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 The aim of this study is to compare the functional midterm outcome of stemless shoulder prostheses with st and ard anatomical stemmed shoulder prostheses and to show that the STEMLESS results are comparable to the STEMMED with respect to active maximum range of shoulder motion ( ROM ) and Constant score ( CS ) . Methods Seventeen patients underwent total shoulder arthroplasty ( TSA ) in 25 shoulder joints .  Stemless TSA was performed in 12 shoulder joints ( group STEMLESS ) , third-generation stemmed TSA in 13 shoulder joints ( group STEMMED ) . Functional results were documented using the CS . 3D-motion- analysis using the Heidelberg upper extremity model ( HUX ) was conducted to measure active maximum ( ROM ) . Results The group STEMLESS achieved a CS of 67.9 ( SD 12.0 ) points and the group STEMMED of 70.2 ( SD 5.8 points ) without significant difference between the groups ( p = 0.925 ) . The maximum ROM of the group STEMLESS , ascertained by 3-D-motion- analysis , was in forward flexion 125.5 ° ( SD 17.2 ° ) , in extension 49.4 ° ( SD 13.8 ° ) , in abduction 126.2 ° ( SD 28.5 ° ) and in external rotation 40.3 ° ( SD 13.9 ° ) . The maximum ROM of the group STEMMED , also ascertained by 3-D-motion analysis , was in forward flexion 135.0 ° ( SD 16.8 ° ) , in extension 47.2 ° ( SD 11.5 ° ) , in abduction 136.3 ° ( SD 24.2 ° ) and in external rotation 40.1 ° ( SD 12.2 ° ) . The maximum ROM of the STEMLESS group was lower in forward flexion and abduction , higher in extension and almost identical in external rotation . But there was no significant difference ( forward flexion p = 0.174 , extension p = 0.470 , abduction p = 0.345 , external rotation p = 0.978 ) . Conclusion Both types of shoulder prostheses achieve a similar and good active ROM and similar results in CS.Trial registration DRKS00013166 , retrospectively registered , Background Stemless shoulder arthroplasty is a fairly new concept . Clinical and radiological follow-up is essential to prove implant safety and concept . This prospect i ve single-centre study was performed to evaluate the influence of radiological changes on clinical mid-term outcome following stemless humeral head replacement with hollow screw fixation . Methods Short- and mid-term radiological and clinical evaluations were performed in 73 consecutive shoulders treated mainly for idiopathic and posttraumatic osteoarthritis with stemless humeral head arthroplasty including 40 hemi- ( HSA ) and 33 total shoulder arthroplasties ( TSA ) . Operating times of stemless implantations were compared to  110 stemmed anatomical shoulder prostheses .  Appearances of humeral radiolucencies or radiological signs of osteolysis or stress shielding were assessed on st and ardized radiographs . Patients ’ clinical outcome was evaluated using the Constant score and patients ’ satisfaction was documented . Results Radiological changes , detected in 37.0 % , did not affect clinical outcome . Constant scores significantly improved from baseline to short and mid-term follow-up ( p < 0.001 ) . The majority of patients ( 96.2 % ) were satisfied with the procedure . No loosening of the humeral head component was detected during a mean follow-up of 58 months . Operating times were significantly shorter with stemless compared to stemmed implants ( p < 0.001 ) . Conclusions Clinical mid-term outcome after stemless humeral head replacement was not affected by radiological changes . Trial registration The institutional review board ( St. Vincent Hospital Vienna ; 201212_EK01 ; date of issue : 11.12.2012 ) approved the study . The trial was registered at Clinical Trials.gov ( NCT02754024 ) . Retrospective registration BACKGROUND Several stemless shoulder implants are available on the market , but only a few studies have presented results with sufficient mid- to long-term follow-up . The present study evaluated clinical and radiologic outcomes 9 years after anatomic stemless shoulder replacement . METHODS This is a prospect i ve cohort study evaluating the  stemless shoulder prosthesis since 2005 .  Anatomic stemless shoulder replacement using a single prosthesis was performed in 49 shoulders ; 17 underwent total shoulder replacement , and 32 underwent hemiarthroplasty . Forty-three patients were clinical ly and radiologically monitored after a mean of 9 years ( range , 90 - 127 months ; follow-up rate , 88 % ) . The indications for shoulder replacement were primary osteoarthritis in 7 shoulders , post-traumatic in 24 , instability in 7 , cuff tear arthropathy in 2 , postinfectious arthritis in 1 , and revision arthroplasty in 2 . RESULTS The Constant-Murley Score improved significantly from 52 % to 79 % ( P < .0001 ) . The active range of motion also increased significantly for flexion from 101 ° to 118 ° ( P = .022 ) , for abduction from 79 ° to 105 ° ( P = .02 ) , and for external rotation from 21 ° to 43 ° ( P < .0001 ) . Radiologic evaluation revealed incomplete radiolucency in 1 patient without clinical significance or further intervention . No revision caused by loosening or countersinking of the humeral implant was observed . CONCLUSIONS The 9-year outcome after stemless shoulder replacement is comparable to that of third- and fourth-generation st and ard shoulder arthroplasty BACKGROUND The aim of this prospect i ve multicenter study was to evaluate clinical and radiologic results of a new metaphyseal anchored system . This system features a different anchor geometry that potentially leads to better bony integration and less loosening . METHODS From November 2012 until December 2015 , 148 patients ( 151 shoulders ) were treated with the Sidus Stem-Free Shoulder System at 9 centers in Europe . The main indication was primary osteoarthritis ( 80.1 % ) . This analysis only includes patients diagnosed with primary osteoarthritis ( n = 121 ) . A clinical evaluation was performed using the Constant-Murley score , Subjective Shoulder Value , American Shoulder and Elbow Surgeons St and ardized Shoulder Assessment Form , and range of motion . Radiologic assessment was based on the occurrence of radiolucent lines and signs of implant migration , osteolysis , loosening , and heterotopic ossification . RESULTS We evaluated 105 patients after a follow-up period of 2 years . There were 53 women and 52 men . The average age was 64 years . Total shoulder arthroplasty was performed in 73 cases and hemiarthroplasty in 32 . The Constant-Murley score improved from 26 points preoperatively to 70 points at 2 years ' follow-up ( P < .001 ) . The Subjective Shoulder Value increased from 34 % to 84 % ( P < .001 ) , and the American Shoulder and Elbow Surgeons St and ardized Shoulder Assessment Form increased from 34 points to 86 points ( P < .001 ) . Radiologically , neither migration nor loosening was found . However , radiolucent lines of 2 mm or greater could be detected around the glenoid in 2 cases , but none of them have had clinical relevance yet . The overall complication rate was 6.7 % , and the revision rate was 0 % . CONCLUSION Patients with the Sidus Stem-Free Shoulder System achieve good clinical and radiologic short-term results that are comparable with the results of other stem-free shoulder implants Aims The aims of this study were to investigate any possible relationship between a preoperative sensitivity to pain and the degree of pain at rest and on exertion with postoperative function in patients who underwent stemless total shoulder arthroplasty ( TSA ) . Patients and Methods In this prospect i ve study , we included 63 patients who underwent stemless TSA and were available for evaluation one year postoperatively . There were 31 women and 32 men ; their mean age was 71 years ( 53 to 89 ) . The pain threshold , which was measured using a Pain Matcher ( PM ) unit , the  degree of pain ( visual analogue scale at rest and on exertion , and function using the short version of the Disabilities of the Arm , Shoulder and H and question naire ( QuickDASH ) , were recorded preoperatively , as well as three and 12 months postoperatively . Results We found an inverse relationship between both the preoperative PM threshold and pain ( VAS ) at rest and the 12‐month postoperative QuickDASH score ( Pearson correlation coefficient ( r ) ≥ 0.4 , p < 0.05 ) . A linear regression analysis showed that the preoperative PM threshold on the affected side and preoperative pain ( VAS ) at rest were the only factors associated with the QuickDASH score at 12 months . Conclusion These findings indicate the importance of central sensitization in the restoration of function after TSA . Further studies are required to investigate whether extra analgesia and rehabilitation could influence the outcome in at risk patients BACKGROUND Anatomic total shoulder arthroplasty ( TSA ) and reverse total shoulder arthroplasty ( RTSA ) are increasingly common procedures employed to treat arthritic conditions . Although TSA is a widely accepted procedure for glenohumeral arthritis with intact rotator cuff , concerns about RTSA persist because of variable complication rates and outcomes . METHODS This is a prospect i ve , case-control study comparing outcomes and complications after TSA and RTSA . The study included 47 patients undergoing TSA for glenohumeral arthritis and 53 patients undergoing RTSA for rotator cuff tear arthropathy . Average clinical follow-up was more than 2 years in both groups . Major complications included infection , periprosthetic fracture , instability , glenoid loosening , and need for revision surgery . Patient outcome measures included the American Shoulder and Elbow Surgeons score , pain visual analog scale score , and goniometer-measured range of motion . Plain radiographs were review ed to assess for degree of glenoid lucency in TSA and scapular notching in RTSA . RESULTS At 2 years , there were no differences in rate of major complications  ( TSA , 15 % ; RTSA , 13 % ; P = .808 ) or revision surgeries  ( TSA , 11 % ; RTSA , 9 % ) . Outcomes assessed by the American Shoulder and Elbow Surgeons score and visual analog scale were also similar between the 2 groups . TSA patients had greater external rotation than RTSA patients did ( 53 ° vs 38 ° ; P = .001 ) . Otherwise , forward flexion , abduction , and internal rotation were comparable in range of motion . CONCLUSIONS TSA and RTSA  have similar complication rates , need for revision , patient-reported outcomes , and range of motion at 2 years of follow-up . The use of side-by-side cohorts in this study allows st and ardized comparison between these 2 shoulder arthroplasty procedures Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more BACKGROUND This prospect i ve longitudinal study compared clinical and radiologic outcomes of  total shoulder arthroplasty ( TSA )  using 3 different prosthetic design s , the Neer II system , the Bigliani-Flatow ( BF ) , and a stemless prosthesis , the Total Evolutive Shoulder System ( TESS ) . MATERIAL S AND METHODS Patients with advanced osteoarthritis of the glenohumeral joint who underwent TSA  were followed up for 2 years . Four patient-oriented disability outcomes were used . The clinical data collected before surgery and at follow-up assessment s during a 2-year period included active range of motion ( ROM ) in 6 directions and strength . Radiographic signs of glenoid and humeral component loosening were recorded . The incidence of humeral head subluxation was documented . RESULTS Seventy-four patients completed the study . There was a significant improvement in the 4 disability measures , ROM , and strength at 2 years in all 3 groups ( P < .0001 ) . Active external rotation at 90 ° abduction was statistically significantly lower in the Neer II group ( P = .001 ) . The incidence of lucent lines around the glenoid component was higher in the Neer II group ( P = .0002 ) . No statistically significant relationship was seen between type of prosthesis and patient satisfaction ( P > 0.05 ) . CONCLUSIONS The 3 types of TSA prostheses used in this study all provided significant improvement in pain and function and were associated with high patient satisfaction . The Neer II was associated with less active external rotation and more lucent lines BACKGROUND Stemmed humeral components have been used since the 1950s ; canal-sparing ( also known as stemless ) humeral components became commercially available in Europe in 2004 . The Simpliciti total shoulder system ( Wright Medical , formerly Tornier ) is a press-fit , porous-coated , canal-sparing humeral implant that relies on metaphyseal fixation only . This prospect i ve , single-arm , multicenter study 
    Output:
    
agent
Stemless anatomic TSA result ed in similar functional outcomes and complication rates to stemmed TSA with decreased operative time and lower blood loss .
***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 The aim of this study is to compare the functional midterm outcome of stemless shoulder prostheses with st and ard anatomical stemmed shoulder prostheses and to show that the STEMLESS results are comparable to the STEMMED with respect to active maximum range of shoulder motion ( ROM ) and Constant score ( CS ) . Methods Seventeen patients underwent total shoulder arthroplasty ( TSA ) in 25 shoulder joints .  Stemless TSA was performed in 12 shoulder joints ( group STEMLESS ) , third-generation stemmed TSA in 13 shoulder joints ( group STEMMED ) . Functional results were documented using the CS . 3D-motion- analysis using the Heidelberg upper extremity model ( HUX ) was conducted to measure active maximum ( ROM ) . Results The group STEMLESS achieved a CS of 67.9 ( SD 12.0 ) points and the group STEMMED of 70.2 ( SD 5.8 points ) without significant difference between the groups ( p = 0.925 ) . The maximum ROM of the group STEMLESS , ascertained by 3-D-motion- analysis , was in forward flexion 125.5 ° ( SD 17.2 ° ) , in extension 49.4 ° ( SD 13.8 ° ) , in abduction 126.2 ° ( SD 28.5 ° ) and in external rotation 40.3 ° ( SD 13.9 ° ) . The maximum ROM of the group STEMMED , also ascertained by 3-D-motion analysis , was in forward flexion 135.0 ° ( SD 16.8 ° ) , in extension 47.2 ° ( SD 11.5 ° ) , in abduction 136.3 ° ( SD 24.2 ° ) and in external rotation 40.1 ° ( SD 12.2 ° ) . The maximum ROM of the STEMLESS group was lower in forward flexion and abduction , higher in extension and almost identical in external rotation . But there was no significant difference ( forward flexion p = 0.174 , extension p = 0.470 , abduction p = 0.345 , external rotation p = 0.978 ) . Conclusion Both types of shoulder prostheses achieve a similar and good active ROM and similar results in CS.Trial registration DRKS00013166 , retrospectively registered , Background Stemless shoulder arthroplasty is a fairly new concept . Clinical and radiological follow-up is essential to prove implant safety and concept . This prospect i ve single-centre study was performed to evaluate the influence of radiological changes on clinical mid-term outcome following stemless humeral head replacement with hollow screw fixation . Methods Short- and mid-term radiological and clinical evaluations were performed in 73 consecutive shoulders treated mainly for idiopathic and posttraumatic osteoarthritis with stemless humeral head arthroplasty including 40 hemi- ( HSA ) and 33 total shoulder arthroplasties ( TSA ) . Operating times of stemless implantations were compared to  110 stemmed anatomical shoulder prostheses .  Appearances of humeral radiolucencies or radiological signs of osteolysis or stress shielding were assessed on st and ardized radiographs . Patients ’ clinical outcome was evaluated using the Constant score and patients ’ satisfaction was documented . Results Radiological changes , detected in 37.0 % , did not affect clinical outcome . Constant scores significantly improved from baseline to short and mid-term follow-up ( p < 0.001 ) . The majority of patients ( 96.2 % ) were satisfied with the procedure . No loosening of the humeral head component was detected during a mean follow-up of 58 months . Operating times were significantly shorter with stemless compared to stemmed implants ( p < 0.001 ) . Conclusions Clinical mid-term outcome after stemless humeral head replacement was not affected by radiological changes . Trial registration The institutional review board ( St. Vincent Hospital Vienna ; 201212_EK01 ; date of issue : 11.12.2012 ) approved the study . The trial was registered at Clinical Trials.gov ( NCT02754024 ) . Retrospective registration BACKGROUND Several stemless shoulder implants are available on the market , but only a few studies have presented results with sufficient mid- to long-term follow-up . The present study evaluated clinical and radiologic outcomes 9 years after anatomic stemless shoulder replacement . METHODS This is a prospect i ve cohort study evaluating the  stemless shoulder prosthesis since 2005 .  Anatomic stemless shoulder replacement using a single prosthesis was performed in 49 shoulders ; 17 underwent total shoulder replacement , and 32 underwent hemiarthroplasty . Forty-three patients were clinical ly and radiologically monitored after a mean of 9 years ( range , 90 - 127 months ; follow-up rate , 88 % ) . The indications for shoulder replacement were primary osteoarthritis in 7 shoulders , post-traumatic in 24 , instability in 7 , cuff tear arthropathy in 2 , postinfectious arthritis in 1 , and revision arthroplasty in 2 . RESULTS The Constant-Murley Score improved significantly from 52 % to 79 % ( P < .0001 ) . The active range of motion also increased significantly for flexion from 101 ° to 118 ° ( P = .022 ) , for abduction from 79 ° to 105 ° ( P = .02 ) , and for external rotation from 21 ° to 43 ° ( P < .0001 ) . Radiologic evaluation revealed incomplete radiolucency in 1 patient without clinical significance or further intervention . No revision caused by loosening or countersinking of the humeral implant was observed . CONCLUSIONS The 9-year outcome after stemless shoulder replacement is comparable to that of third- and fourth-generation st and ard shoulder arthroplasty BACKGROUND The aim of this prospect i ve multicenter study was to evaluate clinical and radiologic results of a new metaphyseal anchored system . This system features a different anchor geometry that potentially leads to better bony integration and less loosening . METHODS From November 2012 until December 2015 , 148 patients ( 151 shoulders ) were treated with the Sidus Stem-Free Shoulder System at 9 centers in Europe . The main indication was primary osteoarthritis ( 80.1 % ) . This analysis only includes patients diagnosed with primary osteoarthritis ( n = 121 ) . A clinical evaluation was performed using the Constant-Murley score , Subjective Shoulder Value , American Shoulder and Elbow Surgeons St and ardized Shoulder Assessment Form , and range of motion . Radiologic assessment was based on the occurrence of radiolucent lines and signs of implant migration , osteolysis , loosening , and heterotopic ossification . RESULTS We evaluated 105 patients after a follow-up period of 2 years . There were 53 women and 52 men . The average age was 64 years . Total shoulder arthroplasty was performed in 73 cases and hemiarthroplasty in 32 . The Constant-Murley score improved from 26 points preoperatively to 70 points at 2 years ' follow-up ( P < .001 ) . The Subjective Shoulder Value increased from 34 % to 84 % ( P < .001 ) , and the American Shoulder and Elbow Surgeons St and ardized Shoulder Assessment Form increased from 34 points to 86 points ( P < .001 ) . Radiologically , neither migration nor loosening was found . However , radiolucent lines of 2 mm or greater could be detected around the glenoid in 2 cases , but none of them have had clinical relevance yet . The overall complication rate was 6.7 % , and the revision rate was 0 % . CONCLUSION Patients with the Sidus Stem-Free Shoulder System achieve good clinical and radiologic short-term results that are comparable with the results of other stem-free shoulder implants Aims The aims of this study were to investigate any possible relationship between a preoperative sensitivity to pain and the degree of pain at rest and on exertion with postoperative function in patients who underwent stemless total shoulder arthroplasty ( TSA ) . Patients and Methods In this prospect i ve study , we included 63 patients who underwent stemless TSA and were available for evaluation one year postoperatively . There were 31 women and 32 men ; their mean age was 71 years ( 53 to 89 ) . The pain threshold , which was measured using a Pain Matcher ( PM ) unit , the  degree of pain ( visual analogue scale at rest and on exertion , and function using the short version of the Disabilities of the Arm , Shoulder and H and question naire ( QuickDASH ) , were recorded preoperatively , as well as three and 12 months postoperatively . Results We found an inverse relationship between both the preoperative PM threshold and pain ( VAS ) at rest and the 12‐month postoperative QuickDASH score ( Pearson correlation coefficient ( r ) ≥ 0.4 , p < 0.05 ) . A linear regression analysis showed that the preoperative PM threshold on the affected side and preoperative pain ( VAS ) at rest were the only factors associated with the QuickDASH score at 12 months . Conclusion These findings indicate the importance of central sensitization in the restoration of function after TSA . Further studies are required to investigate whether extra analgesia and rehabilitation could influence the outcome in at risk patients BACKGROUND Anatomic total shoulder arthroplasty ( TSA ) and reverse total shoulder arthroplasty ( RTSA ) are increasingly common procedures employed to treat arthritic conditions . Although TSA is a widely accepted procedure for glenohumeral arthritis with intact rotator cuff , concerns about RTSA persist because of variable complication rates and outcomes . METHODS This is a prospect i ve , case-control study comparing outcomes and complications after TSA and RTSA . The study included 47 patients undergoing TSA for glenohumeral arthritis and 53 patients undergoing RTSA for rotator cuff tear arthropathy . Average clinical follow-up was more than 2 years in both groups . Major complications included infection , periprosthetic fracture , instability , glenoid loosening , and need for revision surgery . Patient outcome measures included the American Shoulder and Elbow Surgeons score , pain visual analog scale score , and goniometer-measured range of motion . Plain radiographs were review ed to assess for degree of glenoid lucency in TSA and scapular notching in RTSA . RESULTS At 2 years , there were no differences in rate of major complications  ( TSA , 15 % ; RTSA , 13 % ; P = .808 ) or revision surgeries  ( TSA , 11 % ; RTSA , 9 % ) . Outcomes assessed by the American Shoulder and Elbow Surgeons score and visual analog scale were also similar between the 2 groups . TSA patients had greater external rotation than RTSA patients did ( 53 ° vs 38 ° ; P = .001 ) . Otherwise , forward flexion , abduction , and internal rotation were comparable in range of motion . CONCLUSIONS TSA and RTSA  have similar complication rates , need for revision , patient-reported outcomes , and range of motion at 2 years of follow-up . The use of side-by-side cohorts in this study allows st and ardized comparison between these 2 shoulder arthroplasty procedures Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more BACKGROUND This prospect i ve longitudinal study compared clinical and radiologic outcomes of  total shoulder arthroplasty ( TSA )  using 3 different prosthetic design s , the Neer II system , the Bigliani-Flatow ( BF ) , and a stemless prosthesis , the Total Evolutive Shoulder System ( TESS ) . MATERIAL S AND METHODS Patients with advanced osteoarthritis of the glenohumeral joint who underwent TSA  were followed up for 2 years . Four patient-oriented disability outcomes were used . The clinical data collected before surgery and at follow-up assessment s during a 2-year period included active range of motion ( ROM ) in 6 directions and strength . Radiographic signs of glenoid and humeral component loosening were recorded . The incidence of humeral head subluxation was documented . RESULTS Seventy-four patients completed the study . There was a significant improvement in the 4 disability measures , ROM , and strength at 2 years in all 3 groups ( P < .0001 ) . Active external rotation at 90 ° abduction was statistically significantly lower in the Neer II group ( P = .001 ) . The incidence of lucent lines around the glenoid component was higher in the Neer II group ( P = .0002 ) . No statistically significant relationship was seen between type of prosthesis and patient satisfaction ( P > 0.05 ) . CONCLUSIONS The 3 types of TSA prostheses used in this study all provided significant improvement in pain and function and were associated with high patient satisfaction . The Neer II was associated with less active external rotation and more lucent lines BACKGROUND Stemmed humeral components have been used since the 1950s ; canal-sparing ( also known as stemless ) humeral components became commercially available in Europe in 2004 . The Simpliciti total shoulder system ( Wright Medical , formerly Tornier ) is a press-fit , porous-coated , canal-sparing humeral implant that relies on metaphyseal fixation only . This prospect i ve , single-arm , multicenter study 
    Output:
    