JBJS - 2026-09-15 - Journal Article
Bridging the Global Implementation Gap in Immediate Weight-Bearing After Hip Fracture Surgery: The WAIT-Free Consensus for Low-Adoption Regions.
Mao W, Jiang J, Shi ZM, Hong CC, Turabi RY, Karim MA, Sukati F, Giordano V, Altamirano-Cruz MA, Reyes AL, Li Y, Trikha V, Rasheed MA, Saengsin J, Tekin C, Grünberg L, Nashi N, Sammy Loh KY, Rui YF, Tian KW, Wang ZH, Liu T, Zhang L, Yang AL, Chen M, Hu SJ, Du SC, Chang SM, Huat Chua IT, Jia WT, Ma X
Topics
Key Takeaway
A 31-expert, 15-country Delphi consensus (≥2/3 threshold, 3 rounds) produced 13 recommendations across 4 domains to guide immediate WBAT implementation after hip fracture surgery in low-adoption regions representing >50% of the world's population.
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Summary
The WAIT-Free Consensus addressed the failure to implement immediate WBAT after hip fracture surgery across low-adoption regions including China, South Asia, Southeast Asia, the Middle East, Latin America, and Africa. A structured 3-round Delphi process with 31 international experts and a ≥2/3 consensus threshold generated 13 recommendations organized around shared decision-making, mobility-based stratification, fall prevention, and postoperative stability-based triage. The output includes a pragmatic supportive-factor checklist designed for phased implementation adaptable to local resource constraints.
Key Limitation
The consensus is entirely expert-opinion-based with no prospective outcome data from low-adoption region institutions, meaning the 13 recommendations have not been validated against mortality, complication, or functional endpoints in the target populations.
Original 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.