Objective. To determine the effectiveness of progressive quadriceps strengthening with or without neuromuscular electrical stimulation (NMES) on quadriceps strength, activation, and functional recovery after total knee arthroplasty (TKA), and to compare progressive strengthening with conventional rehabilitation.

Among the new 5-mm laparoscopic electrosurgical and ultrasonic instruments available for testing, RX, LS, and FT produced the highest mean burst pressures. FT had the shortest mean seal times for medium and large vessels. Minimal or no seal failures occurred with HS, RX, LS, LM, and FT.

Microwave ablation is a safe and effective technology for hepatic tumor ablation. In our study, clustered antennae resulted in larger ablation volumes. Further studies with histological confirmation are needed to verify clinical results.

Many treatment strategies have been proposed for pyogenic liver abscesses; however, the indications for liver resection for treatment have not been studied in a systematic manner. The purpose of our study was to evaluate the role of surgical treatment in pyogenic abscesses and to determine an optimal treatment algorithm. We retrospectively reviewed the medical records of all patients who had a pyogenic liver abscess at Rhode Island Hospital between 1995 and 2002. Abscesses and treatment strategies were classified into three groups each. The abscess groups included Abscess Type I (small <3 cm), Abscess Type II (large >3 cm, unilocular), and Abscess Type III (large >3 cm, complex multilocular). The treatment strategy groups included Treatment Group A (antibiotics alone), Treatment Group B (percutaneous drainage plus antibiotics), and Treatment Group C (primary surgical therapy). Descriptive statistics were calculated and χ2 used for comparison with a P < 0.05 considered significant. Our study consisted of 107 patients with pyogenic liver abscess. The success rate for small abscesses treated with antibiotics was 100 per cent. The success rate with antibiotics and percutaneous drainage for large, unilocular abscesses was 83 per cent and for large, multiloculated abscesses was 33 per cent. None of the 27 patients who had surgical therapy for large, multiloculated abscesses had recurrences. Surgical treatment for large (>3 cm), multiloculated abscesses had a significantly higher success rate than percutaneous drainage plus antibiotic therapy (33% versus 100%, P ≤ 0.01). The mortality rate for the percutaneous drainage plus antibiotic group was not significantly different from the primary surgical group (4.2% versus 7.4%, P = 0.40). We propose a treatment algorithm with small abscesses being treated with antibiotics alone; large, uniloculated abscess with percutaneous drainage plus antibiotics; and large, multiloculated abscessed treated with surgical therapy.

Objective. Individuals with medial compartment knee osteoarthritis (OA) and genu varum use different movement and muscle activation patterns to increase joint stability during gait. The purpose of this study was to ascertain whether opening-wedge high-tibial osteotomy (OW-HTO) corrected pathomechancial abnormalities associated with the progression of knee OA. Methods. Fifteen patients diagnosed with medial knee OA and genu varum who were scheduled for OW-HTO were tested prior to and 1 year following OW-HTO. Fifteen age-and sex-matched controls were also tested. Frontal plane laxity was measured from stress radiographs. All participants underwent quadriceps strength testing with a burst superimposition technique and gait analysis with surface electromyography to calculate knee joint kinematics and kinetics and muscle co-contraction during the stance phase of gait. Participants rated their knee function and instability using a self-report questionnaire. Results. Static alignment improved following the surgery. Medial laxity (P ‫؍‬ 0.003) and instability (P ‫؍‬ 0.002) significantly improved, and statistical reductions in the adduction moment resulted in lower levels of vastus medialismedial gastrocnemius muscle co-contractions (P ‫؍‬ 0.089). Despite improvements in global rating of knee function (P ‫؍‬ 0.001), the OA group's ratings remained significantly lower than those of the healthy controls (P ‫؍‬ 0.001). Quadriceps strength deficits and knee flexion impairments persisted. Conclusion. Persistent quadriceps weakness and impaired knee kinematics after realignment suggest that the movement strategy may perpetuate joint destruction and impede the long-term success of realignment. Rehabilitation should focus on quadriceps strength and improving joint mobility to improve the long-term function of individuals with medial knee OA.

The goal of opening wedge high tibial osteotomy (HTO) is to reduce excessive loading on the medial compartment of the knee by correcting varus deformity, thereby reducing pain and improving function. Although surgical outcome is reportedly poor in cases of under-or overcorrection, the recommended alignment varies. The aim of this study was to investigate the effect of the degree of frontal plane knee alignment following open wedge HTO surgery on muscle cocontraction, joint moments, and self-reported functional outcome. Sixteen patients with medial compartment osteoarthritis (OA), who were scheduled for an opening wedge osteotomy, were recruited for participation in the study. Data were collected using an optoeletric motion analysis system and varus and valgus angulations of the knee were measured, using standing, long cassette, radiographs of the lower extremities. Results showed that physical function improved significantly overall (p < 0.001). However, those subjects whose knee alignment was further away from the group's postoperative mean tended to improve less in their Knee Outcome Survey-Activities of Daily Living Scale (KOS-ADLS) scores than those closer to the mean (p ¼ 0.07). They also had higher medial and lateral co-contractions and higher adduction moments one year after surgery (p 0.009 and p ¼ 0.048, respectively) and were more likely to show a change towards increased medial muscle co-contraction following surgery, when compared to presurgical values. This outcome may contribute to accelerated degeneration of the knee for this group of people. ß

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Laparoscopic ventral hernia repair provides improved quality-of-life, compared with open repair, 6 months postoperatively. Nearly all physical variables measured by the CCS were significantly better when ventral hernias were repaired laparoscopically.