Immediate weight-bearing after hip fracture: a consensus written for the regions that still wait

The edition in brief

The WAIT-Free consensus, published in JBJS on 15 September, brought together 31 experts from 15 countries through a three-round Delphi process to help regions where immediate weight-bearing as tolerated after hip fracture surgery is not routine — including South Asia — adopt it safely. Its 13 recommendations prioritise immediate weight-bearing for patients who walked independently before the fracture, pair it with fall prevention and perioperative optimisation, and tailor the protocol to fixation stability. A US registry of 13,901 shoulder arthroplasties found anatomic total shoulder replacements using the recalled Exactech Equinoxe system had a higher revision risk than other devices (HR 1.87, 1.33 to 2.62), with no difference for elective reverse arthroplasty; patients with these implants merit a low threshold for review. In 581 patients after hamstring ACL reconstruction, each degree of posterior tibial slope raised rerupture odds by 28% at every age, but absolute risk fell steeply with age — for a 15° slope, a predicted 36.6% at 18 against 3.9% at 45. A sham-controlled trial in 96 people with knee osteoarthritis found high-frequency TENS added nothing to an exercise programme. The pearl covers starting bone protection after a fragility hip fracture.