A consensus sets out how to make immediate weight-bearing after hip fracture surgery routine in South Asia and other low-adoption regions

The edition in brief

Immediate weight-bearing as tolerated after hip fracture surgery is standard in North America and Europe but not in South Asia, China, Southeast Asia, the Middle East, Latin America or Africa. The WAIT-Free consensus, from 31 experts in 15 countries using a three-round Delphi process, made 13 recommendations: shared decision-making with proportionate documentation, prioritising patients who walked independently before the fracture, structured fall prevention and perioperative optimisation, and weight-bearing triage by fixation versus arthroplasty. It is consensus, not trial evidence, but it addresses the medicolegal and cultural barriers that keep older patients in bed in Indian wards. In a US registry of 13,901 shoulder replacements, anatomic total shoulder arthroplasty with Exactech Equinoxe devices had a higher revision risk than other devices (HR 1.87, 1.33–2.62), with no difference for reverse arthroplasty. A meta-analysis of 31 observational studies found prior arthroscopy associated with more infection after arthroplasty (OR 1.33, 1.14–1.56), driven by the knee and shoulder, not the hip. Robotic total hip arthroplasty reduced leg-length discrepancy by about 2 mm and gave small early score gains in seven mostly non-randomised studies. In 5,653 ACL reconstructions, quadriceps tendon grafts had more reoperations for extension deficit or pain than hamstring grafts (11.9% vs 5.5%; adjusted OR 1.96). The pearl: give every arthroplasty patient a record of the implant they received.