human
***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: Background For total hip arthroplasty ( THA ) , minimally invasive surgery ( MIS ) uses a smaller incision and less muscle dissection than the classic approach ( CLASS ) , and may lead to faster rehabilitation . Questions / purpose sDoes minimally invasive hip arthroplasty result in superior clinical outcomes ? Patients and Methods In this double-blind r and omized controlled trial , 120 consecutive primary noncemented THAs in 120 patients were assigned to one of two groups ( MIS or CLASS ) . The r and omization sequence was stratified for two groups of surgeons , ie , those using a posterolateral approach ( PL-CLASS or PL-MIS ) and those using an anterolateral approach ( AL-CLASS or AL-MIS ) . Length of the incisions was 18 cm for the CLASS procedures . MIS incisions were extended at the skin level to 18 cm at the end of the procedure . The primary end point was the Harris hip score ( HHS ) at 6 weeks postoperatively . Patient-centered question naires were obtained preoperatively and after 6 weeks and 1 year . Results For the patients in the MIS group ( average 7.8 cm incision length ) , statistically significant increased mean HHSs were seen compared with the CLASS group at 6 weeks and 1 year . This difference was small and mainly caused by the favorable results of the PL-MIS . In the MIS group , surgical time was longer . A learning curve was observed based on operation time and complication rate . Although not statistically significant , the perioperative complication rate was rather high in the ( anterolateral ) MIS group . Conclusions The minimal invasive approach in THA did not show a clinical ly relevant superior outcome in the first postoperative year . Level of Evidence Level I , therapeutic study . See Guidelines for Authors for a complete description of levels of evidence Background There has been increasing interest in performing total hip arthroplasty ( THA ) with minimally invasive surgery ( MIS ) . This study was conducted to examine the effectiveness of MIS-THA using the new two-incision technique versus the one-incision technique . Methods A consecutive series of 113 patients who underwent MIS-THAs ( 63 one-incision cases , 50 two-incision cases ) were studied .  One-incision THA was performed with a posterolateral approach . For the two-incision , the first incision for cup insertion was made over the anterolateral side of the hip . Intermuscular dissection was performed between the gluteus medius and the tensor fascia lata . The second incision , for stem insertion , was made on the posterolateral side of the hip along the fiber of the gluteus maximus . Intermuscular dissection was made between the gluteus medius and the piriformis . Results Postoperative rehabilitation was significantly more rapid in the new two-incision group compared to the group with one incision . Postoperatively , the Harris Hip Score and the Western Ontario and the McMaster Universities Osteoarthritis Index score were significantly different between the two groups , especially the functional sections . Conclusions The findings of this study show that our new two-incision MIS-THA is an excellent surgical modality that allows early rehabilitation PURPOSE OF THE STUDY There have been few prospect i ve studies comparing minimally invasive approaches for total hip replacement . We wanted to ascertain the contribution of the minimally invasive posterior approach in comparison with the st and ard posterolateral approach in terms of early outcome . MATERIAL S AND METHODS This was prospect i ve comparative consecutive series of patients . Patients with major architectural problems or undergoing revision arthroplasty were excluded . One hundred ten patients ( 116 hips ) were divided into two groups which were comparable for number of patients , gender , age , body mass index , indication for surgery , and preoperative function scores . The preoperative ASA score was lower in the minimally invasive group ( p=0.04 ) . The patients were in the lateral reclining position for the two approaches and classical instrumentation using the same implants ( stems and cemented or non-cemented cups ) were used . We noted operative time and blood loss ( using the Brecher method based on the hematocrit at day 1 and 5 and the number of blood transfusions ) , postoperative pain , and implant position . Functional outcome was assessed with the modified Harris score and the WOMAC index ( at 6 weeks and 3 and 6 months ) . Statview(R ) was used to search for statistical significance considering p<0.05 as significant . RESULTS Mean length of incision was 8.5 cm versus 15.1 cm . Mean blood loss was significantly less in the minimally invasive group ( p=0.027 ) as was the level of postoperative pain as confirmed by the lesser consumption of morphine analgesics ( p=0.006 ) . Other operative variables as well as implant position were comparable . There were no major complications in the minimally invasive group . In the st and ard group , there was one case of common peroneal nerve palsy , two dislocations , and two fractures related to falls after prosthesis implantation . The WOMAC index was better after the minimally invasive approach at six weeks and at three months ( p<0.05 ) . The modified Harris score was better only at six weeks . Functional outcome and pain became comparable thereafter . DISCUSSION AND CONCLUSION The minimally invasive posterior approach does not require an orthopedic table nor specific instrumentation . A minute procedure is required with ligature of the posteromedial circumflex artery of the thigh to improve exposure and limit intraoperative bleeding . It enables satisfactory reproducible implant positioning . Conversion to an open posterolateral approach is possible if needed . The minimally invasive posterior approach enables a reduction in intraoperative bleeding and in postoperative pain while allowing earlier more rapid rehabilitation . Early clinical outcome is better but beyond six weeks , the functional results are comparable for the two approaches . The minimally invasive posterior approach is a reliable reproducible approach with a progressive learning curve BACKGROUND AND PURPOSE Systematic review s and meta-analyses often include an evaluation of the method ological quality of the individual studies that have been included , and are usually conducted by at least 2 individuals . The objective of this study was to assess the method ological quality and reliability of a series of r and omized controlled trials ( RCTs ) of both pharmacological and nonpharmacological interventions by use of the 10-item Physiotherapy Evidence -Based Data base ( PEDro ) Scale . METHODS Two abstract ors independently review ed 81 RCTs assessing a variety of interventions . The Cohen kappa statistic and the intraclass correlation coefficient ( ICC ) were used to assess agreement between abstract ors . RESULTS The average total PEDro scores were 5.94 ( SD=1.43 ) for all studies combined , 6.88 ( SD=1.2 ) for pharmacological studies , and 5.29 ( SD=1.26 ) for nonpharmacological studies . The median score for pharmacological studies was significantly higher than that for nonpharmacological studies ( 7 versus 5 ) . Pair-wise kappa scores ranged from a low of .452 for concealed allocation among drug trials to perfect agreement ( 1.00 ) for r and omization and reporting of results from between-group comparisons . The ICCs associated with the cumulative PEDro score were .91 ( 95 % confidence interval [CI]=.83-.94 ) for all studies , .89 ( 95 % CI=.78-.95 ) for pharmacological studies , and .91 ( 95 % CI=.84-.952 ) for nonpharmacological studies . DISCUSSION AND CONCLUSION The method ological quality for pharmacological interventions was significantly higher than that for nonpharmacological interventions . There was good agreement between raters at an individual item level and in total PEDro scores . A lack of reporting clarity , poor organization of the report , or the failure to include salient details contributed to less-than-perfect agreement between raters Minimally invasive total hip arthroplasty  using a short skin incision is a subject of much debate in the literature . The present study estimates the possible minimal length of the exposure in an unselected patient cohort and compares the lateral mini-incision technique and traditional total hip arthroplasty ( THA ) .  One hundred and two patients were divided into three groups according to the type of surgery and length of incision : mini-incision ( less than 10  cm ) was performed in 38 patients ; midi-incision ( 10–14 cm ) in 43 ; and  st and ard-incision ( longer than 14 cm ) in 21 patients . No statistical difference was found with regard to intraoperative and total blood loss , the rate of complications , and postoperative recovery . Significantly decreased body mass index ( BMI ) , shorter operative time , and higher number of hips with malpositioning of the acetabular cup were found in the mini-incision group . These patients , however , experienced less pain in the early postoperative period and were highly satisfied with the cosmetic results . The length of incision was shortened and optimized ( less than 14 cm ) in 82 % of patients , and mini-incision was performed in 38 patients of this unselected cohort . Because of the underst and able dem and of the patients for less invasive intervention , the surgeon should use a smaller but not necessarily mini-incision with minimal soft tissue trauma that still allows him to perform the procedure well , without compromising the type of implants and the otherwise excellent long-term results . R and omized prospect i ve studies are needed to explore the real value of the minimally invasive total hip arthroplasty . RésuméLa chirurgie arthroplastie de la hanche par voie mini invasive est un sujet de débat et de controverse dans la littérature . Cette étude a pour but d’estimer la longueur minimale de la voie d’abord sur une suite de patients non sélectionnés et de comparer la technique de mini incision avec la technique d’incision traditionnelle antérolatérale .  Cent deux patients ont été divisés en trois groupes , en fonction du type de chirurgie et en fonction de la longueur d’incision . Premier groupe : mini incision moins de 10 cm chez 38 patients , deuxième groupe : incision moyenne 10 à 14 cm chez 43 patients et troisième groupe : incision st and ard , supérieure à 14 cm chez 21 patients . Aucune différence statistique n’a été trouvée pour la perte sanguine et sur le taux des complications post-opératoires . Dans le groupe des mini incisions peu de sujets avaient une surcharge pondérale , par contre , il existait un gr and nombre de hanches avec une mal position de la cupule . Ces patients ont cependant présenté moins de douleur dans la période post-opératoire et ont été très satisfaits du résultat cosmétique . La longueur de l’incision dans la chirurgie prothétique de la hanche peut être raccourcie et la longueur optimum peut être de moins de 14 cm chez 82 % des patients . Une mini incision a été réalisé dans cette série , chez 38 patients du fait de la dem and e des patients pour une chirurgie mini invasive , les chirurgiens ont utilisé une petite incision avec un minimum de traumatisme des tissus mous . Cette mini incision doit donc permettre au chirurgien de réaliser son intervention correctement sans compromission sur le type d ’ implants , ni sur la qualité des résultats à long terme . Il n’y a pas besoin pour cela nécessairement d’une mini incision néanmoins des études prospect ives r and omisées doivent être réalisées pour explorer le vrai résultat de la chirurgie arthroplastie par voie mini invasive Patients are inquiring about  mini-incision primary total hip arthroplasty  with increasing frequency . There are no published r and omized controlled trials to substantiate cl aims that the mini-incision direct lateral approach is better than a st and ard approach . The purpose of our study was to review our initial experience with the mini-incision technique through the direct lateral approach , with the intent of implementing a r and omized controlled trial if the approach could be shown as safe and effective . Of importance was determining if there is any difference in component positioning and if there is any difference in intraoperative or postoperative complications between the two groups . We retrospectively compared a consecutive series of 87 primary total hip arthroplasties . Thirty-four total hip arthroplasties were done using a mini-incision direct lateral approach . The mean abduction angle was 45 ° for both groups . The femoral stem alignment was within five degrees of neutral in 97 % of the mini group and 94 % of the st and ard group . There were no dislocations , infections , neurologic or wound complications . There were no differences in medical complications or blood transfusions . A significant decrease was found regarding body mass index , which reflects the bias in patient selection and lack of r and omization . We conclude that it is safe to continue further study with this approach because as there was no increase in complications or component malpositioning . Level of Evidence : Therapeutic study , Level III ( retrospective comparative study ) . See the Guidelines for Authors for a complete description of levels of evidence BACKGROUND Minimally invasive total hip arthroplasty has stirred substantial controversy with regard to whether it provides superior outcomes compared with total hip arthroplasty performed through longer incisions . The orthopaedic literature is deficient in well- design ed scientific studies to support the clinical superiority of this approach . The objective of this study was to compare the results of a single mini-incision approach with those of a st and ard-incision total hip arthroplasty in the early postoperative period . METHODS Two hundred and nineteen patients ( 219 hips ) admitted for unilateral total hip arthroplasty between December 2003 and June 2004 were r and omized to undergo surgery through a short incision of < or=10 cm or a st and ard incision of 16 cm .  All patients were blinded to the size of the inc 
    Output:
    
agent
The meta- analysis of the current evidence base showed that minimally invasive THA is associated with a significantly increased risk of transient lateral femoral cutaneous nerve palsy ( p = 0.006 ) with no significantly better outcome
***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: Background For total hip arthroplasty ( THA ) , minimally invasive surgery ( MIS ) uses a smaller incision and less muscle dissection than the classic approach ( CLASS ) , and may lead to faster rehabilitation . Questions / purpose sDoes minimally invasive hip arthroplasty result in superior clinical outcomes ? Patients and Methods In this double-blind r and omized controlled trial , 120 consecutive primary noncemented THAs in 120 patients were assigned to one of two groups ( MIS or CLASS ) . The r and omization sequence was stratified for two groups of surgeons , ie , those using a posterolateral approach ( PL-CLASS or PL-MIS ) and those using an anterolateral approach ( AL-CLASS or AL-MIS ) . Length of the incisions was 18 cm for the CLASS procedures . MIS incisions were extended at the skin level to 18 cm at the end of the procedure . The primary end point was the Harris hip score ( HHS ) at 6 weeks postoperatively . Patient-centered question naires were obtained preoperatively and after 6 weeks and 1 year . Results For the patients in the MIS group ( average 7.8 cm incision length ) , statistically significant increased mean HHSs were seen compared with the CLASS group at 6 weeks and 1 year . This difference was small and mainly caused by the favorable results of the PL-MIS . In the MIS group , surgical time was longer . A learning curve was observed based on operation time and complication rate . Although not statistically significant , the perioperative complication rate was rather high in the ( anterolateral ) MIS group . Conclusions The minimal invasive approach in THA did not show a clinical ly relevant superior outcome in the first postoperative year . Level of Evidence Level I , therapeutic study . See Guidelines for Authors for a complete description of levels of evidence Background There has been increasing interest in performing total hip arthroplasty ( THA ) with minimally invasive surgery ( MIS ) . This study was conducted to examine the effectiveness of MIS-THA using the new two-incision technique versus the one-incision technique . Methods A consecutive series of 113 patients who underwent MIS-THAs ( 63 one-incision cases , 50 two-incision cases ) were studied .  One-incision THA was performed with a posterolateral approach . For the two-incision , the first incision for cup insertion was made over the anterolateral side of the hip . Intermuscular dissection was performed between the gluteus medius and the tensor fascia lata . The second incision , for stem insertion , was made on the posterolateral side of the hip along the fiber of the gluteus maximus . Intermuscular dissection was made between the gluteus medius and the piriformis . Results Postoperative rehabilitation was significantly more rapid in the new two-incision group compared to the group with one incision . Postoperatively , the Harris Hip Score and the Western Ontario and the McMaster Universities Osteoarthritis Index score were significantly different between the two groups , especially the functional sections . Conclusions The findings of this study show that our new two-incision MIS-THA is an excellent surgical modality that allows early rehabilitation PURPOSE OF THE STUDY There have been few prospect i ve studies comparing minimally invasive approaches for total hip replacement . We wanted to ascertain the contribution of the minimally invasive posterior approach in comparison with the st and ard posterolateral approach in terms of early outcome . MATERIAL S AND METHODS This was prospect i ve comparative consecutive series of patients . Patients with major architectural problems or undergoing revision arthroplasty were excluded . One hundred ten patients ( 116 hips ) were divided into two groups which were comparable for number of patients , gender , age , body mass index , indication for surgery , and preoperative function scores . The preoperative ASA score was lower in the minimally invasive group ( p=0.04 ) . The patients were in the lateral reclining position for the two approaches and classical instrumentation using the same implants ( stems and cemented or non-cemented cups ) were used . We noted operative time and blood loss ( using the Brecher method based on the hematocrit at day 1 and 5 and the number of blood transfusions ) , postoperative pain , and implant position . Functional outcome was assessed with the modified Harris score and the WOMAC index ( at 6 weeks and 3 and 6 months ) . Statview(R ) was used to search for statistical significance considering p<0.05 as significant . RESULTS Mean length of incision was 8.5 cm versus 15.1 cm . Mean blood loss was significantly less in the minimally invasive group ( p=0.027 ) as was the level of postoperative pain as confirmed by the lesser consumption of morphine analgesics ( p=0.006 ) . Other operative variables as well as implant position were comparable . There were no major complications in the minimally invasive group . In the st and ard group , there was one case of common peroneal nerve palsy , two dislocations , and two fractures related to falls after prosthesis implantation . The WOMAC index was better after the minimally invasive approach at six weeks and at three months ( p<0.05 ) . The modified Harris score was better only at six weeks . Functional outcome and pain became comparable thereafter . DISCUSSION AND CONCLUSION The minimally invasive posterior approach does not require an orthopedic table nor specific instrumentation . A minute procedure is required with ligature of the posteromedial circumflex artery of the thigh to improve exposure and limit intraoperative bleeding . It enables satisfactory reproducible implant positioning . Conversion to an open posterolateral approach is possible if needed . The minimally invasive posterior approach enables a reduction in intraoperative bleeding and in postoperative pain while allowing earlier more rapid rehabilitation . Early clinical outcome is better but beyond six weeks , the functional results are comparable for the two approaches . The minimally invasive posterior approach is a reliable reproducible approach with a progressive learning curve BACKGROUND AND PURPOSE Systematic review s and meta-analyses often include an evaluation of the method ological quality of the individual studies that have been included , and are usually conducted by at least 2 individuals . The objective of this study was to assess the method ological quality and reliability of a series of r and omized controlled trials ( RCTs ) of both pharmacological and nonpharmacological interventions by use of the 10-item Physiotherapy Evidence -Based Data base ( PEDro ) Scale . METHODS Two abstract ors independently review ed 81 RCTs assessing a variety of interventions . The Cohen kappa statistic and the intraclass correlation coefficient ( ICC ) were used to assess agreement between abstract ors . RESULTS The average total PEDro scores were 5.94 ( SD=1.43 ) for all studies combined , 6.88 ( SD=1.2 ) for pharmacological studies , and 5.29 ( SD=1.26 ) for nonpharmacological studies . The median score for pharmacological studies was significantly higher than that for nonpharmacological studies ( 7 versus 5 ) . Pair-wise kappa scores ranged from a low of .452 for concealed allocation among drug trials to perfect agreement ( 1.00 ) for r and omization and reporting of results from between-group comparisons . The ICCs associated with the cumulative PEDro score were .91 ( 95 % confidence interval [CI]=.83-.94 ) for all studies , .89 ( 95 % CI=.78-.95 ) for pharmacological studies , and .91 ( 95 % CI=.84-.952 ) for nonpharmacological studies . DISCUSSION AND CONCLUSION The method ological quality for pharmacological interventions was significantly higher than that for nonpharmacological interventions . There was good agreement between raters at an individual item level and in total PEDro scores . A lack of reporting clarity , poor organization of the report , or the failure to include salient details contributed to less-than-perfect agreement between raters Minimally invasive total hip arthroplasty  using a short skin incision is a subject of much debate in the literature . The present study estimates the possible minimal length of the exposure in an unselected patient cohort and compares the lateral mini-incision technique and traditional total hip arthroplasty ( THA ) .  One hundred and two patients were divided into three groups according to the type of surgery and length of incision : mini-incision ( less than 10  cm ) was performed in 38 patients ; midi-incision ( 10–14 cm ) in 43 ; and  st and ard-incision ( longer than 14 cm ) in 21 patients . No statistical difference was found with regard to intraoperative and total blood loss , the rate of complications , and postoperative recovery . Significantly decreased body mass index ( BMI ) , shorter operative time , and higher number of hips with malpositioning of the acetabular cup were found in the mini-incision group . These patients , however , experienced less pain in the early postoperative period and were highly satisfied with the cosmetic results . The length of incision was shortened and optimized ( less than 14 cm ) in 82 % of patients , and mini-incision was performed in 38 patients of this unselected cohort . Because of the underst and able dem and of the patients for less invasive intervention , the surgeon should use a smaller but not necessarily mini-incision with minimal soft tissue trauma that still allows him to perform the procedure well , without compromising the type of implants and the otherwise excellent long-term results . R and omized prospect i ve studies are needed to explore the real value of the minimally invasive total hip arthroplasty . RésuméLa chirurgie arthroplastie de la hanche par voie mini invasive est un sujet de débat et de controverse dans la littérature . Cette étude a pour but d’estimer la longueur minimale de la voie d’abord sur une suite de patients non sélectionnés et de comparer la technique de mini incision avec la technique d’incision traditionnelle antérolatérale .  Cent deux patients ont été divisés en trois groupes , en fonction du type de chirurgie et en fonction de la longueur d’incision . Premier groupe : mini incision moins de 10 cm chez 38 patients , deuxième groupe : incision moyenne 10 à 14 cm chez 43 patients et troisième groupe : incision st and ard , supérieure à 14 cm chez 21 patients . Aucune différence statistique n’a été trouvée pour la perte sanguine et sur le taux des complications post-opératoires . Dans le groupe des mini incisions peu de sujets avaient une surcharge pondérale , par contre , il existait un gr and nombre de hanches avec une mal position de la cupule . Ces patients ont cependant présenté moins de douleur dans la période post-opératoire et ont été très satisfaits du résultat cosmétique . La longueur de l’incision dans la chirurgie prothétique de la hanche peut être raccourcie et la longueur optimum peut être de moins de 14 cm chez 82 % des patients . Une mini incision a été réalisé dans cette série , chez 38 patients du fait de la dem and e des patients pour une chirurgie mini invasive , les chirurgiens ont utilisé une petite incision avec un minimum de traumatisme des tissus mous . Cette mini incision doit donc permettre au chirurgien de réaliser son intervention correctement sans compromission sur le type d ’ implants , ni sur la qualité des résultats à long terme . Il n’y a pas besoin pour cela nécessairement d’une mini incision néanmoins des études prospect ives r and omisées doivent être réalisées pour explorer le vrai résultat de la chirurgie arthroplastie par voie mini invasive Patients are inquiring about  mini-incision primary total hip arthroplasty  with increasing frequency . There are no published r and omized controlled trials to substantiate cl aims that the mini-incision direct lateral approach is better than a st and ard approach . The purpose of our study was to review our initial experience with the mini-incision technique through the direct lateral approach , with the intent of implementing a r and omized controlled trial if the approach could be shown as safe and effective . Of importance was determining if there is any difference in component positioning and if there is any difference in intraoperative or postoperative complications between the two groups . We retrospectively compared a consecutive series of 87 primary total hip arthroplasties . Thirty-four total hip arthroplasties were done using a mini-incision direct lateral approach . The mean abduction angle was 45 ° for both groups . The femoral stem alignment was within five degrees of neutral in 97 % of the mini group and 94 % of the st and ard group . There were no dislocations , infections , neurologic or wound complications . There were no differences in medical complications or blood transfusions . A significant decrease was found regarding body mass index , which reflects the bias in patient selection and lack of r and omization . We conclude that it is safe to continue further study with this approach because as there was no increase in complications or component malpositioning . Level of Evidence : Therapeutic study , Level III ( retrospective comparative study ) . See the Guidelines for Authors for a complete description of levels of evidence BACKGROUND Minimally invasive total hip arthroplasty has stirred substantial controversy with regard to whether it provides superior outcomes compared with total hip arthroplasty performed through longer incisions . The orthopaedic literature is deficient in well- design ed scientific studies to support the clinical superiority of this approach . The objective of this study was to compare the results of a single mini-incision approach with those of a st and ard-incision total hip arthroplasty in the early postoperative period . METHODS Two hundred and nineteen patients ( 219 hips ) admitted for unilateral total hip arthroplasty between December 2003 and June 2004 were r and omized to undergo surgery through a short incision of < or=10 cm or a st and ard incision of 16 cm .  All patients were blinded to the size of the inc 
    Output:
    