A hip fracture is a serious injury involving a break in the upper quarter of the femur near the hip joint. This injury almost always requires surgical intervention to stabilize the bone and restore function, especially since most hip fractures occur in older adults whose bone health is compromised. When a patient can walk again is complex and highly individualized, depending largely on the type of surgery performed, the patient’s overall health, and commitment to rehabilitation. Clarity on mobility timelines begins with understanding the surgical strategy used to repair the fracture.
Types of Hip Fracture Surgery and Their Impact on Mobility
The specific surgical approach chosen is the most significant factor determining the initial walking timeline. Surgeons generally choose between two primary methods: internal fixation or hip replacement (arthroplasty).
Internal fixation involves using metal hardware, such as screws, plates, or rods, to hold the fractured bone pieces together while the body heals naturally. This method is often preferred for less severe or non-displaced fractures. Because fixation relies on the bone healing process, the surgeon may restrict weight-bearing for several weeks to prevent the hardware from failing or the fracture from shifting.
Conversely, arthroplasty involves removing the damaged femoral head and replacing it with prosthetic components. This procedure is common for severe fractures or for patients whose pre-existing bone quality suggests poor healing potential. The mechanical stability of the implant often allows for immediate weight-bearing, which can accelerate the early phases of recovery.
Immediate Post-Operative Weight-Bearing Restrictions
Regardless of the surgical technique, the surgeon provides specific orders regarding how much weight can be placed on the operated leg immediately after the procedure. These orders are categorized by weight-bearing status and are absolutely non-negotiable in the initial days and weeks.
Non-Weight Bearing (NWB) is the strictest restriction, meaning the foot may not touch the floor at all, requiring the patient to hop or use a wheelchair for mobility. A slightly less restrictive status is Toe-Touch or Partial Weight Bearing (PWB), which permits only the toes to touch the ground for balance, allowing minimal weight (often less than 25% of body weight) to be applied.
The most permissive statuses are Weight Bearing As Tolerated (WBAT) or Full Weight Bearing (FWB), which allow the patient to place as much weight on the leg as comfort permits. The use of mobility aids like a walker or crutches is required during this phase to strictly comply with the prescribed weight-bearing limit and prevent a fall that could compromise the surgical repair.
Key Milestones and Expected Walking Timelines
Regaining the ability to walk is a phased process that begins almost immediately following surgery.
Initial Mobilization (Days 1-7)
During the first few days in the hospital, the goal is to transition from lying in bed to standing and taking a few steps with heavy assistance, often with the support of a walker and a physical therapist. This early mobilization is important for preventing complications associated with prolonged immobility, such as blood clots or pneumonia.
Transition Phase (1 to 3 Months)
The next significant milestone typically occurs within the first one to three months post-surgery. Patients begin transitioning from a standard walker to a less supportive device, such as a cane or single crutch, as their strength and balance improve. Many patients achieve the ability to walk short distances with a single aid within six to twelve weeks, though this depends heavily on the initial weight-bearing status.
Independent Walking (3 to 12 Months)
Moving into the three-to-six-month phase, the focus shifts to achieving independent walking without any assistive devices for short to moderate distances. This period is marked by dedicated work on correcting gait abnormalities and increasing endurance. The final phase of recovery, spanning six to twelve months, involves returning to pre-injury activity levels, with full strength and complete gait correction being the ultimate goal.
The Essential Role of Rehabilitation and Physical Therapy
Physical therapy (PT) is the active mechanism that allows a patient to meet the timeline milestones and is essential for recovery. PT begins within 24 hours of surgery and focuses on protecting the surgical site while systematically rebuilding the body’s support structures.
A primary goal is to restore the hip’s range of motion, which is often limited immediately after surgery due to pain and swelling. Therapists also focus intently on rebuilding muscle strength, particularly in the large muscle groups surrounding the hip, such as the quadriceps and glutes. These muscles are necessary to stabilize the joint and support the body during walking.
Correcting gait abnormalities and improving balance are also central to the rehabilitation process, as these are critical for preventing future falls. Sustained progress relies heavily on the patient’s commitment to a structured home exercise program, which reinforces the gains made during supervised therapy sessions.