COMPREHENSIVE SURGICAL MANAGEMENT OF ARTHRITIC KNEE

Total knee arthroplasty is not the only available surgical option for arthritic knees. It varies according to patient''s age and severity of the disease. 105 arthritic knees were surgically treated at the Joint Replacement Centre of Army Hospital (R&R) in last 4 years. 77 knees were osteoarthritic and 28 were rheumatoid. 24 of these were treated by arthroscopic debridement, 7 underwent unicondylar knee replacement and 74 underwent total knee replacement using Freeman Samuelsun (F/S) or Low Contact Stress (LCS) implants. The indications, contraindications, results and complications of these procedures are discussed.KEY WORDS: Arthroscopic debridement knee, Knee arthroplasty, Osteoarthritis, Rheumatoid arthritis, Unicondylar knee replacement     

Intracervical versus vaginal misoprostol for cervical dilatation prior to operative hysteroscopy—a comparative study

Background

Hysteroscopic surgery requires pre-operative cervical ripening to facilitate adequate dilatation of the cervix for insertion of operative hysteroscope. This study was conducted to compare the efficacy of intracervical misoprostol with vaginal misoprostol in achieving cervical ripening before operative hysteroscopy.

Methods

In this randomised comparative study conducted at a tertiary care teaching hospital, 56 patients needing operative hysteroscopy were divided into two groups of 28 patients, one for intracervical misoprostol and the other for vaginal misoprostol. Four hundred microgram of misoprostol was inserted on the night before and in the morning of operative hysteroscopy intracervically in group I and vaginally in group II.

Results

Primary outcome measure was number of patients achieving 7 mm preoperative dilatation of cervix. Largest Hegar dilator that could be passed into the uterine cavity past the internal optic sheath without resistance was noted in each case. Mean cervical dilatation prior to operative hysteroscopy was calculated. In addition, incidence of slipping of vulsellum and cervical laceration was also noted. Time to achieve full cervical dilatation was recorded. In 23/28 cases of group I and 5/28 in group II, size 7 Hegar dilator could be passed without effort. Mean cervical dilatation was 7.5 mm in group I and 5.7 mm in group II. Slipping of the vulsellum and cervical lacerations were seen in significantly less patients in group I. Mean time to achieve cervical dilatation to 10 mm was 43.39 seconds in group I and 103.96 seconds in group II (P<0.0001).

Conclusion

Intracervical administration of misoprostol is an effective method of achieving cervical ripening for easy cervical dilatation up to 10 mm prior to operative hysteroscopy.Key Words: cervical ripening, intracervical administration, misoprostol, operative hysteroscopy