Bridging the Global Implementation Gap in Immediate Weight-Bearing After Hip Fracture Surgery

Postoperative care for hip fractures remains globally inequitable. Immediate weight-bearing as tolerated (WBAT) after surgery is widely recommended in North America and Europe, yet it is not routinely implemented across regions that collectively represent over half of the world's population, including the People's Republic of China, South Asia, Southeast Asia, the Middle East, Latin America, and Africa (hereafter referred to as low-adoption regions [LARs]). To address this gap, the WAIT-Free Consensus was developed to support the safe and sustainable implementation of immediate WBAT for older adults with a hip fracture in these settings. A multidisciplinary Consensus Development Group of 31 international experts from 15 countries reviewed the available evidence and used a structured, 3-round Delphi process with a consensus threshold of ≥2/3 to develop and refine recommendations. The final consensus statement comprised 13 recommendations organized around 4 domains: (1) shared decision-making with proportionate documentation of informed discussions about benefits and realistic risks, (2) mobility-based stratification that prioritizes immediate WBAT for patients who were independently ambulatory before the fracture, (3) structured fall prevention and multidisciplinary perioperative optimization, and (4) postoperative stability-related triage to individualize weight-bearing protocols after internal fixation versus arthroplasty. In addition, a pragmatic supportive-factor checklist is provided to guide phased implementation. This consensus statement provides a structured, evidence-informed pathway for LARs to adopt immediate WBAT after hip fracture surgery in older adults. The recommendations can be adapted to local resource constraints, with implementation audited using context-specific indicators and refined iteratively as capacity and evidence evolve.

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Publication Details

Journal
Journal of Bone and Joint Surgery
Published
2026-09-15
DOI
https://doi.org/10.2106/jbjs.26.00980
Primary Topic
Hip and Femur Fractures
Type
article
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article

Bridging the Global Implementation Gap in Immediate Weight-Bearing After Hip Fracture Surgery

Khin Yee Sammy Loh, Jirawat Saengsin, Jia Jiang, Lisa Grünberg et al.
Journal of Bone and Joint Surgery
Hip and Femur Fractures
article

Bridging the Global Implementation Gap in Immediate Weight-Bearing After Hip Fracture Surgery

Khin Yee Sammy Loh, Jirawat Saengsin, Jia Jiang, Lisa Grünberg, Wei Mao, Marco Antonio Altamirano-Cruz, Vincenzo Giordano, Çağatay Tekin, Ivan Tjun Huat Chua, Mahmoud Abdel Karim, Alberto Córdoba López, Ruqayyah Turabi, Choon Chiet Hong, Nazrul Nashi, Shi‐Min Chang, Vivek Trikha, Falethu Sukati, Yunfeng Rui, A. Yang, Shou-Chao Du, Muhammad Asif Rasheed, Jia Wei-tao, Z Y Shi, Sun-jun HU, Xin Ma, Ming Chen, Zhen-Hai Wang, Ke-Wei Tian, Tao Liu, Yan Li, Li Zhang
article en

Abstract

Postoperative care for hip fractures remains globally inequitable. Immediate weight-bearing as tolerated (WBAT) after surgery is widely recommended in North America and Europe, yet it is not routinely implemented across regions that collectively represent over half of the world's population, including the People's Republic of China, South Asia, Southeast Asia, the Middle East, Latin America, and Africa (hereafter referred to as low-adoption regions [LARs]). To address this gap, the WAIT-Free Consensus was developed to support the safe and sustainable implementation of immediate WBAT for older adults with a hip fracture in these settings. A multidisciplinary Consensus Development Group of 31 international experts from 15 countries reviewed the available evidence and used a structured, 3-round Delphi process with a consensus threshold of ≥2/3 to develop and refine recommendations. The final consensus statement comprised 13 recommendations organized around 4 domains: (1) shared decision-making with proportionate documentation of informed discussions about benefits and realistic risks, (2) mobility-based stratification that prioritizes immediate WBAT for patients who were independently ambulatory before the fracture, (3) structured fall prevention and multidisciplinary perioperative optimization, and (4) postoperative stability-related triage to individualize weight-bearing protocols after internal fixation versus arthroplasty. In addition, a pragmatic supportive-factor checklist is provided to guide phased implementation. This consensus statement provides a structured, evidence-informed pathway for LARs to adopt immediate WBAT after hip fracture surgery in older adults. The recommendations can be adapted to local resource constraints, with implementation audited using context-specific indicators and refined iteratively as capacity and evidence evolve.

Journal of Bone and Joint Surgery
Karolinska University Hospital (SE), German Sport University Cologne (DE), National University of Singapore (SG), Chinese University of Hong Kong (HK), Shanghai Jiao Tong University (CN), King's College London (GB), Universidad de Guadalajara (MX), Combined Military Hospital (PK), Tan Tock Seng Hospital (SG), Steve Biko Hospital (ZA), Chinese PLA General Hospital (CN), Karolinska Institutet (SE), Hospital Barros Luco-Trudeau (CL), Lok Nayak Jai Prakash Narayan Hospital (IN), Zhongda Hospital Southeast University (CN), Yantaishan Hospital (CN), Shanghai Sixth People's Hospital (CN), National University Hospital (SG), Nanxi Mountain Hospital (CN), National University Health System (SG), Qilu Hospital of Shandong University (CN), Secretaria Municipal de Saúde (BR), Luoyang Orthopedic-Traumatological Hospital of Henan Province (CN), Cairo University hospitals (EG), Yangpu Hospital of Tongji University (CN), Chiang Mai University (TH), All India Institute of Medical Sciences (IN), University of Pretoria (ZA), University of Health Sciences Antigua (AG), Jazan University (SA)
Openalex Percentile: Top 9%
Hip and Femur Fractures
DOISourceOpenAlex
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