Teaching of patients undergoing total hip replacement surgery.

We studied the effect of patient teaching in 60 patients who underwent primary total hip replacement surgery. All the patients received an illustrated patient guide. In addition to the general patient teaching given by doctors, nurses and physiotherapists, a randomly chosen group of 27 patients received a session of intensified patient teaching. At the follow-up, 2-3 months postoperatively, 61% of patients thought that they had received the main part of their information from the physiotherapists, 9% from their doctors and 4% from the nursing staff. The importance of a well-illustrated guide was pointed out. The knowledge of potential complications, such as infection, remained poor; 37% could not name one single relevant complication. At the follow-up, the younger or better educated patients did not score any better. The experimental group who had received intensified teaching differed only slightly from the controls, but they knew significantly better when to inform their doctor of potential complications. Also, the experimental group showed greater interest in obtaining more information about their replaced hip. Patients in the experimental group showed significantly better adherence to the instructions for the postoperative rehabilitation programme.

[Postoperative rehabilitation in patients with hip fractures]. / Postoperativ rehabilitering hos patienter med höftfrakturer.

The purpose of the present study was to determine the variables associated with the length of hospital stay and to evaluate the ability to reach prefracture ADL-status after operation on patients with proximal fractures of femur. One hundred patients with cervical and trochanteric fracture were operated with internal fixation and endoprosthesis during a two year period. The type of surgical procedure selection was made by the surgeons own decision as part of treatment routine. The data were collected using a structured interview, participating observation and content analysis. The follow-up period was six months. The mean hospitalization time was 31.5 days, when seven patients with extremely long hospitalization, due to waiting for a long term care, were excluded. Stepwise regression analysis was used to determine variables associated with a longer hospital stay. Variables that related to poor prognosis were age, sex of patient, operation delay, weightbearing, medication, dizziness, status post paralysis and circumstances of dwelling. A significant difference was found between internal fixation and endoprosthesis at patient with cervical fracture of femur regarding to the length of hospital stay and ability to reach prefracture ADL-status in two weeks after operation. Results of this study showed, that the objective, to discharge patients in two or three weeks, was not achieved. This study also showed, that all patients did not regain the prefracture ADL-status during a follow-up period. It is important to assure the effectiveness of treatment after discharge from hospital in primary care and to prevent proximal fractures of femur in the elderly.