Objective To explore the influencing factors of early weight-bearing exercise after hip fracture surgery in the elderly from the perspective of medical staff. Methods Based on the theory of planned behavior, a descriptive qualitative research method was adopted. Orthopedic surgeons, rehabilitation therapists and nurses directly involved in relevant work at Shanghai Sixth People’s Hospital were selected for interviews from October to December 2025. The influencing factors of postoperative early weight-bearing exercise in elderly hip fracture patients were inquired, and directed content analysis was used for data sorting and analysis. Results A total of 26 medical staff were interviewed. The analysis revealed that the facilitating factors for early weight-bearing exercise in elderly patients after hip fracture surgery included behavioral attitude (medical staff’s recognition of the rehabilitation and professional value of early weight-bearing), subjective norm (multidisciplinary collaboration and promotion by administrators), and perceived behavioral control (intelligent devices and information support improving self-efficacy). The barriers consisted of behavioral attitude (fear of risks and pressure from institutional environment), subjective norm (negative social pressure from patients and their families, and hierarchical dependence among medical staff), and perceived behavioral control (insufficient human resources, lack of objective assessment tools, and equipment deficiencies). Conclusions Early weight-bearing exercise after hip fracture surgery in the elderly is constrained by multidimensional factors. Intervention strategies should be developed from the dimensions of attitude reconstruction, norm reshaping and control empowerment to narrow the knowledge-practice gap between evidence-based guidelines and clinical practice, so as to effectively facilitate the clinical implementation of early weight-bearing exercise.