***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 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The recovery of patients undergoing total shoulder arthroplasty ( TSA ) can be adversely affected by a number of complications . Autologous platelet gel ( APG ) , produced by activating platelet-rich plasma ( PRP ) , has been shown to improve hemostasis and wound healing and reduce infections in some surgical procedures . Activated platelet-poor plasma ( PPP ) has also been used as a hemostatic agent . This study examines the effects of APG and PPP treatment on TSA patients postoperatively . After Institutional Review Board ( IRB ) approval , 40 patients undergoing TSA at our institution were prospect ively enrolled in our study . They were r and omized into either a control ( n = 20 ) or study ( n = 20 ) group , with the study group receiving APG and PPP treatment .  Preoperative demographic data , pre- and postoperative laboratory data , pain scores , pain medication , complications , pre- and postoperative range of motion measurements , and postoperative lengths of stay were recorded for each group . The preoperative internal rotation index was significantly higher in the control group compared with treatment patients ( 4.64 + /- 4.46 vs. 1.88 + /- 2.44 , p < .05 ) . The percent hemoglobin retained postoperatively was higher in the treatment group at 24 ( 84.54 + /- 5.32 vs. 79.87 + /- 8.73 ) and 72 hours ( 87.46 + /- 16.03 vs. 76.70 vs. 5.96 ) , but neither difference reached statistical significance . The treatment group had significantly lower pain scores ( p = .007 ) and total fentanyl requirements ( p < .05 ) compared with control patients . The internal rotation index improvement factor ( postoperative internal rotation index/preoperative internal rotation index ) was significantly higher in the treatment group vs. the control group ( p < .05 ) . Although it did not reach statistical significance , the treatment group was discharged almost 9 hours earlier than the control group ( 64.44 + /- 15.23 vs. 73.39 + /- 15.37 ) . APG and PPP treatment decreased pain and provided a greater increase in internal rotation measurements postoperatively OBJECTIVES The aim of this study was to evaluate the effects of moderately intensive pool exercise therapy on patients with rheumatoid arthritis ( RA ) . METHODS Forty-six patients with chronic RA were r and omly assigned to a treatment group and a control group . The treatment group ( n = 20 ) exercised in a temperate pool twice a week for 12 weeks . The control group ( n = 23 ) continued with their previous activities .  Aerobic capacity , measured by means of a submaximum bicycle test , and the physical component of the SF-36 were chosen as the primary outcome measures . Two tests of muscle endurance were chosen as the secondary outcome measure . Additional functional tests and instruments were included . RESULTS No significant differences between the groups were found for the primary outcome measures . Significant improvements in the following aspects of muscular function ( P < 0.05 ) were found in the treatment group when their performance was compared with that of the control group : isometric shoulder endurance , grip force , dynamic endurance of lower extremities ( chair test ) and muscle function of lower extremities . Significant improvements were also found for vitality ( SF-36 ) compared with the control group . The improvements in the training group were maintained for 3 months . CONCLUSIONS Pool exercise therapy of moderate intensity significantly improved muscle endurance in the upper and lower extremities in patients with RA , while no impact on aerobic capacity was found . However , the study population was small and there is a need for further studies with larger population SUMMARY Objective : To evaluate the efficacy and safety of oxaprozin in comparison with diclofenac in patients with periarthritis pain of the shoulder previously unsuccessfully treated with nonsteroidal anti-inflammatory drugs other than diclofenac and oxaprozin . Methods : In this open , multicentre , r and omised , controlled study , eligible patients with periarthritis of the shoulder were r and omised to receive either oxaprozin 1200 mg once daily ( n = 49 ) or diclofenac 50 mg three times daily ( n = 47 ) . The treatment period was 15 ± 1 days . The study was planned on a hypothesis of equivalence between the two study drugs . The primary study endpoint was the change from baseline at day 15 in the patient-assessed shoulder pain score . Secondary efficacy variables included investigator-assessed shoulder function , patient-assessed quality of life on the Short-Form-36 ( SF-36 ) Acute Health Survey and both patients ’ and investigators ’ overall assessment of efficacy . Results : At day 15 , the mean changes in shoulder pain score from baseline in the oxaprozin and diclofenac groups were –5.85 ± SD 4.62 and –5.54 ± SD 4.41 , respectively . The difference between the two groups was not statistically significant , confirming the hypothesis of the study that oxaprozin is as effective as diclofenac . Investigator-assessed shoulder function improved in both groups but more so in the oxaprozin group ( p = 0.028 at day 15 ) . Quality of life as measured by SF-36 total score was also improved in both treatment groups , with a trend toward greater improvement in the oxaprozin group . Furthermore , a significantly more favourable effect on the SF-36 ‘ mental health ’ item was observed in oxaprozin compared with diclofenac-treated patients at day 15 ( p = 0.0202 ) . As assessed by investigators , the overall efficacy of oxaprozin was superior to that for diclofenac at visit 3 ( 8 ± 1 days ) ( p = 0.0067 ) . Patients also assessed the overall efficacy  of oxaprozin as superior to that of diclofenac at visits 3 ( 8 ± 1 days ) ( p = 0.0235 ) and 4 ( 15 ± 1 days ) ( p = 0.0272 ) . Only six adverse events , all of which were mild or moderate in intensity and occurred in four diclofenac recipients , were observed in the study . Conclusions : As expected , once-daily oxaprozin proved to be as effective as diclofenac three times daily in reducing the primary efficacy variable of  patient-assessed shoulder pain score in patients with periarthritis of the shoulder refractory to previous treatments with other NSAIDs . Oxaprozin was shown to be superior to diclofenac in improving shoulder function and was considered by investigators and patients to have greater overall efficacy than diclofenac . In addition , oxaprozin showed a trend toward superior results in improving patients ’ quality of life compared with diclofenac . A trend towards better tolerability results for oxaprozin compared with diclofenac was also noted HypothesisArthroscopic acromioclavicular joint ( ACJ ) resection for asymptomatic ACJ arthritis combined with rotator cuff repair leads to more satisfactory pain relief and decrease reoperation rate when inferiorly directed osteophytes present at the undersurface of ACJ . Material s and methods Between January 2006 and May 2008 , a total of 83 patients ( 83 shoulders ) , 40 males and 43 females , who were planned to have arthroscopic repair of a tear measuring 1–3 cm in the anterior-posterior dimension with advanced ACJ arthritis with inferiorly directed osteophytes at the undersurface of the ACJ on MRI were entered into this study . Patients were r and omized into two groups . Group 1 included 31 patients , who underwent arthroscopic distal clavicle resection combined with rotator cuff repair .  Group 2 included 52 patients , who underwent isolated rotator cuff repair .  Patients were evaluated preoperatively and postoperatively using the University of California Los Angeles ( UCLA ) score and the American Shoulder and Elbow Surgeons ( ASES ) score . Pain , tenderness on ACJ , and cross body adduction test were compared between groups . Results The mean follow-up was 31.7 months ( range 34–38 ) . The UCLA scores and ASES scores were lower in group 1 at week 6 ( p < .05 ) , and week 12 ( p < .05 ) , but higher at the last follow-up at 2 years ( p < .05 ) postoperatively . VAS score was higher in group 1 at week 6 ( p < .05 ) , and at week 12 ( p < .05 ) , but lower in group 2 at the last follow-up ( p < .05 ) . Only in group 2 , two ( 3.8 % ) cases developed ACJ pain during follow-up and one ( 1.9 % ) case underwent reoperation for additional ACJ resection . Conclusions This study shows that distal clavicle resection combined with rotator cuff repair for asymptomatic ACJ arthritis with inferiorly directed osteophytes lower functional scores due to temporary pain in early postoperative periods , but better functional outcomes with satisfactory pain relief and no reoperation rate were observed after 2 years Multiple joint replacement in 1 operative session is frequently performed in the lower extremity but less often in the upper extremity . The purpose of the present study is to determine whether a 1-stage arthroplasty of the ipsilateral shoulder and elbow affects the clinical outcome . Replacement of the ipsilateral shoulder and elbow was performed in 34 rheumatoid patients ( 42 upper extremities ) . In 11 patients ( 13 upper limbs ) , the  shoulder and elbow arthroplasty  was a 1-stage procedure . The average follow-up of the whole group was 4.5 years ( range , 2 - 12 years ) . The patients were in a prospect i ve study and evaluated clinical ly and radiographically . With a 1-stage procedure , the hospitalization time was shorter . The overall Hospital for Special Surgery shoulder score and its items ( pain , function , and strength ) were similar at follow-up in the 2 groups , and only the motion score showed more improvement in the 1-stage group . The clinical outcome of elbow arthroplasty  was similar in both groups , regardless of the sequence of surgery . From this study , it may be concluded that a 1-stage procedure for shoulder and elbow arthroplasty will reduce the hospitalization time and does not adversely affect the clinical outcome BACKGROUND Both total shoulder arthroplasty and hemiarthroplasty have been used commonly to treat severe osteoarthritis of the shoulder ; however , their effect on disease-specific quality -of-life outcome is unknown . The purpose of this study was to compare the quality -of-life outcome following hemiarthroplasty with that following total shoulder arthroplasty in patients with osteoarthritis of the shoulder . METHODS Forty-two patients with a diagnosis of osteoarthritis of the shoulder were r and omized to receive a hemiarthroplasty or a total shoulder arthroplasty .  One patient died , and all others were evaluated preoperatively and at six weeks and three , six , twelve , eighteen , and twenty-four months postoperatively with use of a st and ardized format including a disease-specific quality -of-life measurement tool ( Western Ontario Osteoarthritis of the Shoulder [ WOOS ] index ) , general shoulder rating scales ( University of California at Los Angeles [ UCLA ] shoulder scale , Constant score , and American Shoulder and Elbow Surgeons [ ASES ] evaluation form ) , general pain scales ( McGill pain score and visual analogue scale ) , and a global health measure ( Short Form-36 [ SF-36 ] ) . When a patient required revision of a hemiarthroplasty to a total shoulder arthroplasty , the last score before he or she " crossed over " was used for the analysis . RESULTS Significant improvements in disease-specific quality of life were seen two years after both the total shoulder arthroplasties and the hemiarthroplasties . There were no significant differences in quality of life ( WOOS score ) between the group treated with total shoulder arthroplasty and that treated with hemiarthroplasty ( 90.6 + /- 13.2 and 81.5 + /- 24.1 points , respectively ; p = 0.18 ) . The other outcome measures demonstrated similar findings . Two patients in the hemiarthroplasty group crossed over to the other group by undergoing a revision to a total shoulder arthroplasty because of glenoid arthrosis . CONCLUSIONS Both total shoulder arthroplasty and hemiarthroplasty improve disease-specific and general quality -of-life measurements . With the small number of patients in our study , we found no significant differences in these measurements between the two treatment groups . LEVEL OF EVIDENCE Therapeutic Level HYPOTHESIS The correct implantation of the glenoid component is of paramount importance in total shoulder arthroplasty ( TSA ) . We hypothesized that the accuracy of the glenoid positioning in the transverse plane can be improved using intraoperative navigation . MATERIAL S AND METHODS This prospect i ve , r and omized clinical study comprised 2 groups of 10 patients each with osteoarthritis of the shoulder TSA , with or without intraoperative navigation .  Glenoid version was measured on axial computed tomography scans preoperatively and 6 weeks postoperatively . RESULTS The operating time was significantly longer in the navigation group ( 169.5 + /- 15.2 vs 138 + /- 18.4 min ) . We found an average change of retroversion from 15.4 degrees + /- 5.8 degrees ( range , 3.0 degrees -24.0 degrees ) preoperatively to 3.7 degrees + /- 6.3 degrees ( range , -8.0 degrees to 15.0 degrees ) postoperatively in the navigation group compared with 14.4 degrees + /- 6.1 degrees ( range , 2.0 degrees -24.0 degrees ) preoperatively to 10.9 degrees + /- 6.8 degrees ( range , 0. 
    Output:
    
The studies identified were unable to provide a clear indication of best intervention for shoulder arthritis .
Sparse evidence is available for all other interventions , regardless of whether operative or non-operative .