***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Background The primary purpose of this r and omized controlled trial ( RCT ) was to compare knee-specific outcomes ( stiffness , pain , function ) between patellar retention and resurfacing up to 10 years after primary total knee arthroplasty ( TKA ) . Secondarily , we compared re-operation rates . Methods 38 subjects with non-inflammatory arthritis were r and omized at primary TKA surgery to receive patellar resurfacing ( n = 21 ; Resurfaced group ) or to retain their native patella ( n = 17 ; Non-resurfaced group ) . Evaluations were performed preoperatively , one , five and 10 years postoperatively by an evaluator who was blinded to group allocation . Self-reported knee-specific stiffness , pain and function , the primary outcomes , were measured by the Western Ontario McMaster Osteoarthritis Index ( WOMAC ) . Revision rate was determined at each evaluation and through hospital record review . Results 30 ( 88 % ) and 23 ( 72 % ) of available subjects completed the five and 10-year review respectively . Knee-specific scores continued to improve for both groups over the 10-years , despite diminishing overall health with no significant group differences seen . All revisions occurred within five years of surgery ( three Non-resurfaced subjects ; one Resurfaced subject ) ( p = 0.31 ) . Two revisions in the Non-resurfaced group were due to persistent anterior knee pain . Conclusions We found no differences in knee-specific results between groups at 5–10 years postoperatively . The Non-resurfaced group had two revisions due to anterior knee pain similar to rates reported in other studies . Knee-specific results provide useful postoperative information and should be used in future studies comparing patellar management strategies . Clinical Trials.gov The superiority between the posterior cruciate-retaining and the posterior cruciate-substituting design s still remains controversial . We performed a prospect i ve , r and omized control study for evaluation of the superiority of these design s. This study investigated 58 knees in 29 patients with simultaneous bilateral total knee arthroplasty , in which the high-flex CR design was r and omly implanted in one knee and the high-flex PS design was implanted in the other knee . The follow-up duration averaged 5.0 years , with a minimum duration of 3 years . Postoperatively , Knee Score and pain points in Knee Score result ed in no significant differences between the 2 design s. However , postoperative arc of range of motion , patient satisfaction , and posterior knee pain at passive flexion in the PS design were significantly superior to that of the CR design Background Total knee arthroplasty with the use of a tourniquet during the entire operation has not been shown to improve the performance of the operation and may increase the risk of complications . Questions / purpose sWe asked whether the limited use of a tourniquet for cementation only would affect ( 1 ) surgical time ; ( 2 ) postoperative pain and motion of the knee ; ( 3 ) blood loss ; or ( 4 ) complications such as risk of nerve injuries , quadriceps dysfunction , and drainage compared with use of a tourniquet throughout the procedure . Methods Seventy-one patients ( 79 knees ) were r and omized to either use of a tourniquet from the incision through cementation of the implants and deflated for closure ( operative tourniquet group ) or tourniquet use only during cementation ( cementation tourniquet group ) . The initial study population was a minimum of 30 knees in each group as suggested for r and omized studies by American Society for Testing and Material s st and ards ; termination of the study was determined by power analysis performed after 40 knees in each group showed any statistical solution to our questions would require a minimum of 260 more cases . Patients were excluded who were considered in previous r and omized studies as high risk for complications , which might be attributed to the tourniquet . Results There were no differences in terms of surgical time , pain scores , pain medicine requirements , range of motion , hemoglobin change , or total blood loss . One major complication ( compartmental syndrome ) occurred in a patient with tourniquet inflation until closure . No other complications were attributed to the use of a tourniquet . Conclusions With the numbers available , our results suggest that there are no important clinical differences between patients who had a tourniquet inflated throughout the procedure compared with those who had it inflated only during cementation . Tourniquet inflation for cementation only provides the benefit of bloodless bone for fixation and may eliminate the risks associated with prolonged tourniquet use . Level of Evidence Level I , therapeutic study . See Guidelines for Authors for a complete description of levels of evidence BACKGROUND Anterior knee pain is still a major problem in total knee arthroplasty ( TKA ) . Although the most widely accepted opinion is that anterior knee pain is often associated with a patellofemoral etiology , there is no clear consensus as to etiology or treatment . Disabling pain receptors by electrocautery could theoretically achieve denervation of the anterior knee region . The present prospect i ve r and omized controlled study aim ed to evaluate results after patellar denervation with electrocautery in TKA at a minimum follow-up of 2 years . HYPOTHESIS Patellar denervation provides some benefit in terms of pain and clinical outcomes after TKA without patellar resurfacing . PATIENTS AND METHODS Clinical and radiological results for 35 patients with single-stage bilateral TKA ( 70 knees ; 26 women , nine men ; mean age , 68 years [ range , 58 to 77 years ] ) were review ed . In addition to removal of all osteophytes , patellar denervation by electrocautery was performed on one patella ; and debridement alone , removing all osteophytes , was performed on the contralateral patella , as a control . KSS score and a visual analog scale ( VAS ) were used to assess pre- and postoperative anterior knee pain . RESULTS Mean follow-up was 36 months ( 24 to 60 months ) . No revisions or re-operations were performed . There were no patellar fractures . On all parameters ( KSS score , range of motion and VAS ) , there was a statistically significant pre- to postoperative difference in favor of the denervation group . DISCUSSION Patellar denervation with electrocautery can reduce anterior knee pain , with satisfactory clinical and radiological outcome , in TKA without patellar resurfacing . LEVEL OF EVIDENCE Level II : low-powered prospect i ve r and omized trial We r and omized 126 consecutive patients undergoing primary total knee arthroplasty into group 1 : patella denervation ( n = 63 ) and group 2 : no patella denervation ( n = 63 ) . Assessment was performed preoperatively and at 3 , 12 and 24 months post-operatively . Average follow-up of patients was 26.5 months for denervation group and 26.3 months for no denervation group ( P = 0.84 ) . Pain scores for anterior knee pain were significantly better in the denervation group at 3 months but not at 12 and 24 months . Patient satisfaction was higher in the denervation group . Flexion range was higher in the denervation group at 3 , 12 and 24 months review ( P < 0.01 ) . There were , however , no statistically significant differences with other vali date d knee scores Background Adequate and intensive rehabilitation is an important requirement for successful total knee arthroplasty . Although research suggests that Continuous Passive Motion ( CPM ) should be implemented in the first rehabilitation phase after surgery , there is substantial debate about the duration of each session and the total period of CPM application . A Cochrane review on this topic concluded that short-term use of CPM leads to greater short-term range of motion . It also suggested , however , that future research should concentrate on the treatment period during which CPM should be administered . Methods In a r and omised controlled trial we investigated the effectiveness of prolonged  CPM  use in the home situation as an adjunct to st and ardised PT . Efficacy was assessed in terms of faster improvements in range of motion ( RoM ) and functional recovery , measured at the end of the active treatment period , 17 days after surgery . Sixty patients with knee osteoarthritis undergoing TKA and experiencing early postoperative flexion impairment were r and omised over two treatment groups . The experimental group received CPM + PT for 17 consecutive days after surgery , whereas the usual care group received the same treatment during the in-hospital phase ( i.e. about four days ) , followed by PT alone ( usual care ) in the first two weeks after hospital discharge . From 18 days to three months after surgery , both groups received st and ardised PT . The primary focus of rehabilitation was functional recovery ( e.g. ambulation ) and regaining RoM in the knee . Results Prolonged use of CPM slightly improved short-term RoM  in patients with limited RoM at the time of discharge after total knee arthroplasty when added to a semi-st and ard PT programme . Assessment at 6 weeks and three months after surgery found no long-term effects of this intervention Neither did we detect functional benefits of the improved RoM at any of the outcome assessment s. Conclusion Although results indicate that prolonged CPM use might have a small short-term effect on RoM , routine use of prolonged CPM in patients with limited RoM at hospital discharge should be reconsidered , since neither long-term effects nor transfer to better functional performance was detected . Trial Registration IS RCT Minimally invasive surgery has recently been introduced in TKA surgery . The purpose of this study was to evaluate the effect of eversion of the patella , on safety and functional result after TKA . In a prospect i ve , r and omised , double blinded trial , 60 patients were divided in two groups : group A underwent TKA through a st and ard medial parapatellar arthrotomy , with patellar eversion . Group B underwent the same exposure , except for the fact that the patella was subluxed laterally . All other treatment protocol s were identical . Outcomes were measured until 1 year postoperatively . Radiographic evaluation included AP , lateral , skyline and full leg st and ing radiographs . VAS , WOMAC score , Knee Society Knee and Function score were performed . Active and passive range of motion ( ROM ) and knee proprioception was measured . All patients underwent isokinetic strength testing . The mean passive ROM changed from 121 ° preoperatively to 121 ° postoperatively in group A , compared to 118 ° –131 ° respectively in group B at 1 year ( P = 0.003 ) . The mean active ROM changed from 112 ° to 115 ° in group A , and from 108 ° to 125 ° in group B ( P = 0.005 ) . All other parameters were not significantly different . Patellar dislocation without eversion for exposing the knee during TKA is a safe procedure and improves ROM at 1 year postoperatively BACKGROUND There is conflicting evidence regarding the merits of patellar resurfacing during total knee arthroplasty , as many of the previous r and omized controlled trials have not been adequately powered . METHODS A pragmatic , multicenter , r and omized controlled trial was initiated in 1999 in the United Kingdom . Within a partial factorial design , 1715 patients were r and omly allocated  to receive or not receive patellar resurfacing during total knee arthroplasty .  The primary outcome measure was the Oxford Knee Score ; secondary measures included the Short Form-12 , the EuroQoL 5D , cost , cost-effectiveness , and the need for subsequent knee surgery . RESULTS The mean Oxford Knee Score was 35 points at five years postoperatively in both groups . There was no significant difference between the groups with respect to the mean Oxford Knee Score ( difference , 0.59 point ; 95 % confidence interval , -0.58 to 1.76 points ) or any other outcome measure at five years postoperatively . The outcome was not affected by whether the patella was domed or anatomic . There was no significant difference between the two groups with respect to the prevalence of knee-related readmission , of minor or intermediate reoperation , or of subsequent patella-related surgery . The total health care cost for the primary arthroplasty , subsequent monitoring , and any revision surgery did not differ significantly between the two groups . CONCLUSIONS In the largest r and omized controlled trial of patellar resurfacing reported to date , the functional outcome , reoperation rate , and total health care cost five years after primary total knee arthroplasty were not significantly affected by the addition of patellar resurfacing to the surgical procedure Background and purpose Although a tourniquet may reduce bleeding during total knee replacement ( TKA ) , and thereby possibly improve fixation , it might also cause complications . Migration as measured by radiostereometric analysis ( RSA ) can predict future loosening . We investigated whether the use of a tourniquet influences prosthesis fixation measured with RSA . This has not been investigated previously to our knowledge . Methods 50 patients with osteoarthritis of the knee were r and omized to cemented TKA with or without tourniquet . RSA was performed postoperatively and at 6 months , 1 year , and 2 years . Pain during hospital stay was registered with a visual analog scale ( VAS ) and morphine consumption was measured . Overt bleeding and blood transfusions were registered , and total bleeding was estimated by the hemoglobin dilution method . Range of motion was measured up to 2 years . Results RSA maximal total point motion ( MTPM ) differed by 0.01 mm ( 95 % CI –0.13 to 0.15 ) . Patients in the tourniquet group had less overt bleeding ( 317 mL vs 
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Do patients need continuous passive motion for their post-surgery rehabilitation ?
At the same time , it is becoming apparent that a meticulous operative technique , respecting the soft tissue envelope and knowing the principles of alignment and soft tissue balancing , are some of the parameters that might contribute more to achieving the optimal results for the patients