Depending on the country, this term includes also rehabilitation, ortho-geriatric and orthopaedic departments for the management of the older adults presenting with hip fracture. According to the country, different healthcare professionals retain the responsibility for the management of the patients throughout the care pathway after hip fracture. In most countries, in-hospital stay is usually short (on average a week), and post-acute rehabilitation is performed in different settings, such as other in-hospital wards, i.e., geriatric or rehabilitation department; out-of-hospital facilities, i.e., rehabilitation clinics; physical therapy units; or home-based services. Some countries support most sophisticated models, i.e., rehabilitation wards specifically designed for the rehabilitation of geriatric patient (Geriatric Rehabilitation Unit) or even orthopaedic geriatric patients (Geriatric Orthopaedic Rehabilitation Unit) [4].

Rehabilitation is a goal-oriented and time-limited process that focuses on making a functionally impaired person to reach the optimum mental, physical and social functional level. The aim of the rehabilitation team is to restore the functional level of people who sustained a fracture as a consequence of falling and to avoid falls and fall-related fractures by educating groups under high risk (Fig. 14.2).

Rehabilitation after surgical stabilization of a hip fracture is crucial in optimization of post-injury mobility, restores prefracture function and avoids long-term institutionalization. Patient’s medical history concerning other co-morbidities and data about frequency, characteristics and number of previous falls during the last year are important [3].

The degree of healing varies widely depending on the age, concomitant diseases of the patient and other factors such as thyroid hormone levels, nutritional status, etc. Common conditions that disturb the healing fracture include diabetes, circulatory disorders, anaemia, hypothyroidism, nutritional deficiency-malnutrition (lack of vitamin C or D, insufficient protein intake) and long-term use of alcohol and tobacco. Drugs which may also disturb the healing fracture including non steroidal anti-inflammatory drugs (NSAIDs), glucocorticoids and antibiotics (ciprofloxacin) [5]. Rehabilitation physicians are facing life-threatening medical complications such as cardiopulmonary problems, deep vein thrombosis and ischaemic attack in hip-fractured subjects, but also variable complications such as hip pain, uneven limb length, heterotopic ossification, decubitus ulcers and neurological complications which possible occur after hip fracture and should be treated. A thorough clinical examination of gait and balance disorders is also necessary to inspect current impairments or disabilities and organize the rehabilitation process [3] (Table 14.1).

Immediately after the operation, breathing exercises to reduce the risk of atelectasis and other pulmonary complications while the patient is still in bed should be started. Breathing exercises can be either energetic or passive when a physical therapist helps the patient. The individuals are also given spirometers and are instructed to take deep breaths, keeping the inhaled air inside for a couple of seconds and then exhale. The following primary exercises are important for increasing circulation to legs and to prevent blood clots, to strengthen muscles and to improve hip movement and should be started gradually from the first day after surgery with an intensity that does not exceed the limits of pain tolerance (for analytical descriptions, please see Table 14.2). They should be performed in a supine body position with the lower limbs partially abducted. The patient is encouraged to bend his operated limb. “Pump-like” energetic exercises (ankle pumps), ankle rotations and straight leg raises for the lower extremities are basic in the programme. However, upper extremities and trunk strengthening must also be part of the rehabilitation programme, to assure that patient has adequate strength in the arms for moving around in bed, for standing up from a chair and for walking when using a walker or crutches. Exercises to keep trunk muscles strong may help avoid back problems, which may arise from the initial uneven weight bearing. Abdominal and dorsal muscles should also be exercised isometrically and then energetically, in order to minimize the risk of low back pain during weight-bearing exercises.

However there are some limitations on range of motion (ROM) after surgery depending on the surgical procedure (hip fractures stabilized with internal fixation do not require ROM precautions). The patient is instructed to avoid (a) hip flexion greater than 70–90° for 6 weeks, (b) inner and/or outer hip rotation and adduction exceeding the neutral position for at least a 6-week period (in posterior approach), (c) forward bending and lying on the operated hip’s side for the first 2 weeks and (d) putting the lower extremities in a crosswise position. By the third day after surgery, the patient should start training from a sitting position. While standing down during transfer from bed to chair, the hip must be abducted. Weight bearing should start later on at 6th to 10th day, when the patient is capable of standing on his feet by himself. Partial weight bearing should be preserved for 6–12 weeks. Most of the patients are more likely to start using a walker frame and then progressively move to using crutches. In the partial weight-bearing stage of rehabilitation, the operated hip is allowed to bear only a load of 30 kg. Gradually, the patients will be allowed to start walking on crutches for 4–6 weeks. Complete weight bearing depends on the surgical procedure. Usually the patient is scheduled after total hip arthroplasty after a period of 6 months and after open reduction and internal fixation after 3 months [3].