Variation in post-operative weight-bearing practice following hip fracture surgery: A national hip fracture audit review.

Background: Hip fracture care has undergone a significant transformation, with a growing emphasis on patient experience and functional outcomes. Following national guidance that recommends early unrestricted weight-bearing, it is assumed that this is standard practice across all trauma units. Methods: Using anonymous aggregate data from the National Hip Fracture Database (NHFD) for the 2023 calendar year, weight-bearing status for patients who underwent primary hip fracture surgery across 169 hospitals in England, Wales, and Northern Ireland was investigated. The study excluded revision surgeries, periprosthetic fractures, non-operative cases, and patients who died before surgery. Results: Of 74,513 patients studied, 93.2% were fully weight-bearing, 3.1% were non-weight-bearing, and 3.6% had no data recorded. Significant variation existed across hospitals, with nine hospitals reporting 10% or more of their hip fracture cases as non-weight-bearing and one site recording 100% of patients as non-weight-bearing. Discussion: This study challenges the assumption of uniform early weight-bearing practices. With projected increases in hip fracture admissions and associated healthcare costs, optimising patient mobilisation is crucial. The wide variation in weight-bearing instructions suggests inconsistent application of clinical guidance, which will likely impact patient recovery, length of stay, and overall healthcare efficiency. Conclusion: Mobilisation after hip fracture surgery needs to be more consistent. Healthcare leaders must remain vigilant in ensuring full weight-bearing becomes the default approach and seek justification where this is not the case.