Phase I: Protection and Early Mobilisation (0–6 Weeks)

Immobilisation:

• None.

Precautions:

• Weight bearing as tolerated.

• Avoid twisting and pivoting on the operated leg.

• Avoid low chairs and uncontrolled sitting/standing.

Therapy:

• Early mobilisation with physiotherapy.

• Gait re-education with appropriate walking aid.

• Hip range of motion exercises within comfort.

• Isometric strengthening of quadriceps, gluteals, and core.

• Respiratory exercises and venous thromboembolism prevention strategies.

Criteria to Progress:

• Pain controlled.

• Safe mobilisation with walking aid.

• Tolerating weight bearing as tolerated.

Phase II: Strengthening and Functional Recovery (6–12 Weeks)

Precautions:

• Avoid high-impact activities and sudden directional changes.

Therapy:

• Progress hip and knee range of motion.

• Strengthening of hip abductors, extensors, and quadriceps.

• Balance and proprioception training.

• Gradual reduction in walking aids as gait normalises.

Criteria to Progress:

• Improved gait pattern.

• Minimal pain during daily activities.

• Improving lower limb strength and endurance.

Phase III: Advanced Strengthening Phase (12–16 Weeks)

Precautions:

• Avoid impact loading if pain or weakness persists.

Therapy:

• Progressive strengthening of lower limb and core.

• Endurance training (e.g. walking, cycling).

• Functional retraining for stairs, uneven surfaces, and daily activities.

Criteria to Progress:

• Near-normal gait without assistive devices.

• Good functional strength and balance.

Phase IV: Return to Function (4–6 Months)

Precautions:

• Gradual return to higher-demand activities only once strength and confidence allow.

Therapy:

• Continued strengthening and conditioning.

• Activity-specific rehabilitation as required.

Criteria to Discharge:

• Independent, pain-free ambulation.

• Functional strength appropriate for age and activity demands.

• Radiographic evidence of fracture healing and clearance by treating surgeon.

General Recommendations

Work:

• Office and sedentary work may resume after approximately 4–6 weeks depending on comfort and mobility

• Manual labour is commonly delayed until approximately 4–6 months or longer depending on fracture healing and occupational demands

Driving:

• It is important that you are medically fit to return to driving and you feel safe to control the vehicle and take evasive action if needed.

Sports and Leisure:

• Upper-limb exercise and non-impact activities may resume as comfort allows.

• Progressive return to gym and functional lower limb activities from approximately 3–4 months.

• Running, jumping, pivoting, contact sport, and impact activities are typically introduced from approximately 6 months or longer with full recovery and surgeon clearance.

Thromboprophylaxis

A combination of mechanical and pharmacological thromboprophylaxis is generally recommended following lower limb orthopaedic surgery. The selection of the specific agent (e.g., aspirin, low molecular weight heparin, or a direct oral anticoagulant) and the duration of prophylaxis will be discussed and determined in consultation with A/Prof Ernstbrunner and his medical team, based on the individual patient's risk profile and comorbidities.

Disclaimer: This protocol is intended as a general rehabilitation guide only. Rehabilitation progression should always be individualised and may be modified by A/Prof Ernstbrunner and the treating rehabilitation team based on the patient’s clinical progress, surgical findings, and individual circumstances.