

The three repairs, and what each one means at home

Where the bone broke decides which operation is done, and the NHS lists three. Ask the ward which one it was, because it changes what the hip can do.

Fixing the bone

The broken bone is held together with metal and left to knit back. Your relative keeps their own joint, and it is the bone that has to mend.

Screws, nails, rods or plates

Replacing half the joint

The ball at the top of the thigh bone is replaced and the socket is left alone. NICE says replacement is the operation for a displaced break inside the joint capsule.

A hemiarthroplasty

Replacing the whole joint

NICE says this should be offered for that break where the person could walk outdoors with no more than a stick, is not cognitively impaired and is fit for the operation.

A total hip replacement

A mended bone and a new joint do not feel the same to stand on, and the instructions that come with them differ, so everyone helping needs the same sheet. Whichever operation was done, your relative will be got out of bed sooner than the family expects. NICE asks hospitals to offer a physiotherapy assessment and, unless there is a medical or surgical reason not to, mobilisation on the day after surgery, then mobilisation at least once a day. Standing on a hip that broke two days ago sounds alarming, and it gives somebody the best chance of walking again.

The first days home

Getting them home, and what the house needs first

Government guidance on hospital discharge says going home should be the default, with short-term care and rehabilitation put in first and longer-term needs assessed once somebody has recovered as far as they are going to. In practice that means a discharge date that can move by a day either way, and a house that has to be ready first.

Ask what has been arranged rather than assuming it has, because an occupational therapist may have ordered a raised toilet seat or a frame that has not arrived yet. Government guidance says unpaid carers and family members should be involved in discharge decisions, so say plainly what you can and cannot cover. Hospital discharge explained sets out the process and the right equipment to aid the elderly covers the aids.

Week by week

How much help each stage takes, and why it falls away

Recovery from a broken hip runs in stages rather than in a straight line, and the help needed is heaviest at the start. These are the stages as a family meets them, with the timings from the NHS and NICE.

In hospital
From the operation to the day they come home
Ward staff, day and night
The NHS says a stay of around 1 to 4 weeks is usual. NICE asks for a physiotherapy assessment and, unless there is a medical or surgical reason to wait, getting the person moving on the day after surgery, then mobilising at least once a day.
What they can usually manage
Standing, then a few steps with a frame and a physiotherapist alongside. Most of the day is still spent in a bed or a chair.
What still needs somebody there
Washing, dressing, the toilet, meals and pain relief are all done on the ward, so the difficulty at home is easy to underestimate from a visit.
The help that fits
This is the week to ask questions rather than to book anything: which operation was done, what weight the hip may take, what the exercises are, what equipment is coming and whether reablement has been arranged.
What to pass on to the team
Confusion that was not there before, a wound that is weeping, a temperature, or a leg that will not take the weight the team expected.
Week 1
The first days back through the front door
Most of the day, and the nights
Tired, sore and slower than anyone expected. A hospital corridor is flat, wide and handrailed, and a hallway with a rug in it is none of those things.
What they can usually manage
Short journeys inside the house with a frame or crutches, sitting in a high chair, and a little of a wash done sitting down.
What still needs somebody there
Getting out of bed, washing, dressing below the waist, meals, drinks, tablets on time, and the walk to the toilet in the dark.
The help that fits
Someone there for most of the day, and for the first nights if your relative lives alone. A morning visit and an evening visit cover the two hardest parts of the day, with family or a night carer for the dark hours.
What to pass on to the team
Pain that is getting worse rather than easier, a fall, not drinking, not eating, or a night spent awake and frightened.
Weeks 2 and 3
A routine, and the exercises becoming the work
Morning and evening visits
The wound is settling and the stitches or clips come out once it has healed enough. The hip fracture programme NICE describes covers rehabilitation in the community as well as on the ward, so ask who is picking the physiotherapy up at home.
What they can usually manage
Getting up and about the house, sitting down to a meal at the table, and doing the exercises with somebody counting.
What still needs somebody there
Showering or a full wash, dressing, stairs, cooking, shopping, laundry, and a lift to the fracture clinic or the GP.
The help that fits
A morning visit for washing and dressing and an evening one for a meal and the tablets, with the exercises fitted into both.
What to pass on to the team
Exercises being skipped, a joint that feels stiffer than last week, low mood, or a wound that is redder or hotter.
Weeks 4 to 6
Doing more, and wanting the house back
A visit a day, then fewer
Where a council provides reablement or intermediate care, this is where the free six weeks run out. It is also where a family starts to see which parts of the old life have come back and which have not.
What they can usually manage
Washing and dressing with something to hold on to, short walks outside with a stick or a frame, and making a hot drink.
What still needs somebody there
Heavy jobs, the weekly shop, changing a bed, and anything that needs both hands while standing. Confidence outside the house can lag a long way behind the leg.
The help that fits
One visit a day, dropping to a few a week. A longer weekly visit for shopping, laundry and the appointments works better than adding minutes to the morning.
What to pass on to the team
A stall or a step backwards, a near miss on the stairs, or a person who has stopped going out at all.
Month 3 onwards
What the recovery has settled at
A visit or two a week, or a new normal
The NHS says a broken hip takes several weeks or months to heal and that a person may never get back the same strength and movement they had before, and may need a walking stick or frame.
What they can usually manage
The ordinary day again for some people, at a slower pace and with a stick or a frame where there was none before.
What still needs somebody there
Whatever has not come back. For one family that is the shopping and the bath. For another it is help every day, and the question becomes what the arrangement should be from here.
The help that fits
A visit or two a week for the jobs that stay hard, or a longer-term arrangement if the fracture has changed what your relative can do alone.
What to pass on to the team
Another fall, pain in the hip that returns, or bone health that nobody has looked at since the fracture.

Timings from the NHS pages on hip fracture and recovering from one, and from NICE clinical guideline CG124 on hip fracture management. The bars are the shape of the help families plan for rather than a clinical measure, and nobody moves through these stages at the same speed. Where the surgical team or the physiotherapist says something different about this hip, that instruction comes first.

The exercises decide how much movement comes back, and they are also the part that slips. The NHS says your relative will be given exercises to continue at home and that it is important to keep doing them. Somebody sitting with them and counting makes that more likely than a sheet left on the side. Hourly care after a hospital stay covers what those visits look like, and short-term night care after hospital explains sleeping and waking nights.

Who pays for the help

What each source covers, and what the rest costs

Help comes from several places at once and none covers the whole thing. Seeing which part each one does makes it easier to work out what is left to fill.

	What it covers	When and how long	What it costs
NHS community therapy	Physiotherapy after discharge, the wound, and any clinical need at home	For as long as the clinical need lasts	Free at the point of use
Council reablement or intermediate care	Short-term help with washing, dressing and moving about again	Where a council provides it after a hospital stay	Free for the first 6 weeks, by regulation
Hourly visits from a carer	Washing, dressing, meals, medication prompts, the exercises, shopping and appointments	Booked as you need them, heaviest in the first fortnight	£18 to £25 an hour on PrimeCarers, our fee included
A carer overnight	Somebody there for the toilet trips and the pain relief	Usually the first nights, or longer if your relative lives alone	Sleeping nights £130 to £145
A live-in carer for a few weeks	Day and night in one arrangement, for a slow recovery or somebody alone	Booked by the week	From £1,050 a week, typically £1,120

NHS community therapy

What it covers: Physiotherapy after discharge, the wound, and any clinical need at home
When and how long: For as long as the clinical need lasts
What it costs: Free at the point of use

Council reablement or intermediate care

What it covers: Short-term help with washing, dressing and moving about again
When and how long: Where a council provides it after a hospital stay
What it costs: Free for the first 6 weeks, by regulation

Hourly visits from a carer

What it covers: Washing, dressing, meals, medication prompts, the exercises, shopping and appointments
When and how long: Booked as you need them, heaviest in the first fortnight
What it costs: £18 to £25 an hour on PrimeCarers, our fee included

A carer overnight

What it covers: Somebody there for the toilet trips and the pain relief
When and how long: Usually the first nights, or longer if your relative lives alone
What it costs: Sleeping nights £130 to £145

A live-in carer for a few weeks

What it covers: Day and night in one arrangement, for a slow recovery or somebody alone
When and how long: Booked by the week
What it costs: From £1,050 a week, typically £1,120

Reablement, community equipment and minor adaptations are free under regulation 4 of the Care and Support (Preventing Needs for Care and Support) Regulations 2014, with the free reablement period capped at six weeks. PrimeCarers introduces carers and families to each other and does not provide or manage care, so hours and rates are agreed with the carer.

Two one-hour visits a day for a fortnight comes to £560 at the typical rate of £20 an hour, and the visits drop back as washing and dressing get easier. The same fortnight through an agency costs £784 to £980, and the hourly cost of care at home sets the two side by side. Ask about reablement while your relative is on the ward, because it is not provided everywhere. Reablement, the free six weeks explains what happens when it ends, and local authority funding for care at home explains how a council decides who pays.

Confidence and walking

Fear of falling again, and what to do if the walking does not come back

The part families are least prepared for is not the wound or the exercises. It is a parent who will not go out, who wants somebody within arm's reach, and who has stopped doing things they did a month ago. That is an understandable response to a fall that ended in an ambulance, and there are things that make it better.

What tends to help

Naming it out loud, so being afraid of falling is something to work on rather than to hide
A short walk every day with somebody beside them, going a little further each time
The strength and balance exercises the physiotherapist gave, done at the same time each day
A walking aid measured for them, not a stick borrowed from a cupboard
A medication review with the GP or pharmacist, and whatever else caused the fall
An alarm they can press from the floor, so lying there for hours is not what they dread

What tends to set it back

Taking over jobs your relative can still do, which teaches them that they cannot
Hovering, which tells somebody they are unsafe more loudly than words do
Letting them stop walking outside, because confidence falls faster than strength does
Deciding in week two what the rest of their life looks like, when week six looks different

Some people do not get back to walking as they did. The NHS says plainly that a person may never get back the same strength and movement they had before the break, and may need a walking stick or a frame. If that is where your relative ends up, the decision is what help their new normal takes rather than whether the recovery failed. Walking aids and how to choose covers the aid and pendant alarms and sensors covers the alarm. Age UK has advice on falls and confidence, and the Royal Osteoporosis Society runs a helpline staffed by specialist nurses if nobody has yet looked at why the bone broke.

If the help is going to carry on, step back before the six weeks run out. Live-in care covers somebody there day and night, and respite care covers a break for you if you have become the person doing all of this.

Questions

Questions families ask after a broken hip

Plan for weeks rather than days. The NHS says the hospital stay is usually around 1 to 4 weeks, and that a broken hip takes several weeks or months to heal after that. The help is heaviest in the first fortnight home, when washing, dressing, meals and getting to the toilet all need somebody there, and it tapers from week three or four. Whatever your relative was struggling with before the fall will still be there afterwards.

Usually, and it is worth asking rather than assuming. NICE asks surgeons to operate with the aim of letting the person bear their full weight, without restriction, immediately after the operation. Some breaks and some repairs still come with a limit for a few weeks. The instruction for your mother comes from her surgical team and her physiotherapist, so ask for it in writing and make sure everybody helping at home has seen it.

Not in the first days home, and it depends on the person after that. Pain relief given on time on a ward has to be remembered at home, and the walk to the toilet in the dark is where a second fall is most likely. Later it depends on how steady they are, whether there are stairs, and whether they could get help if they ended up on the floor.

Some of it. NHS community services such as physiotherapy and wound care are free at the point of use. Where a council provides reablement or intermediate care after a hospital stay, regulation 4 of the Care and Support (Preventing Needs for Care and Support) Regulations 2014 stops it charging for the first six weeks, and community equipment and minor adaptations are free under the same regulation. Reablement is not provided everywhere, so ask the discharge team. Anything you arrange yourselves you pay for.

Washing and dressing the parts your relative cannot reach, meals and drinks, prompting medication, doing the exercises alongside them, shopping and going with them to the clinic. A carer does not give clinical advice, dress a surgical wound or take over from the physiotherapist. Carers on PrimeCarers charge £18 to £25 an hour with our fee included, and agencies charge £28 to £35 for a similar visit.

Ring 999 or go to A&E if your relative suddenly becomes confused, which the NHS treats as an emergency, or if there is chest pain or difficulty breathing. Ring the GP, 111 or the number on the discharge letter the same day for a temperature, a wound that is weeping or getting redder, pain that is worse rather than easier, a leg that will not take the weight it took yesterday, or another fall even if it seemed to do no harm.

Hip fracture recovery at home, week by week

Find carers near home for the weeks after the operation