Chapter III

RESEARCH MATERIAL / OBJECT AND METHODS

3.1. Research Material / Object

3.1.1. Place and time of research

The research was conducted at Wahidin Sudirohusodo General Hospital, Orthopedics and

Traumatology Department, Univesitas Hasanuddin, Makassar. The research plan is conducted in

January 2013 to January 2018

3.1.2 Population

The population included in this study are all patients with fracture neck femur in elderly

patients above the age of 60 years irrespective of sex treated by AMP hemiarthroplasty, from

january 2013 - january 2018 at Wahidin Sudirohusodo General Hospital, Makassar.

3.1.3. Research Sample and Sampling Method

This study used all patients who meet the inclusion and exclusion criteria. The sampling

method was to collect patient medical data as secondary data and conduct interviews and clinical

examinations as primary data.

3.1.4. Sample

All patients are at the age above 60 years. Patients with Garden type 2, 3 and 4 were

considered (Huebert, 2003). Majority of patients had fracture following slip and fall. The patients

with pathological fracture, stress fracture and open injury were excluded. There are no patients

with Parkinsonism, hemiplegia or any other neurological disease. Patients are treated with

cemented bipolar prosthesis and patients were treated with uncemented AMP. All patients

undergo surgery within the first week of admission.

3.1.5 Inclusion and Exclusion Criteria

a. Inclusion Criteria

1. All the elderly patients with fracture neck of femur.

2. Patients willing to participate in study.

b. Exclusion Criteria

1. Patients with injury to ipsilateral knee joint, leg.

2. Patients who were not willing to participate in study.

3. Patients with dementia.

4. Patients who are non- ambulatory.

5. Patients with pathologic femoral neck fracture.

3.1.6. Tools and Materials

1. Medical Records

2. Writing tools

3. Questionnaire

4. Laptop

5. SPSS version 19

3.2 Research Method

3.2.1 Research Design

This is a 5-year retrospective study from January 2013 to January 2018, conducted at

Wahidin Sudirohusodo General Hospital, Orthopedics and Traumatology Department,

Universitas Hasanuddin, Makassar. Elderly patients aged 60 years and above with displaced
intracapsular fracture neck of femur are operated by using Austin Moore Prosthesis (AMP)

hemiarthroplasty were included in the study.

3.2.2 Research Procedure

1. Identifying patients with neck femur fractures who were treated with AMP

hemiarthroplasty from medical records and patient registers starting from January 2013 to

January 2018 at Wahidin Sudirohusodo Hospital Makassar as secondary data.

2. Patients who meet the research criteria undergo interview procedures (name, age,

occupation) and fill out a clinical function assessment questionnaire according to the

Haris Hip Score and the Oxford Hip Score as primary data to obtain clinical outcome

data.

3. Perform statistical analysis using the independent sample T-test

4. The results are collected, recorded and analyzed, then discussion and conclusions will be

drawn from the procedure

3.2.3 Research Instrument

The primary assessment was made by a research according to the recall principle:

estimation of living conditions, walking ability, activity of daily living (ADL) according to Katz

Katz et al. (1963) and HRQoL during the last week prior to the trauma. The postoperative follow-

ups were performed at four, 12, 24 and 48 months after surgery and included both clinical and

radiological assessments. The clinical evaluation included history of any adverse events or hip

complications, hip function and HRQoL. Hip function was reported using the Harris hip score

(HHS) (Banaszkiewicz, 2014). The HHS contains four parameters: pain, function, absence of

deformity and range of motion. Higher score means better hip function and the maximum score is

100. The HRQoL was assessed prior to fracture and at follow-ups with a generic instrument, the
health part of EuroQol (EQ-5D index score) (Brooks & Group, 1996). The score is self-reported

and goes from 0, which indicates the worst possible health state, to 1 which indicates the best

possible health state. If the patient was unable to attend the follow-up, a home visit was offered

and carried out. Acetabular erosion was evaluated by a radiologist (GL) and graded according to

the method described by Baker et al. (2006). The system is a four-step grading system: grade 0

(no erosion), grade 1 (narrowing of the joint space), grade 2 (acetabular bone erosion) and grade

3 (protrusio acetabuli).

3.2.3 Research Flow

Selection of patient medical records for the period January 2013 January 2018

Selection of patients based on inclusion criteria and exclusion criteria

Identifying name, age, gender, occupation

Evaluation of clinical functional results and filling out a questionnaire according to the HHS and OHS
methods

Data analysis

3.2.4 Research Subjective and Objective Criteria

1) Subjective Criteria

A group of femur neck fracture patients who had been operated on with AMP

hemiarthroplasty at Wahidin Sudirohusodo Hospital Makassar during the period January

2013 - January 2018.

 2) Objective Criteria

Long term functional outcome based on haris hip score and oxford hip score method

3.2.5 Operational Definition

3.2.6. Variable Classification

1) Independent Variable: AMP hemiarthroplasty on neck femur fracture Dependent variable:

clinical function outcome according to HHS and OHS criteria

2) Control variables: age, sex, and occupation

3.2.7. Statistical analysis

The data obtained, processed with the help of software with statistical methods and

presented in the form of narratives, tables and graphs. The statistical test used in this study was

the independent sample T-test using the SPSS for Windows version 19 computer program.