Réadaptation après une chirurgie de la hanche

• Use culturally safe, trauma- and violence-informed care. Explain why questions matter, seek permission before sensitive topics, and adapt communication to the patient’s language, identity, culture, disability and previous health care experiences (Public Health Agency of Canada, 2018).
• Informations sociodémographiques : age, sex, gender identity, language, living arrangement, occupation, caregiving responsibilities, health literacy, supports and communication or access needs.

Primary concerns

• Surgery and current plan: reason for surgery; operated side; procedure, date, approach, implant or fixation when known; operation and discharge records; surgeon and follow-up; weight-bearing status; movement precautions; wound plan; venous thromboembolism plan; and any postoperative complication or readmission.
• Current symptoms and course: hip, groin, thigh, knee or back pain; wound change; swelling or bruising; calf symptoms; fever or chills; shortness of breath or chest symptoms; fatigue; dizziness; numbness or weakness; sleep; and whether mobility or daily activities are improving, unchanged or worsening.
• Baseline and current functioning: mobility and gait aid before surgery or fracture; current bed mobility, transfers, walking, stairs, self-care, household and community activities; falls; work or caregiving; driving; recreation; social participation; and assistance needed.
• Hip-fracture context when relevant: fall or trauma mechanism, fragility-fracture history, time on the floor, other injuries, pre-fracture residence and mobility, osteoporosis care, prior falls, delirium and the person’s account of the event.
• Revue des systèmes corporels : cardiovascular and respiratory; neurological, cognitive and vestibular; musculoskeletal; skin and wound; vascular; genitourinary and gastrointestinal; nutritional; endocrine and metabolic; sleep; and mood symptoms that may affect safety, healing or rehabilitation.
• Health, lifestyle and history: frailty; osteoporosis and previous fractures; venous thromboembolism or bleeding; diabetes; cardiovascular, respiratory, kidney, liver, neurological and musculoskeletal conditions; infection history; recent hospitalization; physical activity; nutrition and hydration; sleep; tobacco; alcohol or substance use; and current medications and supplements, including analgesics, anticoagulants, corticosteroids and psychotropic medicines.
• Cognition and communication: baseline cognition, new or fluctuating confusion, attention, memory, ability to learn or follow the plan, hearing, vision, communication aids, decision-making support and caregiver observations.
• Environment and supports: discharge destination, home layout, stairs, bathroom and sleeping setup, mobility and dressing equipment, transportation, access to food and medications, caregiver availability, home services and the person’s ability to summon help.
• Social determinants of health: housing, income, food security, discrimination, social support, caregiver strain, transportation, digital access and availability or affordability of rehabilitation, equipment and follow-up (Public Health Agency of Canada, 2026).
• Soins et interventions antérieurs : inpatient and community rehabilitation, education, exercise, gait aids, home modifications, pain care and other approaches tried; what helped, did not help, caused harm or was difficult to continue.
• Patient perspective: understanding of the operation and recovery plan, priorities, preferences, cultural context, acceptable risk, confidence, concerns, expectations and previous experiences of care.
• Flag review: check Red Flags and refer to the separate fixed Orange Flags and Yellow Flags modules when relevant.

​​Outcomes measures:

• Use measures that are meaningful to the patient, safe for the surgical phase and practical to repeat. Record the setup, gait aid, assistance and weight-bearing status so repeated results are comparable.
• Patient-specific functioning: Patient-Specific Functional Scale (PSFS).
• Disability and participation: WHO Disability Assessment Schedule 2.0 (WHODAS 2.0).
• Qualité de vie : WHOQOL-BREF.
• Hip-specific symptoms and functioning: the Hip Disability and Osteoarthritis Outcome Score, Joint Replacement (HOOS, JR) can be used after hip replacement when it fits the person’s age, goals and surgical population. It is not a universal measure after hip-fracture fixation.
• Mobility performance: a safe repeatable task such as the Timed Up and Go ou 10 Meter Walk Test, selected according to walking ability and the clinical question.
• Pain and other symptoms: a consistent pain rating plus symptom location, wound and swelling observations, medication use and effect on sleep, mobility and participation.
• Objectifs individuels : agree on patient-defined goals and how progress will be recognized. SMART wording may be used when helpful but is not required.

Orange Flags are signs that a mental health or substance use concern may require emergency or timely assessment or shared care, and may change whether and how MSK care proceeds. They are not diagnoses. Ask directly and respectfully when concern arises, considering immediate safety, severity, change from usual, daily functioning and context. Psychosocial factors that may affect recovery but do not require separate mental health or medical assessment are addressed under Yellow Flags.

ACTION: Arrange emergency assessment now when there is immediate danger or an urgent medical need:

• Suicide, self-harm or harm to others: current intent or plan, a recent attempt, inability to stay safe, or behaviour suggesting an immediate risk of serious harm.
• Severe change in mental state: extreme agitation, confusion, disorganization, possible psychosis or mania with impaired judgment or unsafe behaviour, or inability to meet basic needs when this creates immediate danger.
• Substance-related or medical emergency: suspected overdose, severe intoxication, dangerous withdrawal, delirium or another sudden change requiring urgent medical care.

When immediate safety is uncertain, do not leave the person alone while help is arranged. Follow local emergency procedures and call 9-1-1 for immediate danger or urgent medical need. If the person is thinking about suicide, call or text 9-8-8: Suicide Crisis Helpline with them or support them to do so.

If violence, abuse or exploitation is disclosed or suspected, support immediate safety and follow applicable safety and reporting requirements.

ACTION: Arrange prompt medical or mental health assessment when there is:

• Suicide or self-harm thoughts: thoughts without immediate danger.
• Substantial symptoms or effects: severe, persistent or worsening symptoms of depression, anxiety, trauma, possible psychosis or mania, eating problems or substance use that substantially affect daily life, decision-making or safe participation in care.
• Other reasons for assessment: a marked change from usual behaviour or functioning; concern about medication or substance effects; a presentation outside the clinician’s competence; or a request for help.

Agree with the patient on who will be contacted, how soon and what to do if the situation worsens. Confirm that the person has connected with the service when clinically important.

ACTION: Adapt and coordinate MSK care:

• Safe care: care may continue when it is safe and acceptable and does not delay needed assessment. Adapt communication, examination and care; obtain ongoing consent; and coordinate with other providers with the patient’s permission.
• Continue the MSK assessment: do not assume that a mental health or substance use concern explains the MSK presentation. Continue to consider physical causes and the patient’s account.
• Questionnaires: they may support conversation and monitoring, but do not establish a diagnosis or replace direct questions, clinical judgment or action.
• Acceptable support: ask what type of help is acceptable and whether language, cultural, family, community or other supports are important to the patient.

ACTION: Document and follow up:

Record the concern; relevant questions and the patient’s responses; the safety decision and reasons; actions, advice and referrals; communication and consent; follow-up; and any unresolved concern. Follow applicable privacy, safety and reporting requirements.

For provincial, territorial and national services, see Mental health support: Get help (Public Health Agency of Canada 2026).

Yellow Flags are personal, social, work, school, healthcare, environmental or structural factors that may influence symptoms, functioning, participation or response to care. They are contextual, not diagnoses or certain predictions, and do not mean that symptoms are psychological. They guide how care is tailored and do not by themselves require urgent referral. Explore them through conversation and ongoing outcome review, with attention to the patient’s priorities, strengths and circumstances. A separate Yellow Flag score is not required. New or worsening signs of serious physical illness follow the Red Flag process. Mental health or substance use concerns that need separate assessment, or any immediate safety concern, follow the Orange Flag process and applicable emergency or safeguarding procedures.

Explore relevant factors:

• Understanding, expectations and healthcare experiences: concerns about injury or damage, uncertainty, recovery expectations, confidence, conflicting advice, previous dismissal or harm, and trust in care.
• Responses to symptoms and activity: worry, fear, avoidance, cycles of doing too much and then needing prolonged rest, difficulty pacing, coping, sleep, confidence in self-management, and return to meaningful activities.
• Emotional and life context: distress, low mood, anxiety, grief, trauma, caregiving, relationship change, job loss or other major events. Ask permission before sensitive questions and limit discussion to what is relevant and acceptable to the patient.
• Relationships, culture and strengths: supportive relationships, isolation, family and community roles, cultural or spiritual practices, identity, preferences, language and other sources of resilience.
• Work, school and administrative context: physical and psychosocial demands, control, satisfaction, job security, accommodations, return concerns, and compensation, insurance or legal processes. Explore these neutrally and in context.
• Social and structural conditions: consider social and structural determinants of health (Public Health Agency of Canada 2026), including income, housing, food security, transportation, childcare, access and cost of care, discrimination, racism, colonialism, neighbourhood and workplace conditions, and physical or digital accessibility.

ACTION: Respond with the patient:

• Ask, do not assume: use open questions to understand what helps, what gets in the way, what matters and what feels feasible. Ask about strengths and protective factors, not only difficulties. Do not treat a person’s circumstances, culture or choices as a deficit.
• Plan together: integrate relevant findings into shared goals, education, self-management, physical activity or exercise, and participation in meaningful activities. Adapt communication, setting, pace, cost and access where possible.
• Connect and coordinate: with the patient’s consent, consider appropriate clinical, social, workplace, school, community, Indigenous or culturally specific supports. Clarify who will do what and follow up when the connection is important to the plan.
• Review response to care: reassess the patient’s account and the pathway’s selected outcomes at clinically relevant points. If progress differs from expected, review the clinical impression, care plan, access and other barriers; do not automatically attribute the outcome to Yellow Flags.
• Document: record relevant factors and strengths, the patient’s priorities and preferences, agreed actions, consent, referrals or coordination, follow-up, and any change requiring the Orange Flag process.

Select examination elements that answer a clinical question or may change care. Adapt the examination to the patient’s surgical plan, presentation, comfort, consent and abilities.

• Consent and comfort: explain what you propose, provide choices about positioning, draping, pace, assistance and caregiver involvement, and confirm ongoing consent before examining the hip, groin, wound or other sensitive areas.
• Surgical plan and stability: confirm the procedure, date, weight-bearing status, movement precautions, wound instructions and medical clearance before loading or moving the hip. Defer or modify testing when these are unknown or the person is medically unstable.
• General observation and wound: alertness, distress, breathing, pallor, hydration, posture, spontaneous movement, swelling, bruising, dressing or incision condition, drainage, skin integrity and signs of pressure injury.
• Vital signs and medical screening when indicated: heart rate and rhythm, blood pressure, oxygen saturation, temperature, orthostatic response, pain behaviour and signs of acute illness, bleeding or medication adverse effects.
• Neurovascular examination: distal pulses, colour, temperature, capillary refill, swelling, sensation and motor findings when new pain, weakness, numbness, vascular symptoms or a surgical complication is plausible.
• Gait and mobility: bed mobility, sit-to-stand, transfers, gait initiation, step pattern, turning, walking distance, stairs, weight-bearing tolerance, assistance and safe use of the prescribed gait aid.
• Évaluation fonctionnelle : patient-prioritized self-care, dressing, toileting, household, vehicle, work or community tasks and the interaction among the person, equipment, environment and available support.
• Hip and lower-limb movement: active and passive movement only as needed and within the surgical plan, noting movement quality, pain, restriction and protective behaviour. Include the knee, ankle, lumbar spine or other regions when they may explain symptoms or limit mobility.
• Force et contrôle du moteur : safe functional loading and selected hip, knee and ankle muscle testing, with attention to hip abductors and extensors, quadriceps, asymmetry, inhibition and control during transfers, stance and gait.
• Balance and falls assessment: standing balance, turning, reaching and other tasks matched to safety and goals, especially after a fragility fracture or when falls, fear or unsteadiness are present.
• Imagerie : review available postoperative imaging and the surgical report when relevant. New imaging is not routine for expected recovery; arrange medical or surgical assessment when new trauma, deformity, inability to bear weight, worsening focal pain or another suspected complication is likely to change care.
• Repeat and adapt: repeat focused findings to review progress, check the fit of the working presentation and decide whether rehabilitation, medical assessment or surgical follow-up needs to change.

Working clinical presentations

These presentations can overlap or change. Use them to organize assessment and care, not as fixed stages or substitutes for the surgical diagnosis and plan.

• Uncomplicated recovery after primary elective total hip arthroplasty: expected postoperative pain, swelling, weakness and mobility change with a clear surgical plan, stable wound and gradual progress in walking and daily activities (NICE, 2020; Rehabilitative Care Alliance, 2026).
• Recovery after hip-fracture repair or hemiarthroplasty: mobility loss after a traumatic or fragility fracture, often with falls risk, frailty, osteoporosis, delirium or reduced pre-fracture reserve. Rehabilitation is coordinated with medical, geriatric, bone-health and falls care when relevant (American Academy of Orthopaedic Surgeons, 2021; NICE, 2023; Ontario Health, 2024).
• Self-directed recovery with planned review: the person understands the plan, manages exercises and daily activities safely, has suitable support and equipment, and is progressing toward goals without a need for frequent supervision.
• Mobility or daily-activity limitation requiring supervised rehabilitation: persistent gait, transfer, stair, balance, strength, endurance or self-care difficulty that is safe to address and not explained by a new surgical complication.
• Complex or slower recovery: frailty, multimorbidity, pain, fear, cognitive or sensory impairment, deconditioning, other musculoskeletal problems, limited support or access barriers slow progress or increase the need for coordinated care.
• Procedure-specific or surgically restricted recovery: revision, bone graft, osteotomy, fracture fixation, abductor repair, intraoperative complication or another surgical factor requires a plan that differs from routine primary arthroplasty care. Follow the surgeon’s restrictions and review points.
• Atypical or worsening post-surgical presentation: new systemic symptoms, wound change, marked pain increase, mechanical symptoms, neurological change, loss of weight-bearing tolerance or decline after earlier improvement. Recheck Red Flags and arrange medical or surgical assessment.

Base care on the presentation, safety, goals, context and response. Use adaptable principles and options rather than a ranked sequence, and repeat meaningful outcomes to guide change.

Surgical plan and care transitions

• Procedure-specific plan: obtain and follow the operation and discharge information, including weight bearing, movement precautions, wound care and surgical follow-up. Do not apply a standard set of hip precautions or range-of-motion restrictions to every person (NICE, 2020; Rehabilitative Care Alliance, 2026).
• Communication across settings: share current mobility, assistance, equipment, medication, wound, restriction and goal information with the person, caregivers and relevant surgical, medical and rehabilitation providers at each transition (NICE, 2023; Rehabilitative Care Alliance, 2026).
• Fragility hip-fracture follow-up: for adults aged 50 years or older after surgery for a fragility hip fracture, confirm scheduled primary care follow-up within 2 weeks of inpatient discharge and orthopaedic follow-up within 12 weeks of surgery. Arrange shared care when these appointments or the osteoporosis assessment are missing (Ontario Health, 2024).

Education, self-management and participation

• Recovery plan: explain the procedure-specific plan, expected day-to-day variation, safe activity progression, exercise, use of aids, wound care, medication coordination, follow-up and who to contact with questions. Pace information and include caregivers when the person agrees (NICE, 2020; NICE, 2023; Rehabilitative Care Alliance, 2026).
• Return to valued activities: use patient-defined goals and graded practice for self-care, household tasks, community mobility, work, driving, sexual activity and recreation. Match advice to surgical guidance, ability and risk rather than a universal calendar (NICE, 2020).
• Recognizing complications: review the wound, deep vein thrombosis, pulmonary embolism, infection, dislocation and fracture features in Red Flags and make clear whom to contact and when emergency care is needed.

Physical activity and exercise

• Early safe mobility: after elective primary hip replacement, mobilization can begin on the day of or day after surgery once the person is medically stable, has appropriate assistance and is cleared under the surgical plan. After surgery for a fragility hip fracture, mobilization to weight-bearing as tolerated within 24 hours and daily mobilization are care standards unless the documented surgical or medical plan requires modification. Progress bed mobility, transfers, walking and stairs according to tolerance and safety (NICE, 2020; NICE, 2023; Ontario Health, 2024).
• Progressive exercise after hip replacement: options include hip and lower-limb range of motion within the surgical plan, progressive strengthening, balance, gait, endurance and task practice. Select and progress exercises according to baseline capacity, current impairments, goals and response (Rehabilitative Care Alliance, 2026; World Health Organization, 2023).
• Mobility training after hip fracture: gait, balance and daily-task practice can form the core, with strengthening and endurance added to identified needs. Coordinate interprofessional rehabilitation across inpatient and community settings toward pre-fracture functioning, accounting for frailty, cognition, medical conditions and pre-fracture mobility when setting the starting level and supervision (Fairhall et al., 2022; NICE, 2023; Ontario Health, 2024).
• Delivery and dose: individual, group, home, community, virtual or hybrid formats can be used. Match frequency, progression and supervision to safety, learning needs, support, access and observed response; a fixed number of visits is not required (NICE, 2020; Rehabilitative Care Alliance, 2026).

Mobility aids, daily activities and environment

• Gait aids: assess, fit and teach the use of a walker, crutches or cane. Review weight-bearing technique, turning, stairs and use in the person’s actual environment, and reduce support only when gait remains safe and consistent (Rehabilitative Care Alliance, 2026).
• Daily activities and equipment: occupational therapy, home assessment and equipment such as a raised seat, rails, dressing aids or bathing equipment can form part of care when they improve safety or independence. Review whether the home setup and caregiver plan remain workable (NICE, 2020; Rehabilitative Care Alliance, 2026).

Hands-on and symptom-relieving care

• Cold, positioning and swelling care: cold and comfortable positioning can be used for short-term symptom relief. Use compression or elevation only when consistent with wound, vascular and surgical guidance, and stop if symptoms worsen (Rehabilitative Care Alliance, 2026).
• Hands-on care: gentle soft-tissue or movement-based care away from the healing incision can be used when it is consistent with the surgical plan and helps a specific symptom or movement goal. Avoid deep pressure over the surgical site and do not use hands-on care in place of progressive mobility and exercise (Rehabilitative Care Alliance, 2026; World Health Organization, 2023).

Psychological, social and interdisciplinary support

• Confidence, mood and cognition: address concerns about falling or movement with clear information, graded practice and caregiver support. In hospital and after transitions or changes in medical status, follow the local standardized delirium screening and management process. New or worsening delirium follows Red Flags; persistent mood, cognitive or behavioural needs can be managed with the appropriate medical, geriatric or mental-health provider (Ontario Health, 2024).
• Interdisciplinary care: surgical and primary care, geriatrics, nursing, physiotherapy, occupational therapy, pharmacy, dietetics, home care and social services can be coordinated around medical stability, mobility, self-care, nutrition, cognition, bone health, falls and transition needs (American Academy of Orthopaedic Surgeons, 2021; NICE, 2023; Ontario Health, 2024; Rehabilitative Care Alliance, 2026).
• Fragility-fracture follow-through: after a fragility fracture, connect rehabilitation with falls assessment, osteoporosis and bone-health care, nutrition, medication review and community supports rather than treating mobility in isolation (NICE, 2023; Ontario Health, 2024; World Health Organization, 2024).
• Access and feasibility: transportation, cost, housing, language, technology, caregiver availability and service access can shape the plan. Select options the person can use and revisit barriers when participation is difficult.

Medication coordination

• Analgesia and postoperative medicines: coordinate with an authorized prescriber or pharmacist when pain limits rehabilitation, adverse effects such as sedation, dizziness, nausea or constipation occur, or questions arise about anticoagulants, venous thromboembolism prevention or other postoperative medicines. Medication changes remain within the appropriate provider’s scope (NICE, 2020; NICE, 2023).

Monitoring and reassessment

• Agree on a reassessment point based on the surgical phase, safety, goals, care being tried, patient needs and access rather than a fixed visit schedule.
• Repeat the small outcome set recorded at baseline and review pain, wound and swelling, relevant neurological and vascular findings, mobility, functioning, participation, benefits, harms, treatment burden and progress toward patient-defined goals.
• Continue what is useful and acceptable; adapt or stop what is not; and revisit the clinical presentation, surgical plan, differential diagnosis, referral or shared care when progress differs from expectations or new safety concerns emerge.

• Expected course: recovery varies with the operation, reason for surgery, baseline mobility, health and support. After uncomplicated elective primary total hip arthroplasty, pain and daily mobility often improve over the first weeks and months, while strength, endurance and confidence may continue to change over a longer period. After hip-fracture surgery, recovery is more variable and return to pre-fracture mobility is not guaranteed (National Institute of Arthritis and Musculoskeletal and Skin Diseases, 2023; Fairhall et al., 2022; NICE, 2023).
• Factors associated with a less favourable course: frailty, cognitive impairment or delirium, multimorbidity, poorer mobility before surgery or fracture, surgical or medical complications, persistent pain, fear of falling or movement, limited caregiver support and barriers to rehabilitation may be associated with slower or incomplete recovery. These are group-level patterns, not certain individual predictions (American Academy of Orthopaedic Surgeons, 2021; Rehabilitative Care Alliance, 2026; World Health Organization, 2024).
• Potential supports for recovery: a clear surgical and rehabilitation plan, early safe mobility, appropriately progressed gait and exercise, adequate pain relief and nutrition, suitable aids and home setup, caregiver involvement and coordinated medical, bone-health and falls care may support recovery (NICE, 2020; NICE, 2023; Ontario Health, 2024; Rehabilitative Care Alliance, 2026).
• Discussing prognosis: explain what is known about the person’s procedure and current progress without promising a date or outcome. Compare change with the person’s baseline and goals, discuss uncertainty plainly, and update the outlook when symptoms, repeated outcomes, support or the surgical plan changes.