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: A number of studies have reported a significant improvement of the postoperative alignment , when computer-navigated total knee arthroplasty ( TKA )  was compared with conventional techniques . However , no studies are available on the functional and patient-relevant outcomes after computer-assisted knee replacement . In a prospect i ve , r and omized trial comparing 27 computer-assisted TKAs with 25 conventional implantations  , the Knee Society Score was used to assess functional status , and the WOMAC question naire was used to record the disease-specific , patient-relevant outcome . At a twelve-month follow-up no significant difference was detected between the two patient groups in either the scores or the number of complications and range of postoperative knee flexion . The results are in agreement with those reported in other studies on the effect of conventional TKA . With the patient group of this size it can be concluded that computer-navigated TKA gives short-term resuits comparable with those achieved by conventional methods of implantation The optimal mode of fixation in total knee arthroplasty ( TKA ) is a subject of debate . We enrolled 100 TKA patients r and omized to cemented or cementless fixation .  Knee Society Scores ( KSS ) , Oxford scores and pain visual analog scales ( VAS ) were collected pre-operatively and post-operatively . Two-year follow-up was obtained for 93 patients . The mean VAS trended higher for the cementless group at 4 months ( P=0.06 ) . At 2 years , the KSS functional scores , Oxford scores , and self-reported questions for satisfaction , less pain and better function were similar but the cemented group had higher KSS clinical scores ( 96.4 vs. 92.3 , P=0.03 ) . More radiolucencies were seen in cementless knees ( P<0.001 ) . The cementless group had one revision for instability and one cemented knee was revised for infection .  Cementless TKA showed equivalent survivorship ( revision for any reason as the endpoint ) compared to cemented TKA at this early follow-up . Close monitoring of radiolucencies is important with continued follow-up INTRODUCTION The use of robotics in total knee arthroplasty ( TKA ) has been shown to minimise human error , as well as improve the accuracy and precision of component implantation and mechanical axis alignment . The present study aim ed to demonstrate that robot-assisted TKA using ROBODOC ® is safe and capable of producing a consistent and accurate postoperative mechanical axis . METHODS We prospect ively recruited 27 consecutive patients who underwent robot-assisted TKA between May and December 2012 . Two patients were excluded from the study due to intraoperative technical problems with the robot .  Long-leg radiography and computed tomography were performed prior to surgery , and used for mechanical axis measurements and component sizing . DigiMatch ™ ROBODOC ® Surgical System software version 4.3.6 ( Curexo Technology Corp , Fremont , CA , USA ) was used in all cases to perform bone cuts in accordance with the preoperative plan . RESULTS The postoperative coronal mechanical alignment was within 3 degrees , with a mean alignment of -0.4 ± 1.7 degrees , confirming the accuracy of the preoperative surgical plan and bone cuts . The mean operating time was 96 ± 15 min , and preoperative planning yielded 100 % implant sizing accuracy . CONCLUSION Robotics has the potential to enable surgeons to consistently attain ideal postoperative alignment . The use of bone movement monitors and an integrated navigation system enhances the safety profile of ROBODOC ® by minimising errors . However , the role of the surgeon in TKA is still vital , as the surgeon is ultimately in charge of planning the surgery , its execution and ensuring soft tissue balance during TKA The accuracy and efficiency of automated cutting guides in CAS systems have not been previously compared with conventional CAS techniques . Therefore , it is not yet clear if these more advanced technologies are warranted . We hypothesized that a novel automated cutting guide with CAS for total knee arthroplasty would be more efficient and more accurate than conventional navigation with sequential cutting blocks . Twelve cadaver legs were used in total . Each leg was r and omly assigned to either an automated guide positioning or a conventional freeh and computer-navigated guide positioning . The guide positions postosseous fixation and the final bone-cut surfaces were digitized and compared to the targeted cutting planes . The final location of the impacted trial implant was also digitized and compared to the planned implant location . The time for each step and the total time taken to prepare the femur were measured for both groups . The mean femoral preparation time was shorter with the automated cutting guide than the conventional method ( 5.5 min versus 13.8 min , p<0.001 ) . The average deviation in the final bone resections from the planned resections was significantly lower for the automated cutting guide in the frontal/rotational plane ( 0.55 ° versus 1.1 ° ) , sagittal plane ( 0.75 ° versus 2.0 ° ) , and cut height direction ( 0.56 mm versus 1.6 mm ) . Therefore , based on these results , we concluded that automated cutting-guide positioning result ed in more efficient and more accurate femoral cuts in comparison to the conventional navigation method in a cadaveric model Purpose Manufacturers of total knee arthroplasty ( TKA )  have introduced narrower femurs to improve bone-implant fit . However , few studies have reported the clinical consequences of mediolateral oversizing . Our hypothesis was that component oversizing negatively influences the results after TKA . Methods One hundred and twelve prospect ively followed patients with 114 consecutive TKA ( 64 females and 50 males ) were retrospectively assessed . The mean age of the patients was 72 years ( range , 56 to 85 years ) . The dimensions of the femur and tibia were measured on a preoperative CT-scan and were compared with those of the implanted TKA . The influence of size variation on the clinical outcomes 1 year after surgery was assessed . Results Mediolateral overhang was observed in at least one area in 66 % of the femurs ( 84 % in females and 54 % in males ) and 61 % of the tibia ( 81 % in females and 40 % in males ) . Twenty-two patients presented no overhang in any area and 16 had overhang in all studied zones . The increase in the Pain and KOOS scores were 43 ± 21 and 36 ± 18 in the patients without overhang and 31 ± 19 and 25 ± 13 in patients with overhang ( p = 0.033 ; p = 0.032 ) . Knee flexion was 127 ° ± 7 and 121 ° ± 11 , respectively . Regression and latent class analysis showed a significant negative correlation between overall oversizing and overall outcome . Conclusions This study confirms that oversizing may lead to worse clinical results in TKA . The clinical consequences are that surgeons should pay attention not to oversize implants during implantation nd that oversizing should be ruled out in case of so called unexplained pain . Level of evidence IV Unicompartmental knee arthroplasty ( UKA ) allows replacement of a single compartment in patients with limited disease . However , UKA is technically challenging and relies on accurate component positioning and restoration of natural knee kinematics . This study examined the accuracy of dynamic , real-time ligament balancing  using a robotic-assisted UKA system . Surgical data obtained from the computer system were prospect ively collected from 51 patients ( 52 knees ) undergoing robotic-assisted medial UKA by a single surgeon .  Dynamic ligament balancing of the knee was obtained under valgus stress prior to component implantation and then compared to final ligament balance with the components in place . Ligament balancing was accurate up to 0.53 mm compared to the preoperative plan , with 83 % of cases within 1 mm at 0 ° , 30 ° , 60 ° , 90 ° , and 110 ° of flexion . Ligamentous laxity of 1.31 ± 0.13 mm at 30 ° of flexion was corrected successfully to 0.78 ± 0.17 mm ( P < 0.05 ) . Robotic-assisted UKA allows accurate and precise reproduction of a surgical balance plan using dynamic , real-time soft-tissue balancing to help restore natural knee kinematics , potentially improving implant survival and functional outcomes This study was aim ed to compare robotic-assisted implantation of a total knee arthroplasty with conventional manual implantation . We controlled , r and omized , and review ed 72 patients for total knee arthroplasty assigned to undergo either conventional manual implantation ( excluding navigation-assisted implantation cases ) of a Zimmer LPS prosthesis ( Zimmer , Warsaw , Ind ) ( 30 patients : group 1 ) or robotic-assisted implantation of such a prosthesis ( 32 patients : group 2 ) . The femoral flexion angle ( gamma angle ) and tibial angle ( delta angle ) in the lateral x-ray of group 1 were 4.19 + /- 3.28 degrees and 89.7 + /- 1.7 degrees , and those of group 2 were 0.17 + /- 0.65 degrees and 85.5 + /- 0.92 degrees . The major complications were from improper small skin incision during a constraint attempt of minimally invasive surgery and during bulk fixation frame pins insertion . Robotic-assisted technology had definite advantages in terms of preoperative planning , accuracy of the intraoperative procedure , and postoperative follow-up , especially in the femoral flexion angle ( gamma angle ) and tibial flexion angle ( delta angle ) in the lateral x-ray , and in the femoral flexion angle ( alpha angle ) in the anteroposterior x-ray . But a disadvantage was the high complication rate in early stage We conducted a prospect i ve , r and omized study to compare the short-term results of minimally invasive and computer-assisted total knee arthroplasty ( MICA-TKA ) with those of conventional total knee arthroplasty ( C-TKA ) for 12-month follow-up . A total of 87 subjects who met the inclusion and exclusion criteria of the study were prospect ively r and omized consecutively into two groups : the C-TKA group ( Group A , n = 44 ) and the MICA-TKA technique ( Group B , n = 43 ) . All the operations were performed by the same senior surgeon . Before surgery and at follow-up , patients were evaluated by the same observer . Tourniquet time as well as total blood loss was compared . Knee Society scores ( KSSs ) , Knee Society functional scores ( KSFSs ) , range of motion ( ROM ) , and radiographic results were assessed and reported preoperatively and at 12-month follow-up . Of these patients , 82 ( Group A 42 ; Group B 40 ) were available for 12-month evaluation . The two groups were found to be similar in terms of coronal mechanical axis . Similarly , the femoral rotational profile revealed that the prosthesis in Group A was implanted with similar internal rotation to Group B. The average blood loss in patients of Group B was significantly reduced as compared to patients of Group A. No significant difference was detected in terms of tourniquet time . Clinical results in Group B , with regard to ROMs and KSSs , as well as KSFSs were significantly superior to that in Group A. Based on the results obtained from this study , it is demonstrated that MICA-TKA leads to a similarly accurate restoration of leg alignment and component orientation compared to the C-TKA . Moreover , MICA-TKA produces superior clinical results to that of C-TKA . However , there is clearly a need for additional high- quality clinical trials with long-term follow-up to confirm the clinical benefits of MICA-TKA We evaluated the influence of CT-free or CT-based computer assisted orthopaedic surgery ( CAOS ) on the alignment of total knee prostheses ( TK ) and micromotion of tibial components . This r and omised study compared 19 CT-free , 17 CT-based CAOS TK , and a matched control group of 21 conventionally placed TK .  Using Roentgen stereophotogrammetric analysis ( RSA ) the migration was measured . The alignment and component positions were measured on radiographs . No significant difference in leg and tibial component alignment was present between the three groups . A significant difference was found for micromotion in subsidence , with the conventional group having a mean of 0.16 mm , compared to the CT-free group at 0.01 mm and the CT-based group at −0.05 mm . No clinical significant difference in alignment was found between CAOS and conventionally operated TK . More subsidence of the tibial component was seen in the conventional group compared to both CAOS groups at two year follow-up . RésuméBut de l'étude : Evaluer l'influence de la navigation avec ou sans scanner sur l'alignement des prothèses totales du genou et sur la micromobilité du composant tibial . Matériel et méthode : nous avons réalisé une étude r and omisée comparant 19 prothèses naviguées sans scanner , 17 prothèses naviguées avec scanner , croisées avec un groupe contrôle de 21 patients avec mise en place d'une prothèse par voie conventionnelle . Nous avons utilisé la méthode RSA pour mesurer la migration . L'alignement et les composants étaient mesurés sur les radiographies . Résultats : il n'y a pas de différence significative au niveau de l'alignement des composants pour les trois groupes , par contre il existe une différence significative en ce qui concerne la migration . Dans le groupe conventionnel celle-ci est d'environ 0,16 mm , 0,01 mm dans le groupe navigation sans scanner et 0,05 mm dans le groupe navigation avec scanner . Conclusion : il n'y a pas de différence significative 
    Output:
    
agent
A literature review of robotic systems showed that these systems can , similarly to computer navigation , reliably improve lower leg alignment , component positioning and soft tissues balancing .
Findings in this study suggest that computer navigation or robotic assistance may help managing these multiple variables and could improve outcomes .
***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: A number of studies have reported a significant improvement of the postoperative alignment , when computer-navigated total knee arthroplasty ( TKA )  was compared with conventional techniques . However , no studies are available on the functional and patient-relevant outcomes after computer-assisted knee replacement . In a prospect i ve , r and omized trial comparing 27 computer-assisted TKAs with 25 conventional implantations  , the Knee Society Score was used to assess functional status , and the WOMAC question naire was used to record the disease-specific , patient-relevant outcome . At a twelve-month follow-up no significant difference was detected between the two patient groups in either the scores or the number of complications and range of postoperative knee flexion . The results are in agreement with those reported in other studies on the effect of conventional TKA . With the patient group of this size it can be concluded that computer-navigated TKA gives short-term resuits comparable with those achieved by conventional methods of implantation The optimal mode of fixation in total knee arthroplasty ( TKA ) is a subject of debate . We enrolled 100 TKA patients r and omized to cemented or cementless fixation .  Knee Society Scores ( KSS ) , Oxford scores and pain visual analog scales ( VAS ) were collected pre-operatively and post-operatively . Two-year follow-up was obtained for 93 patients . The mean VAS trended higher for the cementless group at 4 months ( P=0.06 ) . At 2 years , the KSS functional scores , Oxford scores , and self-reported questions for satisfaction , less pain and better function were similar but the cemented group had higher KSS clinical scores ( 96.4 vs. 92.3 , P=0.03 ) . More radiolucencies were seen in cementless knees ( P<0.001 ) . The cementless group had one revision for instability and one cemented knee was revised for infection .  Cementless TKA showed equivalent survivorship ( revision for any reason as the endpoint ) compared to cemented TKA at this early follow-up . Close monitoring of radiolucencies is important with continued follow-up INTRODUCTION The use of robotics in total knee arthroplasty ( TKA ) has been shown to minimise human error , as well as improve the accuracy and precision of component implantation and mechanical axis alignment . The present study aim ed to demonstrate that robot-assisted TKA using ROBODOC ® is safe and capable of producing a consistent and accurate postoperative mechanical axis . METHODS We prospect ively recruited 27 consecutive patients who underwent robot-assisted TKA between May and December 2012 . Two patients were excluded from the study due to intraoperative technical problems with the robot .  Long-leg radiography and computed tomography were performed prior to surgery , and used for mechanical axis measurements and component sizing . DigiMatch ™ ROBODOC ® Surgical System software version 4.3.6 ( Curexo Technology Corp , Fremont , CA , USA ) was used in all cases to perform bone cuts in accordance with the preoperative plan . RESULTS The postoperative coronal mechanical alignment was within 3 degrees , with a mean alignment of -0.4 ± 1.7 degrees , confirming the accuracy of the preoperative surgical plan and bone cuts . The mean operating time was 96 ± 15 min , and preoperative planning yielded 100 % implant sizing accuracy . CONCLUSION Robotics has the potential to enable surgeons to consistently attain ideal postoperative alignment . The use of bone movement monitors and an integrated navigation system enhances the safety profile of ROBODOC ® by minimising errors . However , the role of the surgeon in TKA is still vital , as the surgeon is ultimately in charge of planning the surgery , its execution and ensuring soft tissue balance during TKA The accuracy and efficiency of automated cutting guides in CAS systems have not been previously compared with conventional CAS techniques . Therefore , it is not yet clear if these more advanced technologies are warranted . We hypothesized that a novel automated cutting guide with CAS for total knee arthroplasty would be more efficient and more accurate than conventional navigation with sequential cutting blocks . Twelve cadaver legs were used in total . Each leg was r and omly assigned to either an automated guide positioning or a conventional freeh and computer-navigated guide positioning . The guide positions postosseous fixation and the final bone-cut surfaces were digitized and compared to the targeted cutting planes . The final location of the impacted trial implant was also digitized and compared to the planned implant location . The time for each step and the total time taken to prepare the femur were measured for both groups . The mean femoral preparation time was shorter with the automated cutting guide than the conventional method ( 5.5 min versus 13.8 min , p<0.001 ) . The average deviation in the final bone resections from the planned resections was significantly lower for the automated cutting guide in the frontal/rotational plane ( 0.55 ° versus 1.1 ° ) , sagittal plane ( 0.75 ° versus 2.0 ° ) , and cut height direction ( 0.56 mm versus 1.6 mm ) . Therefore , based on these results , we concluded that automated cutting-guide positioning result ed in more efficient and more accurate femoral cuts in comparison to the conventional navigation method in a cadaveric model Purpose Manufacturers of total knee arthroplasty ( TKA )  have introduced narrower femurs to improve bone-implant fit . However , few studies have reported the clinical consequences of mediolateral oversizing . Our hypothesis was that component oversizing negatively influences the results after TKA . Methods One hundred and twelve prospect ively followed patients with 114 consecutive TKA ( 64 females and 50 males ) were retrospectively assessed . The mean age of the patients was 72 years ( range , 56 to 85 years ) . The dimensions of the femur and tibia were measured on a preoperative CT-scan and were compared with those of the implanted TKA . The influence of size variation on the clinical outcomes 1 year after surgery was assessed . Results Mediolateral overhang was observed in at least one area in 66 % of the femurs ( 84 % in females and 54 % in males ) and 61 % of the tibia ( 81 % in females and 40 % in males ) . Twenty-two patients presented no overhang in any area and 16 had overhang in all studied zones . The increase in the Pain and KOOS scores were 43 ± 21 and 36 ± 18 in the patients without overhang and 31 ± 19 and 25 ± 13 in patients with overhang ( p = 0.033 ; p = 0.032 ) . Knee flexion was 127 ° ± 7 and 121 ° ± 11 , respectively . Regression and latent class analysis showed a significant negative correlation between overall oversizing and overall outcome . Conclusions This study confirms that oversizing may lead to worse clinical results in TKA . The clinical consequences are that surgeons should pay attention not to oversize implants during implantation nd that oversizing should be ruled out in case of so called unexplained pain . Level of evidence IV Unicompartmental knee arthroplasty ( UKA ) allows replacement of a single compartment in patients with limited disease . However , UKA is technically challenging and relies on accurate component positioning and restoration of natural knee kinematics . This study examined the accuracy of dynamic , real-time ligament balancing  using a robotic-assisted UKA system . Surgical data obtained from the computer system were prospect ively collected from 51 patients ( 52 knees ) undergoing robotic-assisted medial UKA by a single surgeon .  Dynamic ligament balancing of the knee was obtained under valgus stress prior to component implantation and then compared to final ligament balance with the components in place . Ligament balancing was accurate up to 0.53 mm compared to the preoperative plan , with 83 % of cases within 1 mm at 0 ° , 30 ° , 60 ° , 90 ° , and 110 ° of flexion . Ligamentous laxity of 1.31 ± 0.13 mm at 30 ° of flexion was corrected successfully to 0.78 ± 0.17 mm ( P < 0.05 ) . Robotic-assisted UKA allows accurate and precise reproduction of a surgical balance plan using dynamic , real-time soft-tissue balancing to help restore natural knee kinematics , potentially improving implant survival and functional outcomes This study was aim ed to compare robotic-assisted implantation of a total knee arthroplasty with conventional manual implantation . We controlled , r and omized , and review ed 72 patients for total knee arthroplasty assigned to undergo either conventional manual implantation ( excluding navigation-assisted implantation cases ) of a Zimmer LPS prosthesis ( Zimmer , Warsaw , Ind ) ( 30 patients : group 1 ) or robotic-assisted implantation of such a prosthesis ( 32 patients : group 2 ) . The femoral flexion angle ( gamma angle ) and tibial angle ( delta angle ) in the lateral x-ray of group 1 were 4.19 + /- 3.28 degrees and 89.7 + /- 1.7 degrees , and those of group 2 were 0.17 + /- 0.65 degrees and 85.5 + /- 0.92 degrees . The major complications were from improper small skin incision during a constraint attempt of minimally invasive surgery and during bulk fixation frame pins insertion . Robotic-assisted technology had definite advantages in terms of preoperative planning , accuracy of the intraoperative procedure , and postoperative follow-up , especially in the femoral flexion angle ( gamma angle ) and tibial flexion angle ( delta angle ) in the lateral x-ray , and in the femoral flexion angle ( alpha angle ) in the anteroposterior x-ray . But a disadvantage was the high complication rate in early stage We conducted a prospect i ve , r and omized study to compare the short-term results of minimally invasive and computer-assisted total knee arthroplasty ( MICA-TKA ) with those of conventional total knee arthroplasty ( C-TKA ) for 12-month follow-up . A total of 87 subjects who met the inclusion and exclusion criteria of the study were prospect ively r and omized consecutively into two groups : the C-TKA group ( Group A , n = 44 ) and the MICA-TKA technique ( Group B , n = 43 ) . All the operations were performed by the same senior surgeon . Before surgery and at follow-up , patients were evaluated by the same observer . Tourniquet time as well as total blood loss was compared . Knee Society scores ( KSSs ) , Knee Society functional scores ( KSFSs ) , range of motion ( ROM ) , and radiographic results were assessed and reported preoperatively and at 12-month follow-up . Of these patients , 82 ( Group A 42 ; Group B 40 ) were available for 12-month evaluation . The two groups were found to be similar in terms of coronal mechanical axis . Similarly , the femoral rotational profile revealed that the prosthesis in Group A was implanted with similar internal rotation to Group B. The average blood loss in patients of Group B was significantly reduced as compared to patients of Group A. No significant difference was detected in terms of tourniquet time . Clinical results in Group B , with regard to ROMs and KSSs , as well as KSFSs were significantly superior to that in Group A. Based on the results obtained from this study , it is demonstrated that MICA-TKA leads to a similarly accurate restoration of leg alignment and component orientation compared to the C-TKA . Moreover , MICA-TKA produces superior clinical results to that of C-TKA . However , there is clearly a need for additional high- quality clinical trials with long-term follow-up to confirm the clinical benefits of MICA-TKA We evaluated the influence of CT-free or CT-based computer assisted orthopaedic surgery ( CAOS ) on the alignment of total knee prostheses ( TK ) and micromotion of tibial components . This r and omised study compared 19 CT-free , 17 CT-based CAOS TK , and a matched control group of 21 conventionally placed TK .  Using Roentgen stereophotogrammetric analysis ( RSA ) the migration was measured . The alignment and component positions were measured on radiographs . No significant difference in leg and tibial component alignment was present between the three groups . A significant difference was found for micromotion in subsidence , with the conventional group having a mean of 0.16 mm , compared to the CT-free group at 0.01 mm and the CT-based group at −0.05 mm . No clinical significant difference in alignment was found between CAOS and conventionally operated TK . More subsidence of the tibial component was seen in the conventional group compared to both CAOS groups at two year follow-up . RésuméBut de l'étude : Evaluer l'influence de la navigation avec ou sans scanner sur l'alignement des prothèses totales du genou et sur la micromobilité du composant tibial . Matériel et méthode : nous avons réalisé une étude r and omisée comparant 19 prothèses naviguées sans scanner , 17 prothèses naviguées avec scanner , croisées avec un groupe contrôle de 21 patients avec mise en place d'une prothèse par voie conventionnelle . Nous avons utilisé la méthode RSA pour mesurer la migration . L'alignement et les composants étaient mesurés sur les radiographies . Résultats : il n'y a pas de différence significative au niveau de l'alignement des composants pour les trois groupes , par contre il existe une différence significative en ce qui concerne la migration . Dans le groupe conventionnel celle-ci est d'environ 0,16 mm , 0,01 mm dans le groupe navigation sans scanner et 0,05 mm dans le groupe navigation avec scanner . Conclusion : il n'y a pas de différence significative 
    Output:
    