1. Trần Thị Vân Anh, Nguyễn Thanh Hương, Nguyễn Xuân Thùy

2. Content

3. Preamble

4. Total hip arthroplasty (TPA) is optimal therapy for diseases in
the head top and femoral neck.
population aging tendency:
→ There are many patients of femoral neck fracture
and hip disease.
TPA: Technique – Quality of lide (QOL) of patients of hip
dislocation → important

5. The world: Numerous researches on QOL of HD patients
in USA, Australia, Greece, Italy, France, Croatia…
In Vietmale, such research has not been conducted yet.
Viet Duc Hospital: 500 TPA cases (in 2013)
Purpose
- Help patients and doctors to select the suitable
therapy
- Evaluate efficiency of operation and nursing
- Determine supporting methods for nursing and
treatment

6. Veljko santie’(Croatia-
2012) evaluate and
compare points of QOL
02 years before and
Veljko santie’(Croatia-
2012) evaluate and
compare points of QOL
02 years before and
Henning R
Johansson (Germany
- 2010): evaluate 6,
12, 24 months before
and after operation
BSF36 Toolkit
36 questions for 8 problems of QOL
Some international researches on QOL of the after after patients operation
operation
after
total hip arthroplasty using SF36 toolkit
The further it is after operation, the higher QOL point is
Less factors related to QOL changing point
 Study combined with qualitative has not been recorded
yet
Henning R
Johansson (Germany
- 2010): evaluate 6,
12, 24 months before
and after operation
Alessandro Aprato (Italy
-2011) evaluate 2 years
after, compare FNF
group and degenerative
coxathroxis group
Alessandro Aprato (Italy
-2011) evaluate 2 years
after, compare FNF
group and degenerative
coxathroxis group

7. Research objective
Describe changes in QOL of the patients before
and after THA at Viet Duc Hospital in 2014

8. Dịch vụ y tế
Điều trị liên quan đến bệnh
trước và sau phẫu thuật
Đặc điểm cá nhân
- Tuổi
- Giới
- Nơi sinh sống
- Nghề nghiệp
- Trình độ học vấn
- Tình trạng hôn nhân
- Chi phí cho bệnh tật (Có
BHYT hay tự chi trả toàn
bộ )
Đặc điểm cá nhân
- Tuổi
- Giới
- Nơi sinh sống
- Nghề nghiệp
- Trình độ học vấn
- Tình trạng hôn nhân
- Chi phí cho bệnh tật (Có
BHYT hay tự chi trả toàn
bộ )
Yếu tố lâm sàng
Yếu tố lâm sàng
Chẩn đoán:
- Viêm thoái hóa khớpháng
- Hoại tử chỏm xương đùi
- Khối u ở chỏm, cổ xương đùi
- Gãy chỏm hoặc cổ xương đùi
- Chấn thương gây biến dạng ổ cối
Thời gian mắc bệnh
Chỉ số mật độ xương
Chẩn đoán:
- Viêm thoái hóa khớpháng
- Hoại tử chỏm xương đùi
- Khối u ở chỏm, cổ xương đùi
- Gãy chỏm hoặc cổ xương đùi
- Chấn thương gây biến dạng ổ cối
Thời gian mắc bệnh
Chỉ số mật độ xương
Sự đau đớn
Sự đau đớn
- Mức độ đau
- Cường độ
- Thời gian
- Ảnh hưởng đến mất ngủ,đến dinh dưỡng
- Mức độ đau
- Cường độ
- Thời gian
- Ảnh hưởng đến mất ngủ,đến dinh dưỡng
Dịch vụ y tế YYếếuu t ốtố t âtâmm l ýlý
Điều trị liên quan đến bệnh
trước và sau phẫu thuật
Khả năng vận động
- Hoạt động hàng ngày
- Lao động
- Vận động đi lại
- Sinh hoạt cá nhân
Khả năng vận động
- Hoạt động hàng ngày
- Lao động
- Vận động đi lại
- Sinh hoạt cá nhân
Hỗ trợ hàng ngày
Từ gia đình, người
thân và những người
xung quanh
Hỗ trợ hàng ngày
Từ gia đình, người
thân và những người
xung quanh
DDịcịchh v vụụ x xãã h hộội i
Chất lượng cuộc sống
người bệnh
(Có chỉ định phẫu thuật
thay khớp háng)
Khung lý thuyết

9. Research methods

10. • Object: Hip dislocation patients at Viet Duc
Hospital, surgeons and nurses
• Time: Feb - Jun 2014
• Place: 02 Departments of Orthopaedic Sugery,
Orthopaedics Institute under Viet Duc Hospital
• Longitudinal study design: combine
quantitative and qualitative study

11. Sample size, collection, processing, analysis of
data
Quantitative
- Main purpose
04 interview with patients
02 interview with surgeons
01 discussion with nurse group
- Instruction board PVS and TLN
- bandage removal, coding, by-subject
analysis.
Qualitative
-Total: 115 patients
- Interview three times:
Hospitalization, discharge and 01
month after follow-up examination.
- Data entry: Epidatta 3.0;
SPSS16.0 analyzer.
- Analysis: statistic description,
pairing test.

12. Study variables
Quantitative variable
• Personal characteristics
• Clinical characteristics
• QOL point (Gross point: Min=0; Max=100)
Point <25 26-50 51-75 76-100
QOL Poor Average Fair Fairly good
- Good
Qualitative subject: Influence factors and solutions to
QOL improvements for the patients, medical workers.

13. Results and discussion

14. General information on patients (n=115)
Content Frequency Percent
Age
Lưu Hồng Hải
(2008) 54.2
years of age
Anakwe (UK- 2010) 68.0 years
< 30 years of age
08 7,0
30 - 49 years 32 27,8
50 - 69 years 55 47,8
≥ 70 years 20 17,4
Mean age (Mean ± SD) 54,5 ± 11,98
The oldest and youngest age 19 - 87
Veljko santie’(Croatia - 2012)
72.6
Tshonga (Greece - 2011) 74.8
Gender male 80 69,6
female 35 30,4
Residence Rural 71 61,7
Urban 44 38,3
Marriage status Unmarried 07 6,1
Married 99 86,1
Divorce/widowed 09 7,8
Medical
insurance
With medical insurance 107 93,0
self-pay 08 7,0

15. Clinical characteristics (n=115)
Content Frequenc
y Percent
Diagnosis
femoral neck fracture 35 30,4
necrosis of the femoral head 33 28,7
femoral neck disease 04 3,5
Hip osteoarthritis 43 37,4
Suffering period
< 01 month 24 20,9
From 1-> less than 06 months 14 12,2
From 06-> 12 months 15 13,0
>12 months 62 53,9
Surgical methods
total hip arthroplasty 99 86,1
Bipolar hip arthroplasty 16 13,9

16. Mean days of treatment by clinincal features and
surgical method (n=115)
Index Frequency Mean days of treatment ±
SD
Diagnosis
femoral neck fracture 35 11,8 ± 4,15
necrosis of the femoral head 33 9,3 ± 3,54
femoral neck disease 4 9,0 ± 2,00
Hip osteoarthritis 43 8,9 ± 2,56
Surgical methods
total hip arthroplasty 99 9,3 ± 2,94
Bipolar hip arthroplasty 16 13,3 ± 5,02
Total 115 9,8 ± 3,26

17. Mean QOL point before and after operation
Tshonga (Greece – 2011)
QOL point
Before operation 29.3 and
55.1; 62.3 (after 3 , 6 months),
Patient is female > 65 years of
age

18. Mean QOL point by physical health field
Tshonga :
Tshonga :
Before operation
Before operation
29.3
29.3
After 03 months
After 03 months
64.4
64.4
Veljko santie’:
Before operation
Veljko santie’:
Before operation
30
30
After 6 months 65
After 6 months 65

19. Mean QOL point by mental health field
Veljko santie’ : Before
operation 22,2 sau 06
Veljko santie’ : Before
operation 22,2 sau 06
months 94,4
months 94,4
Tshonga Before
operation 18,3;
sau 03 months
Tshonga Before
operation 18,3;
sau 03 months
63,1
63,1

20. “When I did not have access or surgery, people
round me said that my disease could not
operated, that I had to live with such flood.
That’s why I was in two minds about doing and
not doing…”, “Even on that day I was ready for
surgery that is scheduled, my Quá
aunt said: “Oh, my
God. Please, I beg you not to have tải
operation; if
yes, you will be unable to walk, surely like me,
don’t operate”.
Some factors
affect the QOL
change
“After operation, which
food can I eat? What
should I keep off?”
When need, it lacks;
when no need, it is
redundant
Treatment,
Treatment,
care
care
Quá
tải
SOLUTION
-Satellite hospital, transfer of
technical packaget.
- Cooperate with junior
hospitali.
- Build more facilities
Information
supply
Information
supply
Surgerical technique, I have no
comment but patients are overcrowded.
On some days, I have been already
operated but lied with other patients in
the same bed. Being painful and
overcrowde made me unable to move,
but stepping out of bed may tread on
other patients; fear to be stuck, fall may
dislocate the new hip that is more
miserable“
“First day after surgery, I felt
too painful; SOLUTION
using up the
analgestic, I cannot bears
the pain but just wanted to
Monitor, control pain
Work assignment
Train, develop die.”
instruction sheet …
Nutrition provision
SOLUTION
Propaganda method of medicine sector is not
very good; just concentrating in some big cities
and only big hospitals can perform this surgery. A
bit far from these places, in northern delta for
example, people thinks that hip dislocation is so
formidable. They wonder whether they can move
if taking out their hip and replacing with a new
Propaganda method of medicine sector is not
very good; just concentrating in some big cities
and only big hospitals can perform this surgery. A
bit far from these places, in northern delta for
example, people thinks that hip dislocation is so
formidable. They wonder whether they can move
if taking out their hip and replacing with a new
Using mass media.
Develop consulting form, guidance on
monitoring and prevention from post-operative
“Will I move on my foot again? Can I do
heavy works? Or “Will I get married, have
sex or will there any influence, or will my hip
be dislocated?”
complications
artificial hip?” (PTV-02)
artificial hip?” (PTV-02)
Today is the third days
since my operation but
nobody has guided me
to practice; maybe on
weekend no
rehabilitation officers is
working

21. Conclusion

22. Change in QOL of the patients
 There is change in QOL point after TPA ( Hospitalization
24.6; Discharge 39.5; Follow-up exam 61.6 ; p< 0.001)
 Mean point of 8 areas rise at the time of follow-up exam
(p<0.0001).
 Postoperative physical functioning reduced (35.8 to
25.5; p< 0.001)
 Factors affecting the QOL change (from quantitative
results): Overload, treatment and care, information
supply to the patients.

23. Recommendations
 Rehabilitation solution: Training the nurses in
rehabilitation knowledge; assigning the rehabilitation
technicians working on Saturdays and Sundays.
 Provide meals to each patient.
 Develop consulting form, guidance on monitoring and
prevention from after-TPA complications…
 Continue this research for a longer period.

24. THANK YOU VERY MUCH
12/02/14 24