الفهرس 
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Abstract
Introduction:
Total hip replacement is the replacement of severely damage hip with an artificial joint. Total Hip Replacement is one of the most common operations performed in the developed world today. This procedure is usually reserved for the clients older over than age 60 with severe pain and with severely damage hips. The most common causes of chronic hip pain and disability are arthritis; osteoarthritis, rheumatoid arthritis, and traumatic arthritis which are the most common forms of this disease. Osteoarthritis usually occurs in people 50 years of age and older and often individuals with a family history of arthritis.
the post-operative complications can be classified into two types: Immediate complications Include Thrombo-embolism, infection, nerve and blood vessel injury, fracture of femur bone and deep veins thrombosis. While the Late complications. include dislocation of the hip and delayed surgical infections.
Aim of the Study:
This study aims to assess the needs and problems of older adult (OA)clients with total hip replacement (THR) through:
1. Studying thesocio-demographic characteristics of the OA clients with THR.
2. Assessing the knowledge of the OA clients with THR regarding the surgery and the percautions after THR surgery.
3. Assessing the needs based on performance of activities of daily living (ADLs) of OA clients with THR.
4. Identifying the problems of the the OA clients with THR.
5. Assessing the effect of knowledge of OA clients with THR on their activity of daily living (ADLs).
Research Questions:
1- What are the socio-demographic characteristics of the OA clients with THR?
2- What are the needs (Activities of daily living) of the the OA clients with THR?
3- What are the problems of the the OA clients with THR?
4- Are there any relationship between the knowlage of the OA clients with THR and their ADLs?
5- Are there any relationship between the problems of the OA clients with THR and their socio-demographic characteristics ?
6- Are there any relationship between the ADLs of OA clients with THR and the socio-demographic characteristics ?
Subject and Methods:
Research design:
The design of this study is descriptive.
Setting:
The study was conducted at the orthopedic out-patient clinic in two hospitals in Cairo named:
1. Al-Helal Hospital which affailiated to Ministry of Health and Population.
2. El-Demerdash hospitalwhichaffailiated to Ain Shams University.
Sampling:
Type:
Type of sample in this study was a Purposive sample.
Inclusion criteria:
1- Older adult clients attending orthopedic out-patient clinic , 60 years old and over with Total hip replacement.
2- Both gender (males and females).
3- One month to one year after THR surgery.
Size:
The study sample included 80 clients. 50 clients selected from Al-Helal hospital and 30 clients were selected from El-Demedash hospital.
Tools of data collection:
The tools were used for data collection:
An Interview Questionnaire Sheet: It consists of five parts for data collection from the OA clients with THR attending the orthopedic out-patient clinic. It was developed and modified by theinvestigator to assessthe following:
Part. I :Assessment of the Socio-Demographic characteristics of the OA Clients with THR. It will be developed by theinvestigator based on literature review and expert opinions to assess:
a. The personal datafor the OA clients with THR. It consists of 10 closed ended questions such asage, gender, location, social status and the educational level. Also it consists of 3 open ended questions such as number of family members and number of home rooms…etc.
b. The past medical history of the study subjects. It consists of 4 closed ended questions such as past history of chronic disease, mobility problems after THR surgery and the past orthpedic surgery.
Part. II:Assessment of the Knowledge of the OA Clients with THR.It developed by the investigator based on literature review and expert opinions. It consists of 14 questions to assess the following:
a. Knowledge of the OA clients with THR regarding the THR surgery as reported by them. It consists of 8 questions to assess the definition of the THR, reasons for surgery,benefits from surgery, post-operative complication and medications after surgery…etc.
b. Knowledge of the OA clients with THR regarding the precautions after surgery as reported by them.It consists of 6 questions to assess theprecautions regarding the sitting, walking and sleepingafter surgery…etc.
Part. III:Assessment of the Activities of Daily Living (Client Needs) of the OA Clients with THR. It adopted from cleveland clinic (2008) and adapted by the researcher. It consists of 5 questions regarding movement, personnal care, output, instument activities and communication. Every question was divided into subtitals.
Part. IV:Identifying the Present medical problems of the OA Clients with THR.It developed by the investigator based on literature review and expert opinions.It consists of 5 closed ended questions regarding current complain and post operative complications…etc.
Part. V: Assessment of the Environmental Home Safetyof the OA Clients with THR. It adopted from Janice and phyllis (2003) and adapted by the researcher. It includes 8 questions related to general characteristics of the house, such as lighting, ventilation, water supply and sanitation inside the house.
Results:
• The present study revealed that the age of OA with THRranged between 60 - < 65 and 53.7% of than were females.Also the present study revealed 70% of study sample was not working and the monthly income was not sufficient.
• The present study showed that 27.5% of study sample have a history of chronic disease equal between diabetes mellitus and osteoporosis.
• As regard, the Reason for the surgery the result showed that 61.3% done THR surgery due to fracture or dislocation of the joint and 10.0% of them due to rheumatoid arthritis, malignant tumor of hip joint and osteoporosis.
• The score levels regarding the activities of daily living after the surgery of THR is satisfactory.
• The present study revealed 76.2% of sudy sample had unsatisfactory level of knowledge after THR surgery related to Pecautions about the sleeping. While, 78.8% had satisfactory level knowledge related to swimming.
• There was statistically significant relations between the knowledge and socio-demographic characteristics related to age and educational level.
• There was highly statistical significance difference between the knowledge and patient problem related to current complaint, and post- operative complications.