Immediate weight-bearing as tolerated after hip fracture surgery is standard practice in North America and Europe, but not across China, South Asia, Southeast Asia, the Middle East, Latin America and Africa. The WAIT-Free consensus was written for these settings by 31 experts from 15 countries, using a three-round Delphi process with a two-thirds agreement threshold.
It makes 13 recommendations in four domains: shared decision-making with proportionate documentation of benefits and realistic risks; stratification by prefracture mobility, prioritising patients who walked independently; structured fall prevention and multidisciplinary perioperative optimisation; and weight-bearing decisions that account for fixation stability, distinguishing internal fixation from arthroplasty. A supportive-factor checklist is provided for phased implementation and audit.
In Indian wards, older patients are often kept non-weight-bearing after fixation out of caution about construct failure and fear of blame if it happens. The consensus addresses both, by recommending documented discussion rather than defensive restriction. It is expert consensus rather than trial evidence, but the physiological harms of prolonged bed rest in frail older adults are well established.
- Record prefracture mobility for every older patient with a hip fracture on admission
- Default to immediate weight-bearing as tolerated after arthroplasty and stable fixation
- Document the discussion of benefits and risks rather than restricting weight-bearing defensively
- Start physiotherapy mobilisation on the first postoperative day where medically possible
- Build fall-prevention assessment into the postoperative pathway and audit adherence
Why it matters
Keeping older patients off their feet after hip fracture surgery is still common in India and costs mobility that is rarely regained.
Don't overread it
This is a Delphi consensus, not a trial — it sets a pathway, not new evidence on outcomes.
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