Early mobilisation after hip fracture associated with improved survival and recovery

Early mobilisation after hip fracture associated with improved survival and recovery

The Bone
and Joint Journal

mobilisation after hip fracture surgery has become standard care on the basis
of national guidance. The evidence for this is based on one trial of 60
patients which was of low to moderate quality.1 However, further
trials may not now be ethical or feasible but analysis of real-world
observational data presents an opportunity to study the association between
early mobilisation and outcomes, according to the authors of a new study.

from Kings College London analysed the National Hip Fracture Database and
hospital records for 126,897 patients aged ≥ 60 years who underwent surgery for
a hip fracture in England and Wales between 2014 and 2016.2

Key findings

Overall 79% of patients
mobilised early and the overall 30-day survival post-surgery was 94%. However,
there was a greater probability of survival amongst those who mobilised early. (Early
mobilisation is defined as the ability to sit or stand out of bed on the day of
or the day after hip fracture surgery)

weighted probabilities of survival at 30 days post-admission were 95.9% (95% CI
95.7% to 96.0%) and 92.4% (95% CI 92.0% to 92.8%), respectively, among those
who mobilised early and those who mobilised late.

The weighted probabilities of
recovering the ability to walk among those who could walk outdoors and indoors
pre-fracture were 9.7% (95% CI 9.2% to 10.2%) and 81.2% (95% CI 80.0% to
82.4%), respectively, among those who first mobilised early, and 7.9% (95% CI
6.6% to 9.2%) and 73.8% (95% CI 71.3% to 76.2%), respectively, among those who
first mobilised late.

When early mobilisation was achieved,
this was associated with survival and recovery of pre-fracture walking
abilities, irrespective of the presence of a dementia diagnosis.

important  new finding is that by 30 days
post-admission, only 9% of those who could walk outdoors pre-fracture had
recovered this ability, while 80% of those who could only walk indoors
pre-fracture recovered the ability to do so, (among those mobilised early).

authors proposed that early mobilisation should be a measured indicator of
performance internationally. This would enable clinicians to determine the
extent to which they are achieving early mobilisation with their patients and
to evaluate the benefit of quality improvement initiatives to improve


  1. National Clinical Guideline Centre. The
    management of hip fracture in adults. London: National Clinical Guidelines
    Centre, 2011
  2. Goubar A, Martin
    FC, Potter C, Jones GD, Sackley C, Ayis S, Sheehan KJ. The 30-day survival and
    recovery after hip fracture by timing of mobilization and dementia: a UK
    database study. Bone Joint J. 2021;103-B(7):1317-1324. doi:
    10.1302/0301-620X.103B7.BJJ-2020-2349.R1. PMID: 34192935