The Royal Victoria Hospital in Belfast and Altnagelvin Hospital in Londonderry have scored badly in a nationwide survey on treatment of hip fractures.
Only one in five patients at the Royal had surgery within 36 hours compared to a nationwide average of 57%. The figure was 33% in Derry.
Nationally 81% have surgery in the first 48 hours. The Belfast figure was 63% while in Derry it was 69%.
By the latter criterion, the Royal finished second last in the UK.
The Royal fared better in how long it takes to transfer a patient from A&E to an orthopaedic ward.
It finished 98th out of 129 UK hospitals surveyed while Altnagelvin finished 107th.
Around 76,000 people fracture their hips every year in the UK, with 92% of cases among people aged 70 and over.
The audit was carried out for the Royal College of Surgeons.
Reasons for delay include waiting for space on an operating theatre list, not enough staff, waiting for beds and patients not being medically fit for surgery.
The Western Trust said that more than 90% of those who were medically fit for surgery had their operation within 48 hours.
Its statement continued: “The period covered includes the winter 2009/10 period when the trust dealt with an unprecedented level of patients requiring surgery for complex fracture injuries sustained as a result of slips and falls during the adverse weather conditions.”
BBC Northern Ireland health correspondent Marie-Louise Connolly said that improving the figures could prove difficult in the face of impending cuts to health budgets.
“It’s feared the situation may get worse before getting any better,” our correspondent said.
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