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: Implant malposition and poor fixation are potential risks of compromising long-term results after total hip arthroplasty performed with a minimally invasive technique . Between September 2000 and February 2002 , 120 cemented primary total hip arthroplasties were performed at the authors ' institutions in patients with primary osteoarthritis of the hip and with BMI lower than 35 . In 60 of these cases selected at r and om , a posterolateral incision no longer than 10 cm was used . The other 60 THA 's were performed through a st and ard posterolateral approach . The inclination and anteversion of the cup and the position of the femoral stem were assessed on radiographs and statistically evaluated . In the miniinvasive group , the average inclination angle of the cup was 42.3 degrees ( range : 36 to 52 degrees ) and the anteversion angle 13.6 degrees ( range : 6 to 29 degrees ) . The coronal alignment of the femoral component was within 3 degrees of neutral in 54 cases ( 90.0 % ) . Following conventional implantation in the other group , the average cup inclination angle was 42.4 degrees ( range : 35 to 50 degrees ) and the anteversion angle 13.6 degrees ( range : 8 to 24 degrees . A total of 53 stems ( 88.3 % ) were implanted optimally . Statistical analysis found no significant difference between the two groups regarding components position . These findings suggest that using a smaller posterolateral incision as was done in this study does not introduce a potential risk of compromising long-term results BACKGROUND AIMS Evaluation of : 1 . early clinical and radiographic results of  total hip arthroplasty ( THA ) through a st and ard lateral direct approach , 2 . early clinical and radiographic results of THA through a minimal lateral approach , 3 . comparison of the results of THA in these two groups . MATERIAL AND METHODS 120 THAs ( 60 cementless and 60 cemented ) done in 120 patients due to degenerative changes were evaluated prospect ively . 60 THAs were done through a minimal lateral approach and constituted a study group . 60 THAs were done through a direct lateral approach and constituted a control group . The mean age of the 120 patients ( 98 women and 22 men ) was 45 y.o . ( range : 32 - 67 y.o . ) . The duration of follow-up in the study group was from 6 to 12 months ( mean : 8.5 months ) . The duration of follow-up in the control group was from 10 to 16 months ( mean : 10.5 months ) . Mean preoperative functional status of the study group was 44.5 points according to the Harris hip score . Radiographic evaluation of the results was done according to the criteria of the Joint Committee of the Hip Society , AAOS and SICOT . RESULTS 6 months after THA , clinical results were 92 pts in the study group and 88 pts in the control group . Radiographic outcomes were very good in all 120 patients from both arms : there were no differences between the control and study group . The incidence of complications was similar in both groups . CONCLUSIONS Minimally invasive THA demonstrated its value in the treatment of  degenerative changes of the hip joint  with regard to short-term outcomes . The clinical and radiographic outcomes were comparable between the st and ard and minimally invasive approaches . Success with THA using a minimally invasive approach depends on excellent operative technique and experience with st and ard hip approaches rather than on the use of special instruments In a prospect i ve and r and omised clinical study ,  acetabular cups were implanted free-h and  ( control group n=22 )  or with computer assistance using an image-free navigation system ( study group n=23 ) . The cup position was determined postoperatively on pelvic CT . An average inclination of 42.3 ° ( range : 30 ° –53 ° ; SD±7.0 ° ) and an average anteversion of 24.0 ° ( range : −3 ° to 51 ° ; SD±15.0 ° ) were found in the control group , and an average inclination of 45.0 ° ( ranage : 40 ° –50 ° ; SD±2.8 ° ) and an average anteversion of 14.4 ° ( range : 5 ° –25 ° ; SS±5.0 ° ) in the computer-assisted study group . The deviations from the desired cup position ( 45 ° inclination , 15 ° anteversion ) were significantly lower in the computer-assisted study group ( p<0.001 each ) . While only 11/22 of the cups in the control group were within the Lewinnek safe zone , 21/23 of the cups in the study group were placed in this target region (p=0.003).RésuméDans un étude clinique prospect i ve et r and omisé , les cupules acétabulaires ont été implantées de façon habituelle ( n=22 ; groupe témoin ) ou avec assistance d’un ordinateur qui utilise un système de navigation image — libre ( n=23 ; groupe d’étude ) . La place de la cupule a été déterminée après l’opération sur un scanner pelvien . Une inclinaison moyenne de 42,3 ° ( 30 ° à 53 ° ; ±7.0 ° ) et une antéversion moyenne de 24,0 ° ( −3 ° à 51 ° ; ±15.0 ° ) ont été trouvées dans le groupe témoin et une inclinaison moyenne de 45,0 ° ( 40 ° à 50 ° ; ±2.8 ° ) et une antéversion moyenne de 14,4 ° ( 5 ° à 25 ° ; ±5.0 ° ) dans le groupe de l’étude assistée par ordinateur . Les déviations par rapport à la position désirée de la cupule ( 45 ° d’inclinaison , 15 ° d’antéversion ) étaient notablement inférieures dans le groupe de l’étude assistée par ordinateur ( p<0.001 chacun ) . Alors que seulement 11 des 22 cupules du groupe témoin étaient dans la zone sûre de Lewinnek , 21 des 23 cupules du groupe d’étude ont été placées dans cette région cible ( p=0.003 ) Background The Levels of Evidence Rating System is widely believed to categorize studies by quality , with Level I studies representing the highest quality evidence . We aim ed to determine the reporting quality of R and  omised Controlled Trials ( RCTs ) published in the most frequently cited general orthopaedic journals . Methods Two assessors identified orthopaedic journals that reported a level of evidence rating in their abstract s from January 2003 to December 2004 by search ing the instructions for authors of the highest impact general orthopaedic journals . Based upon a priori eligibility criteria , two assessors h and search ed all issues of the eligible journal from 2003–2004 for RCTs . The assessors extracted the demographic information and the evidence rating from each included RCT and scored the quality of reporting using the reporting quality assessment tool , which was developed by the Cochrane Bone , Joint and Muscle Trauma Group . Scores were conducted in duplicate , and we reached a consensus for any disagreements . We examined the correlation between the level of evidence rating and the Cochrane reporting quality score . Results We found that only the Journal of Bone  and Joint  Surgery –  American Volume ( JBJS-A ) used a level of evidence rating from 2003 to 2004 . We identified 938 publications in the JBJS-A from January 2003 to December 2004 . Of these publications , 32 ( 3.4 % ) were RCTs that fit the inclusion criteria . The 32 RCTs included a total of 3543 patients , with sample sizes ranging from 17 to 514 patients . Despite being labelled as the highest level of evidence ( Level 1 and Level II evidence ) , these studies had low Cochrane reporting quality scores among individual method ological safeguards . The Cochrane reporting quality scores did not differ significantly between Level I and Level II studies . Correlations varied from 0.0 to 0.2 across the 12 items of the Cochrane reporting quality assessment tool ( p > 0.05 ) . Among items closely corresponding to the Levels of Evidence Rating System criteria assessors achieved substantial agreement ( ICC = 0.80 , 95%CI:0.60 to 0.90 ) . Conclusion Our findings suggest that readers should not assume that 1 ) studies labelled as Level I have high reporting quality and 2 ) Level I studies have better reporting quality than Level II studies . One should address method ological safeguards individually 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 incision for the duration of the hospital stay . The anesthetic , analgesic , and postoperative physiotherapy protocol s were st and ardized , with the staff also blinded to the technique used . A single surgeon , who had performed more than 300 short-incision hip replacements prior to the start of this study and who performs an average of 415 primary total hip replacements a year , performed all procedures through a single-incision posterior approach using a cementless cup and cemented stem . RESULTS The two groups were matched for age , grade according to the system of the American Society of Anesthesiologists , and body mass index . No significant difference was detected with respect to postoperative hematocrit , blood transfusion requirements , pain scores , or analgesic use . We found no difference in early walking ability or length of hospital stay and no difference in component placement , cement-mantle quality , or functional outcome scores at six weeks . The patient variables significantly associated with a probability of early discharge independent of incision length were patient age and preoperative hemoglobin levels ( p < 0.05 ) . The surgical scars contracted significantly over six weeks ( p < 0.05 ) but by a similar proportion of 11 % to 12 % in both groups . CONCLUSIONS Minimally invasive total hip arthroplasty performed through a single-incision posterior approach by a high-volume hip surgeon with extensive experience in less invasive approaches to the hip is safe and reproducible . However , it offers no significant benefit in the early postoperative period compared with a st and ard incision of 16 cm . As it is not known whether lower-volume and less-experienced surgeons can achieve similar results , the mini-incision technique merits further study before wide dissemination and implementation of this family of surgical approaches can be recommended The version of the acetabular and femoral components in 111 primary total hip arthroplasties was prospect ively evaluated intraoperatively by the surgeon and compared with postoperative computed tomography ( CT ) scan measurements . Intraoperative estimations by the surgeons for acetabular and femoral components were all within 10 degrees to 30 degrees anteversion , with means of 16.0 degrees ( SD = 4.0 degrees ) and 16.4 degrees ( SD = 3.2 degrees ) , respectively . However , CT scan acetabular measurements ranged from 12 degrees retroversion to 52 degrees anteversion ( mean = 22.0 degrees anteversion , SD = 14.0 degrees ) . Similarly , femoral component version ranged from -15 degrees retroversion to 45 degrees anteversion ( mean = 16.8 degrees anteversion , SD = 11.1 degrees ) . According to CT calculations , only 71 % of femoral and 45 % of acetabular components were within the expected clinical version range . In conclusion , the intraoperative estimation of acetabular and femoral version in a total hip arthroplasty is of limited accuracy This study examined the effect of the surgical approach used in  total hip arthroplasty ( THA )  on gait mechanics six months following surgery . Quantitative gait analysis was performed on 29 subjects : 10 anterolateral ( A-L ) and 10 posterolateral ( P-L ) THA patients and nine able-bodied , velocity-matched subjects . Discriminant function analysis was used to determine the distinction of the groups with respect to sagittal plane hip range of motion , index of symmetry , trunk inclination , pelvic drop , hip abduction , and foot progression angles . The A-L group had the largest trunk inclination ( 3.0+/-2.4 degrees ) and the smallest hip range of motion ( 34.0+/-7.4 degrees ) . Both THA groups demonstrated greater asymmetry as expressed by the smaller symmetry index ( 0.97+/-0.04 for A-L and 0.98+/-0.05 for the P-L ) than the able-bodied group ( 0.99+/-0.01 ) . The classification procedure correctly classified 89 % of the control group cases , 90 % of the A-L cases , and 50 % of the P-L cases . These results support the conclusion that six months following surgery , the gait of the majority ( 85 % ) of THA patients has not returned to normal . The A-L patients displayed distinct gait patterns , while a small percentage ( 30 % ) of the P-L patients demonstrated normal gait . While these differences are statistically significant , the clinical significance is unknown and linked to the duration that they persist Introduction Adv 
    Output:
    
agent
Strong evidence was found for a decrease in operative time and intraoperative blood loss for MIS THA , with no difference in complication rates and risk for acetabular outliers .
Strong evidence exists that there is no difference in physical functioning , measured either by question naires or by gait analysis .
Moderate evidence was found for a shorter length of hospital stay after MIS THA .
Conflicting evidence was found for a positive effect of MIS THA on pain in the early postoperative period , but that effect diminished after three months postoperatively .
Strong evidence was found for an increase in operative time for CAS THA , and limited evidence was found for a decrease in intraoperative blood loss .
Furthermore , strong evidence was found for no difference in complication rates , as well as for a significantly lower risk for acetabular outliers .
Conclusions The results indicate that MIS THA is a safe surgical procedure , without increases in operative time , blood loss , operative complication rates and component malposition rates .
However , the beneficial effect of MIS THA on functional recovery has to be proven .
The results also indicate that CAS THA , though result ing in an increase in operative time , may have a positive effect on operative blood loss and operative complication rates .
More importantly , the use of CAS results in better positioning of acetabular component of the prosthesis
***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: Implant malposition and poor fixation are potential risks of compromising long-term results after total hip arthroplasty performed with a minimally invasive technique . Between September 2000 and February 2002 , 120 cemented primary total hip arthroplasties were performed at the authors ' institutions in patients with primary osteoarthritis of the hip and with BMI lower than 35 . In 60 of these cases selected at r and om , a posterolateral incision no longer than 10 cm was used . The other 60 THA 's were performed through a st and ard posterolateral approach . The inclination and anteversion of the cup and the position of the femoral stem were assessed on radiographs and statistically evaluated . In the miniinvasive group , the average inclination angle of the cup was 42.3 degrees ( range : 36 to 52 degrees ) and the anteversion angle 13.6 degrees ( range : 6 to 29 degrees ) . The coronal alignment of the femoral component was within 3 degrees of neutral in 54 cases ( 90.0 % ) . Following conventional implantation in the other group , the average cup inclination angle was 42.4 degrees ( range : 35 to 50 degrees ) and the anteversion angle 13.6 degrees ( range : 8 to 24 degrees . A total of 53 stems ( 88.3 % ) were implanted optimally . Statistical analysis found no significant difference between the two groups regarding components position . These findings suggest that using a smaller posterolateral incision as was done in this study does not introduce a potential risk of compromising long-term results BACKGROUND AIMS Evaluation of : 1 . early clinical and radiographic results of  total hip arthroplasty ( THA ) through a st and ard lateral direct approach , 2 . early clinical and radiographic results of THA through a minimal lateral approach , 3 . comparison of the results of THA in these two groups . MATERIAL AND METHODS 120 THAs ( 60 cementless and 60 cemented ) done in 120 patients due to degenerative changes were evaluated prospect ively . 60 THAs were done through a minimal lateral approach and constituted a study group . 60 THAs were done through a direct lateral approach and constituted a control group . The mean age of the 120 patients ( 98 women and 22 men ) was 45 y.o . ( range : 32 - 67 y.o . ) . The duration of follow-up in the study group was from 6 to 12 months ( mean : 8.5 months ) . The duration of follow-up in the control group was from 10 to 16 months ( mean : 10.5 months ) . Mean preoperative functional status of the study group was 44.5 points according to the Harris hip score . Radiographic evaluation of the results was done according to the criteria of the Joint Committee of the Hip Society , AAOS and SICOT . RESULTS 6 months after THA , clinical results were 92 pts in the study group and 88 pts in the control group . Radiographic outcomes were very good in all 120 patients from both arms : there were no differences between the control and study group . The incidence of complications was similar in both groups . CONCLUSIONS Minimally invasive THA demonstrated its value in the treatment of  degenerative changes of the hip joint  with regard to short-term outcomes . The clinical and radiographic outcomes were comparable between the st and ard and minimally invasive approaches . Success with THA using a minimally invasive approach depends on excellent operative technique and experience with st and ard hip approaches rather than on the use of special instruments In a prospect i ve and r and omised clinical study ,  acetabular cups were implanted free-h and  ( control group n=22 )  or with computer assistance using an image-free navigation system ( study group n=23 ) . The cup position was determined postoperatively on pelvic CT . An average inclination of 42.3 ° ( range : 30 ° –53 ° ; SD±7.0 ° ) and an average anteversion of 24.0 ° ( range : −3 ° to 51 ° ; SD±15.0 ° ) were found in the control group , and an average inclination of 45.0 ° ( ranage : 40 ° –50 ° ; SD±2.8 ° ) and an average anteversion of 14.4 ° ( range : 5 ° –25 ° ; SS±5.0 ° ) in the computer-assisted study group . The deviations from the desired cup position ( 45 ° inclination , 15 ° anteversion ) were significantly lower in the computer-assisted study group ( p<0.001 each ) . While only 11/22 of the cups in the control group were within the Lewinnek safe zone , 21/23 of the cups in the study group were placed in this target region (p=0.003).RésuméDans un étude clinique prospect i ve et r and omisé , les cupules acétabulaires ont été implantées de façon habituelle ( n=22 ; groupe témoin ) ou avec assistance d’un ordinateur qui utilise un système de navigation image — libre ( n=23 ; groupe d’étude ) . La place de la cupule a été déterminée après l’opération sur un scanner pelvien . Une inclinaison moyenne de 42,3 ° ( 30 ° à 53 ° ; ±7.0 ° ) et une antéversion moyenne de 24,0 ° ( −3 ° à 51 ° ; ±15.0 ° ) ont été trouvées dans le groupe témoin et une inclinaison moyenne de 45,0 ° ( 40 ° à 50 ° ; ±2.8 ° ) et une antéversion moyenne de 14,4 ° ( 5 ° à 25 ° ; ±5.0 ° ) dans le groupe de l’étude assistée par ordinateur . Les déviations par rapport à la position désirée de la cupule ( 45 ° d’inclinaison , 15 ° d’antéversion ) étaient notablement inférieures dans le groupe de l’étude assistée par ordinateur ( p<0.001 chacun ) . Alors que seulement 11 des 22 cupules du groupe témoin étaient dans la zone sûre de Lewinnek , 21 des 23 cupules du groupe d’étude ont été placées dans cette région cible ( p=0.003 ) Background The Levels of Evidence Rating System is widely believed to categorize studies by quality , with Level I studies representing the highest quality evidence . We aim ed to determine the reporting quality of R and  omised Controlled Trials ( RCTs ) published in the most frequently cited general orthopaedic journals . Methods Two assessors identified orthopaedic journals that reported a level of evidence rating in their abstract s from January 2003 to December 2004 by search ing the instructions for authors of the highest impact general orthopaedic journals . Based upon a priori eligibility criteria , two assessors h and search ed all issues of the eligible journal from 2003–2004 for RCTs . The assessors extracted the demographic information and the evidence rating from each included RCT and scored the quality of reporting using the reporting quality assessment tool , which was developed by the Cochrane Bone , Joint and Muscle Trauma Group . Scores were conducted in duplicate , and we reached a consensus for any disagreements . We examined the correlation between the level of evidence rating and the Cochrane reporting quality score . Results We found that only the Journal of Bone  and Joint  Surgery –  American Volume ( JBJS-A ) used a level of evidence rating from 2003 to 2004 . We identified 938 publications in the JBJS-A from January 2003 to December 2004 . Of these publications , 32 ( 3.4 % ) were RCTs that fit the inclusion criteria . The 32 RCTs included a total of 3543 patients , with sample sizes ranging from 17 to 514 patients . Despite being labelled as the highest level of evidence ( Level 1 and Level II evidence ) , these studies had low Cochrane reporting quality scores among individual method ological safeguards . The Cochrane reporting quality scores did not differ significantly between Level I and Level II studies . Correlations varied from 0.0 to 0.2 across the 12 items of the Cochrane reporting quality assessment tool ( p > 0.05 ) . Among items closely corresponding to the Levels of Evidence Rating System criteria assessors achieved substantial agreement ( ICC = 0.80 , 95%CI:0.60 to 0.90 ) . Conclusion Our findings suggest that readers should not assume that 1 ) studies labelled as Level I have high reporting quality and 2 ) Level I studies have better reporting quality than Level II studies . One should address method ological safeguards individually 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 incision for the duration of the hospital stay . The anesthetic , analgesic , and postoperative physiotherapy protocol s were st and ardized , with the staff also blinded to the technique used . A single surgeon , who had performed more than 300 short-incision hip replacements prior to the start of this study and who performs an average of 415 primary total hip replacements a year , performed all procedures through a single-incision posterior approach using a cementless cup and cemented stem . RESULTS The two groups were matched for age , grade according to the system of the American Society of Anesthesiologists , and body mass index . No significant difference was detected with respect to postoperative hematocrit , blood transfusion requirements , pain scores , or analgesic use . We found no difference in early walking ability or length of hospital stay and no difference in component placement , cement-mantle quality , or functional outcome scores at six weeks . The patient variables significantly associated with a probability of early discharge independent of incision length were patient age and preoperative hemoglobin levels ( p < 0.05 ) . The surgical scars contracted significantly over six weeks ( p < 0.05 ) but by a similar proportion of 11 % to 12 % in both groups . CONCLUSIONS Minimally invasive total hip arthroplasty performed through a single-incision posterior approach by a high-volume hip surgeon with extensive experience in less invasive approaches to the hip is safe and reproducible . However , it offers no significant benefit in the early postoperative period compared with a st and ard incision of 16 cm . As it is not known whether lower-volume and less-experienced surgeons can achieve similar results , the mini-incision technique merits further study before wide dissemination and implementation of this family of surgical approaches can be recommended The version of the acetabular and femoral components in 111 primary total hip arthroplasties was prospect ively evaluated intraoperatively by the surgeon and compared with postoperative computed tomography ( CT ) scan measurements . Intraoperative estimations by the surgeons for acetabular and femoral components were all within 10 degrees to 30 degrees anteversion , with means of 16.0 degrees ( SD = 4.0 degrees ) and 16.4 degrees ( SD = 3.2 degrees ) , respectively . However , CT scan acetabular measurements ranged from 12 degrees retroversion to 52 degrees anteversion ( mean = 22.0 degrees anteversion , SD = 14.0 degrees ) . Similarly , femoral component version ranged from -15 degrees retroversion to 45 degrees anteversion ( mean = 16.8 degrees anteversion , SD = 11.1 degrees ) . According to CT calculations , only 71 % of femoral and 45 % of acetabular components were within the expected clinical version range . In conclusion , the intraoperative estimation of acetabular and femoral version in a total hip arthroplasty is of limited accuracy This study examined the effect of the surgical approach used in  total hip arthroplasty ( THA )  on gait mechanics six months following surgery . Quantitative gait analysis was performed on 29 subjects : 10 anterolateral ( A-L ) and 10 posterolateral ( P-L ) THA patients and nine able-bodied , velocity-matched subjects . Discriminant function analysis was used to determine the distinction of the groups with respect to sagittal plane hip range of motion , index of symmetry , trunk inclination , pelvic drop , hip abduction , and foot progression angles . The A-L group had the largest trunk inclination ( 3.0+/-2.4 degrees ) and the smallest hip range of motion ( 34.0+/-7.4 degrees ) . Both THA groups demonstrated greater asymmetry as expressed by the smaller symmetry index ( 0.97+/-0.04 for A-L and 0.98+/-0.05 for the P-L ) than the able-bodied group ( 0.99+/-0.01 ) . The classification procedure correctly classified 89 % of the control group cases , 90 % of the A-L cases , and 50 % of the P-L cases . These results support the conclusion that six months following surgery , the gait of the majority ( 85 % ) of THA patients has not returned to normal . The A-L patients displayed distinct gait patterns , while a small percentage ( 30 % ) of the P-L patients demonstrated normal gait . While these differences are statistically significant , the clinical significance is unknown and linked to the duration that they persist Introduction Adv 
    Output:
    