Archives of Orthopaedic and Trauma Surgery

, Volume 138, Issue 11, pp 1519–1524 | Cite as

Timing of physiotherapy following fragility hip fracture: delays cost lives

  • Tal Frenkel RutenbergEmail author
  • Maria Vitenberg
  • Barak Haviv
  • Steven Velkes
Trauma Surgery



Post-operative physiotherapy (PT) following fragility hip fractures is intended to improve balance, gait, and muscle strength for enhanced functional outcomes. This study aims to assess whether postponing initiation of PT effects patients’ outcomes during hospitalization and in the first 3 months following discharge.

Materials and methods

A retrospective study comparing consecutive patients, 65 years and older, who were operated for fragility hip fractures between 2011 and 2016, within 48 h from admission, and started PT treatment either in the first post-operative day (POD1) or later (POD2-5). Patients were operated upon as soon as medically possible and in accordance with theater availability. All surgeries were performed outside of workday hours (either in the afternoon or during the weekend). Group allocation was established corresponding with the surgical day, as PT services are unavailable during weekends and holidays, and surgeries were performed daily. Primary outcomes were mortality either within hospital or in the post-operative year. Secondary outcomes were in-hospital complications, recurrent hospitalizations, and orthopedic complications within 3 months.


747 patients were included in the study; 525 patients started PT at POD1 and 222 had delayed PT. Patients’ demographics, living arrangements, age-adjusted Charlsons’ co-morbidity index, mobility, hemoglobin levels, and implant type were comparable. In-hospital mortality was significantly higher for the delayed PT group, 6.8 vs. 3.2% (OR 2.2, 95% CI 1.06–4.42, p value 0.034). One-year mortality, in-hospital complications, and the average number of 3 months’ recurrent hospitalizations did not differ between groups. A trend for more orthopedic complications was noted in the delayed PT group (p = 0.099), and patients from this group were readmitted more often due to orthopedic surgery-related reasons (p = 0.031).


Post-operative delay in PT following fragility hip fracture surgery was related to increased risk for in-hospital mortality.


Physiotherapy Fragility hip fractures Mortality Proximal femoral fracture Rehabilitation 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the institution review board. This article does not contain any studies with animals performed by any of the authors.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Tal Frenkel Rutenberg
    • 1
    Email author
  • Maria Vitenberg
    • 1
  • Barak Haviv
    • 2
  • Steven Velkes
    • 1
  1. 1.Orthopedic Department, Rabin Medical Center, Beilinson Hospital, Affiliated to the Sackler Faculty of MedicineTel Aviv UniversityPetah TikvaIsrael
  2. 2.Orthopedic Department, Rabin Medical Center, Hasharon Hospital, Affiliated to the Sackler Faculty of MedicineTel Aviv UniversityPetah TikvaIsrael

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