الفهرس 
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Abstract
Summary
Total hip replacement surgery is the most common procedure that can significantly reduce pain, stiffness, enhance mobility and quality of life. The outcomes of surgical management are generally recognized as very satisfactory, with an increase in the life span. In addition, THR is a safe and reliable procedure for the treatment of end stage arthritis (Neuprez et al., 2020).
The success of the surgery depends not only on the surgical technique but also on proper postoperative rehabilitation and compliance with recommended strategies for recovery. Non-compliance can have a negative effect on patients as severe pain, a prolonged hospital stay, and increased health care costs. Overall, patient compliance with recommended strategies for recovery is a critical component of achieving optimal outcomes post THR surgery (Nho et al., 2022).
Aim of the study:
The current study aimed to:-
Assessment of relation between patients’ compliance and their outcomes post total hip replacement surgery through:
1. Assess level of patients’ compliance Post total hip Replacement Surgery.
2. Assess patients’ outcomes post total hip replacement surgery.
Research questions:
This study answered the following questions:-
1. What is the patients’ level of compliance post total hip replacement surgery?
2. What is the relation between patients’ compliance and their outcomes post total hip replacement surgery?
Subjects and methods:
Study design:
Research design:
The current study was conducted through using a descriptive correlation study.
Study setting:
The study was conducted at orthopedic surgery departments (2 & 3) and joint outpatient clinic in El-Demerdash Hospital affiliated to Ain Shams University Hospitals.
Subject:
A purposive sample of 50 patients post total hip replacement was included in this study.
Inclusion criteria:
Patient was selected according to the following criteria:
1. Adult patients from both genders,
2. Patients after 1 month to 1 year post primary total hip replacement surgery,
3. Total hip replacement related to arthritis or accident,
4. Able to communicate and agree to participate in the study.
Exclusions Criteria:
1. Patients with multi-compartment disease as (hemochromatosis, hemophilia),
2. Critical or mental ill patients and other neurological conditions affecting joint function.
Tools of data collection:
Four tools were used in data collections as following:-
Tool I: Patient structured interview questionnaire (Appendix I)
It was developed by investigator in an Arabic language based on reviewing related literatures (Ibrahiem et al., 2021; Amarilla-Donoso et al., 2020 and Matharu et al., 2019) and it contains two parts:
Frist Part: Socio- demographic characteristics.
It was used to assess Socio- demographic characteristics of patients under study, It composed of (12) MCQ questions.
Second Part: patients’ medical history data sheet:
It was used to assess medical history for patients under study, it contains of three sub groups in form of MCQ questions.
A) Anthropometric measurements.
B) Patient’s present history (post-surgery): It was used to assess patient’s present history (post- surgery).
C) Patient’s past history: it was used to assess patient’s past medical history.
Tool II: Patients’ knowledge assessment questionnaire tool (Appendix II):
It was developed by the investigator and write it in an Arabic language based on relevant, recent and related literatures. (Jones et al., 2022; Alokozai et al., 2021; Saunders et al., 2021; Ali et al., 2020, and Tay et al., 2019). It used to assess patient’s knowledge regarding total hip replacement surgery. It included (15) questions in the form of MCQ which classified:
A. Patients’ knowledge regarding total hip replacement surgery, It included seven MCQ questions.
B. Patients’ knowledge regarding Post-surgery instructions: It included five MCQ questions.
C. Patients’ knowledge about precautions to be followed post total hip replacement surgery: It included three MCQ questions.
Tool III: Patients’ compliance assessment questionnaire tool (Appendix III)
It was used to assess Patients’ compliance post total hip replacement surgery, it consisted of two part:-
Frist Part: Morisky Medication Adherence Scale (MMAS-8), this scale adapted from Morisky et al., (2008) with minor modification. To assess patients’ compliance regarding medications post total hip replacement surgery. It contained (8) questions.
Second Part: patient’s compliance post total hip replacement surgery questionnaire:
It was developed by the investigator and write it in an Arabic language based on relevant, recent and related literatures. (Majnik et al., 2022; El Sayed et al., 2021 and McNaught et al., 2021). It used to assess patient’s compliance post total hip replacement surgery.
Tool IV: Western Ontario and Mac master Universities Arthritis Questionnaire (WOMAC) (Appendix IV)
It was standardized tool adopted from Bellamy, (1988).It was used to assess patients’ outcomes post total hip replacement surgery, it included three main sections which consisted of 24 items classified as following;
A. Pain: it included (5 questions).
B. Stiffness: it included (2 questions)
C. Difficulty performing daily activities: it included (17 questions)
Results:
The results of the study showed that:-
• In relation to age, more than one third (34.0%) of the studied patients their age was ≥ 60 years, with Mean age 55.7 ±9.8 years. Also, three fifths (60.0%) of them were females and more than three quarters (76.0%) of them were married. Regarding educational level of the studied patients more than one third (34.0%) had secondary education. Also, it was found that more than half (52.0%) of them lived in the rural areas.
• Regarding total level of knowledge, this result shows that, more than two thirds (68.0%) of the studied patients had unsatisfactory total level of knowledge regarding the total hip replacement.
• Regarding total level of compliance, this result revealed that the majority (80.0%) of the studied patients were non-compliant regarding post total hip replacement surgery.
• Regarding total patient’s outcomes, this result shows that nearly half (46%) of the studied patients had mild level of total outcomes. while, more than two fifths (42%) of them had moderate level of total outcomes.
• There was a statistically significant relation between total patients’ level of knowledge and their age and education level at (P -Value = 0.001 and 0.004 respectively).
• There was a statistically significant relation between total patients’ level of compliance and their age and education level at (P -Value = 0.000). Also, there was a statistically significant relation with their marital status, residence and practice sports at (P -Value = 0.031, 0.024 and 0.021respectively)
• There was a statistically significant relation between their age and floors at (P -Value =0.018 and 0.023 respectively). Also, there was a highly statistically significant relation between total patients’ outcomes and their education level and residence at (P -Value =0.002and 0.001 respectively).
• Regarding correlation between the studied variable, this result illustrate that there was a positive correlation between total level of knowledge score and total level of compliance score regarding post total hip replacement surgery among the studied patients at (r= 0.621). meanwhile, there was a negative correlation between total outcomes score and total level of knowledge and compliance score regarding post total hip replacement surgery among the studied patients at r= -0.528- and r=-0.727-, respectively.
Conclusion:
Based on the result of the presented study and research questions, the study concluded that:
More than two third of the studied patients had unsatisfactory total level of knowledge regarding the hip joint replacement. And, the majority of the studied patients were non-compliant. Also, nearly half of the studied patients had mild level of total outcomes and more than two fifths of them had moderate level of total outcomes.
Moreover, there was a positive correlation between total knowledge score and total compliance score regarding post total hip replacement surgery among the studied patients. Meanwhile, there was a negative correlation between total outcomes score and total level of knowledge and compliance score regarding post total hip replacement surgery with a highly statistical significant relation between the studied patients level of knowledge, level of compliance and total level of outcomes post total hip replacement surgery.
Recommendation
In the light of the result of the present study, the following recommendations are suggested:
• A simplified and comprehensive Arabic guidelines booklet or pamphlet illustrating all instructions the patient may need post total hip replacement surgery.
• Educational program for patients undergoing total hip replacement surgery should be applied in all orthopedic units periodically and regularly to enhance knowledge, compliance and improve patients’ self-care skills after surgery.
• Establishment of a hot line contact on WhatsApp support group for urgent and non-urgent consultations to prevent complications in the early post-operative phase.
• Further studies for factors affecting patients’ compliance with therapeutic regimen and patients outcomes post total hip replacement surgery.
• Replication of the current study on a larger sample and another setting.