Hip fracture (broken hip): symptoms, treatment and recovery

The NHS says a broken hip usually happens because of a fall or injury and is more common in older people and people who have osteoporosis. The symptoms to look for are listed below. Not every person has all of them, and a fracture can be present even if the leg looks normal.

• Pain in your hip, upper leg and groin.

• Not being able to stand or put weight on the affected hip and leg.

• Difficulty moving your hip and leg.

• The affected leg is at an odd angle or looks shorter than the unaffected leg.

• Swelling and bruising around your hip and upper leg.

You will need urgent medical help for a broken hip, or for hip pain after a fall, according to the NHS. A broken hip is serious and needs treatment in hospital straight away.

Most hip fractures follow a fall. The NHS says osteoporosis, a condition that weakens bones and makes them fragile and more likely to break, makes a broken hip more likely. It says the condition develops slowly over several years and is often only diagnosed when a fall or sudden impact causes a bone to break, and lists a broken hip among the most common injuries in people with osteoporosis, alongside a broken wrist and broken spinal bones.

Factors that raise the risk of osteoporosis, according to the NHS, include being a woman (especially with early menopause before 45), taking high-dose steroid tablets for more than 3 months, certain medical conditions, a family history of osteoporosis (particularly a hip fracture in a parent), having a low BMI, not exercising regularly, and heavy drinking and smoking.

NICE says that every year about 65,000 people break their hip and that it can have a huge impact on their lives.

A broken hip needs to be treated in hospital straight away. The NHS says you will usually be given painkillers and have an X-ray to check whether your hip is broken and to decide what treatment is best. You will need surgery. Depending on your age and the type of break, the NHS says you may have surgery to:

• fix the broken bones back into place using screws, nails, rods or plates

• replace some of the damaged hip joint with an artificial part (hemiarthroplasty)

• replace all of the damaged hip joint with an artificial joint (hip replacement)

The NHS says you will usually have surgery on the same day or the day after you arrive at hospital. NICE says this is what the guideline aims for, because early surgery helps recovery and reduces the time to getting you moving again. The hospital will check and treat other conditions that could delay the operation, such as anaemia, blood-thinning medicines, dehydration, uncontrolled diabetes or heart failure, or a chest infection (NICE).

NICE says it also wants hospital teams to check for other health conditions that might need treating, because a hip fracture can often be a sign of other health problems.

The NHS says a broken hip usually takes several weeks or months to heal, but it can take longer. You will usually spend around 1 to 4 weeks in hospital. Soon after surgery you will start regular physiotherapy to help you start standing and moving again, and when you leave hospital you will be given exercises to carry on at home.

The NHS is honest about the outlook: you may never get back the same strength and movement you had before the break, and you may need a walking stick or frame. Some people need help from carers or other health professionals when they move back home. It stresses that doing the exercises your physiotherapist recommends regularly helps your recovery and improves your strength and movement.

NICE adds that, if you are medically stable, able to transfer and mobilise short distances and have not yet reached your full rehabilitation potential, the team may consider early supported discharge, with the hospital team remaining involved.

The NHS says that if you are over 50 and have broken your hip, a fracture liaison service can help you prevent further broken bones and keep your bones healthy. Ask your GP surgery whether there is a fracture liaison service in your area.

The NHS recommends keeping your bones healthy with a balanced diet including calcium and vitamin D and regular exercise, and says osteoporosis can be treated with bone strengthening medicines. For falls prevention the NHS suggests staying active, strength and balance activities at least twice a week, well-fitting shoes with a good grip, non-slip mats and grab rails at home, regular eye and hearing tests, and asking a GP or pharmacist whether any of your medicines could be affecting your balance. Falls services can check muscle weakness, osteoporosis and eyesight, offer strength and balance training and home safety checks, and review medicines.

The NHS advice is to stay calm and check for pain or injuries before trying to move. If you do not feel able to get up, use a phone or personal alarm, or shout or bang on a wall or floor to attract attention, keep warm with anything you can reach, and move gently, changing position about every 30 minutes to help prevent pressure sores. Call 999 if someone has fallen, may have injured their head, back, neck or hip, and cannot get up. If you are helping, do not try to lift them yourself.

The UK sources used for this page focus on older adults, but the NHS says osteoporosis can also affect men, younger women and children, and that other conditions and long-term medicines can weaken bones. NICE says its hip fracture guideline covers people aged 18 and over. The 999 advice above applies at any age.

Most people with a broken hip reach care through an NHS emergency department and are admitted to an orthopaedic or orthogeriatric ward. NICE says the care team should offer a Hip Fracture Programme from admission, and that hospitals should help you through to returning to the community. After discharge, rehabilitation may be provided at home or in a community setting.

NICE says decisions about treatment should be made together with you, your family or carers, and that health professionals should give clear information and talk with you about options. You can ask about private hospital care, but because the best outcomes depend on surgery within about a day, the NHS emergency route is the usual way in. Ask your GP about a fracture liaison service and a falls assessment afterwards.