For good liver reserve patients with large (≥ 10 cm) right‐lobe solitary hepatocellular carcinoma (HCC), resection is technically difficult. Moreover, inadequate future liver remnant volume might preclude major surgical resection. In this case series, we report our early experience in managing a group of such patients using transarterial chemoembolization (TACE) and stereotactic body radiotherapy (SBRT) as a downstaging neoadjuvant therapy before resection. From July 2012 to November 2013, we treated five patients with large right‐lobe, solitary HCC (10–24 cm) by this regime. Portal vein thrombosis was seen in two cases. The tumour showed significant reduction in size, and the left lobe showed significant enlargement. All tumours were successfully resected. Technical difficulty due to post‐TACE and ‐SBRT fibrosis and adhesion can be overcome by using the anterior approach and hanging technique with mild modification. There was one mortality reported in this series, but a post‐mortem study showed acute myocardial infarction without any surgical complications. Radiation‐induced myocardial injury was also excluded. TACE and SBRT are a safe option to downstage large, right‐lobe solitary HCC greater than 10 cm, with or without portal vein thrombosis. Surgical resection after this neoadjuvant therapy can be carried out safely with some modification of technique.

Background:Total knee arthroplasty (TKA) is a cost-effective procedure, but it is also associated with substantial postoperative pain. The present study aimed to compare pain relief and functional recovery after TKA among groups that received intravenous corticosteroids, periarticular corticosteroids, or a combination of both.Methods:This randomized, double-blinded clinical trial in a local institution in Hong Kong recruited 178 patients who underwent primary unilateral TKA. Six of these patients were excluded because of changes in surgical technique; 4, because of their hepatitis B status; 2, because of a history of peptic ulcer; and 2, because they declined to participate in the study. Patients were randomized 1:1:1:1 to receive placebo (P), intravenous corticosteroids (IVS), periarticular corticosteroids (PAS), or a combination of intravenous and periarticular corticosteroids (IVSPAS).Results:The pain scores at rest were significantly lower in the IVSPAS group than in the P group over the first 48 hours (p = 0.034) and 72 hours (p = 0.043) postoperatively. The pain scores during movement were also significantly lower in the IVS and IVSPAS groups than in the P group over the first 24, 48, and 72 hours (p ≤ 0.023 for all). The flexion range of the operatively treated knee was significantly better in the IVSPAS group than in the P group on postoperative day 3 (p = 0.027). Quadriceps power was also greater in the IVSPAS group than in the P group on postoperative days 2 (p = 0.005) and 3 (p = 0.007). Patients in the IVSPAS group were able to walk significantly further than patients in the P group in the first 3 postoperative days (p ≤ 0.003). Patients in the IVSPAS group also had a higher score on the Elderly Mobility Scale than those in the P group (p = 0.036).Conclusions:IVS and IVSPAS yielded similar pain relief, but IVSPAS yielded a larger number of rehabilitation parameters that were significantly better than those in the P group. This study provides new insights into pain management and postoperative rehabilitation following TKA.Level of Evidence:Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.