RECOMMENDATIONS

Document Overview

Design and created by Guideline Central in participation with the American Academy of Orthopaedic Surgeons.

Management of Hip Fractures in Older Adults

American Academy of Orthopaedic Surgeons

Publication Date: Dec 3, 2021

Page Last Updated: May 5, 2026

Interpreting the Strength of Evidence

Strength of Recommendation
Strength	Overall Strength of Evidence	Description of Evidence Quality
Strong	Strong	Evidence from two or more “High” quality studies with consistent findings for recommending for or against the intervention.
Moderate	Moderate	Evidence from two or more “Moderate” quality studies with consistent findings, or evidence from a single “High” quality study for recommending for or against the intervention.
Limited	Low Strength Evidence or Conflicting Evidence	Evidence from two or more “Low” quality studies with consistent findings or evidence from a single “Moderate” quality study recommending for against the intervention or diagnostic or the evidence is insufficient or conflicting and does not allow a recommendation for or against the intervention.
Consensus*	No Evidence	There is no supporting evidence. In the absence of reliable evidence, the guideline development group is making a recommendation based on their clinical opinion. Consensus statements are published in a separate, complimentary document.

Document Overview

Document Title: Management of Hip Fractures in Older Adults

Authoring Society: American Academy of Orthopaedic Surgeons

Document Publication Date: Dec 3, 2021

Page Last Reviewed/Updated: May 5, 2026

Document Type: Guideline

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: www.aaos.org/globalassets/quality-and-practice-resources/hip-fractures-in-the-elderly/hipfxcpg.pdf

Source Citation: American Academy of Orthopaedic Surgeons Management of Hip Fractures in Older Adults Evidence-Based Clinical Practice Guideline. https://www.aaos.org/hipfxcpg.pdf Published December 3, 2021.

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Scope: Assessment and Screening, Diagnosis, Management, Prevention, Rehabilitation, Treatment

Diseases/Conditions (MeSH)

D010024 - Osteoporosis

D058866 - Osteoporotic Fractures

D010024 - Osteoporosis

D058866 - Osteoporotic Fractures

Keywords: elderly, fall prevention, geriatric falls, hip fracture, osteoporosis

Target Patient Population: Elderly patients with hip fractures

Target Provider Population: Orthopedic Surgeons, Geriatricians; Anesthesiologists and other allied providers

Inclusion Criteria: Male, Female, Adult, Older Adult

Health Care Settings: Ambulatory, Emergency Care, Home Health, Hospital, Long Term Care, Operating and Recovery Room, Outpatient

Intended Users: Dietician/Nutritionist, Nurse, Nurse Practitioner, Occupational Therapist, Physical Therapist, Physician, Physician Assistant

Recommendation Development Processes & Methodology

Number of Source Documents: 231

Literature Search Start Date: Sunday, March 1, 2020

Literature Search End Date: Thursday, July 1, 2021

Includes peer/external review process?: Yes

Includes public comment process?: No

Methodologist involvement?: Yes

Patient involvement?: No

Includes multi-disciplinary group?: Yes

Includes systematic review?: Yes

Grades quality of strength of evidence?: Yes

Grades quality of strength of recommendation?: Yes

Discloses funding source?: Yes

Discloses conflicts of interest?: Yes

Includes benefits/harms analysis with recommendations?: Yes

Management of Hip Fractures in Older Adults

RECOMMENDATIONS

PREOPERATIVE TRACTION

SURGICAL TIMING

VTE PROPHYLAXIS

ANESTHESIA

ARTHROPLASTY VS. FIXATION

UNIPOLAR/BIPOLAR HEMIARTHROPLASTY

TOTAL ARTHROPLASTY VS. HEMI ARTHROPLASTY

CEMENTED FEMORAL STEMS

SURGICAL APPROACH

STABLE INTERTROCHANTERIC FRACTURES

SUBTROCHANTERIC OR REVERSE OBLIQUITY FRACTURES

UNSTABLE INTERTROCHANTERIC FRACTURES

TRANSFUSION

MULTIMODAL ANALGESIA

TRANEXAMIC ACID

INTERDISCIPLINARY CARE PROGRAMS

STABLE FEMORAL NECK FRACTURES

PERTROCHANTERIC FRACTURES

WEIGHT BEARING

Interpreting the Strength of Evidence

Document Overview

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Recommendation Development Processes & Methodology