First-day mobilisation is the key to hip fracture recovery

Hip fracture is one of the most common injuries affecting older adults worldwide, with almost all patients (97–98 per cent) treated surgically.

Evidence suggests that early mobilisation following surgery for hip fracture is associated with reduced complications such as pneumonia, deep vein thrombosis and pressure injuries.

While previous studies have explored the benefits of early mobilisation following hip fracture surgery, few studies have examined predictors of actual first-day mobilisation post-operatively.

Metro North General Medical consultant Dr Victoria Woodcroft-Brown said the idea to research predictability of early mobility after hip fracture surgery came to her while she was looking through the Australian and New Zealand Hip Fracture Register (ANZHFR) annual report.

“Clinical practice guidelines recommend that a patient with a hip fracture is to be offered mobilisation without restrictions on weight bearing, starting the day of or the day after surgery and at least once a day thereafter,” Dr Woodcroft-Brown said.

“I noted a significant disparity between the percentage of patients who were given permission to weight bear without restriction after surgery, compared to those who achieved actual first-day mobilisation.

“While the data showed that 94 per cent of patients were permitted to weight bear without restriction after surgery, only 49 per cent of all hip fracture patients in Australia and 40 per cent of those in New Zealand achieved actual first-day mobilisation.

“Moreover, there was a substantial variation of greater than 50 per cent between hospitals across Australia and New Zealand for actual first-day mobilisation rates.”

The retrospective cohort study used data sourced from more than 12,000 patient records gathered from 77 private and public hospitals across Australia and New Zealand.

All participants were over 50 years of age and underwent hip surgery in 2020. Mobilisation was defined as standing and step transferring out of bed onto a chair and/or walking.

The study identified several patient demographic, surgical and hospital factors, which contributed to a lack of first-day post-operative mobility for older patients. This included:

• usually walking with a stick, crutch or frame
• impaired cognition or dementia
• usual place of residence as Residential Aged Care Facility
• a surgical delay of more than 48 hours
• higher American Society of Anaesthesiologists grade, which assesses a patient’s overall health prior to surgery and anaesthesia
• restricted postoperative weight-bearing status.

Mobilisation was also less at hospitals with a higher volume of estimated hip fracture admissions or limited access to weekend therapy services.

The research also found that 44 per cent of patients who underwent a hemiarthroplasty mobilised on day one, compared to 71 per cent of patients who underwent a total hip replacement.

Dr Woodcroft-Brown highlighted that the research’s success was a shared accomplishment.

She acknowledged her seven co-authors, including fellow Metro North clinicians Dr Jack Bell, Dr Chrysanth Pulle and Dr Catherine McDougall, as well as external collaborator Dr Mitchell Sarkies, the ANZHFR, and the many healthcare professionals across Australia and New Zealand who contributed to the Registry.

Together, the team identified several potentially modifiable factors that could influence the odds of hip fracture patients mobilising on day one post-operatively, as well as improve overall clinical care of these patients.

The research supports TPCH prioritising mobilising hip fracture patients the day after surgery wherever possible.

“It was incredibly rewarding research, because early mobilisation following hip surgery is associated with increased likelihood of returning home, as well as improved survival,” Dr Woodcroft-Brown said.