Total Hip Arthroplasty in Ankylosing Spondylitis

Vorawit Atipiboonsin, Witchaporn Witayakom, Rit Apinyankul — Fri, 04 Jul 2025 00:00:00 +0700

Ankylosing spondylitis (AS) is a chronic inflammatory disease affecting the spine, hip joints, and sacroiliac joints. Approximately 24–36% of patients develop hip ankylosis, severely limiting mobility and quality of life. Total Hip Arthroplasty (THA) is often necessary to restore function. However, THA in AS patients is complex due to spinal deformities, reduced spinopelvic mobility, and potential cardiopulmonary complications. Careful preoperative assessment, including evaluation of hip range of motion, spinal alignment, and systemic health, is critical. Surgical approach selection must address the specific type of hip deformity to enable effective soft tissue release. Potential complications include intraoperative fractures and heterotrophic ossification. Accurate positioning of the acetabular component, particularly minimizing anteversion, is essential to prevent instability. Postoperative outcomes are promising, with significant improvements in hip mobility and pain relief. A multidisciplinary team approach, involving orthopedic surgeons, anesthesiologists, and internists, is crucial to managing the complex needs of AS patients undergoing THA and achieving optimal surgical outcomes.

Outcomes After Implementing Sepsis Clinical Practice Guidelines in the Internal Medicine Department of Phraphutthabat Hospital

Pittaya Bumroongthai — Fri, 04 Jul 2025 00:00:00 +0700

Background: The implementation of clinical practice guidelines (CPG) for the treatment of sepsis plays can reduce patient mortality. Currently, updated guidelines based on the Surviving Sepsis Campaign 2021, which have demonstrated improved efficacy, have been adapted for use at Phraphutthabat Hospital.
Objective: To evaluate the outcomes of implementing an updated CPG based on the Surviving Sepsis Campaign, structured as a standing treatment order for the management of sepsis patients.
Materials and Methods: This was a retrospective analytical study of sepsis patients treated in the Department of Internal Medicine at Phraphutthabat Hospital. Patients were divided into two groups: pre-implementation (January–October 31, 2023) and post-implementation (November 2023 – August 2024) of the revised CPG. Data collected included patient demographics, antibiotic administration, fluid volume received, serum lactate levels, fluid reassessment, length of hospital stay, and mortality. Statistical analyses included Fisher’s exact test, t-test, and Mann-Whitney U test for group comparisons.
Results: A total of 304 patients were included, with 152 patients in each group. There were 73 cases (48.0%) and 71 cases (46.7%) of septic shock in the pre- and post-implementation groups, respectively. The 30-day mortality rate in the CPG group decreased from 36.2% to 24.3% (p = 0.025) among sepsis patients, and from 54.8% to 38.0% (p = 0.044) among patients with septic shock. Among the 292 patients who were hospitalized for no more than 30 days, the median length of stay decreased from 8 days [IQR 5,12] to 7 days [IQR 4,11] (p = 0.011). The most common infection site was the urinary tract, and the most frequently identified pathogen was Escherichia coli. After implementing the updated CPG, the percentage of patients who received 1,500 mL of fluids within the three hours, underwent fluid reassessment, and had serum lactate levels measured significantly increased. However, the percentage of patients who received antibiotics within one hour did not differ significantly.
Conclusion: The updated sepsis CPG implemented at Phraphutthabat Hospital effectively reduced 30 day mortality. The percentage of patients who received 1,500 mL of fluids within the three hours, underwent fluid reassessment, and had serum lactate levels measured increased.

Lampang Medical Journal

Total Hip Arthroplasty in Ankylosing Spondylitis

Outcomes After Implementing Sepsis Clinical Practice Guidelines in the Internal Medicine Department of Phraphutthabat Hospital