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: This pilot double blind r and omised controlled study aim ed to investigate whether the midvastus ( MV ) approach without patellar eversion in total knee arthroplasty ( TKA ) result ed in improved recovery of function compared to the medial parapatellar ( MP ) approach . Patients were r and omly allocated to either the MV approach or the MP approach . Achievements of inpatient mobility milestones were recorded . Knee kinematics , muscle strength , Timed Up and Go , WOMAC , and daily step count were assessed before and up to six months after surgery . Cohen 's effect size d was calculated to inform the sample size in future trials . Twenty-eight participants ( 16 males , 12 females ) participated .  Patient mobility milestones such as straight leg raise were achieved on average 1.3 days ( 95 % CI −3.4 to 0.7 , d = 0.63 ) earlier in the MV group . Knee extensor strength at 6 weeks after surgery was higher ( 95 % CI −0.38 to 0.61 , d = 0.73 ) in the MV group . No trends for differences between the groups were observed in knee kinematics , TUG , WOMAC , or step count . Our results suggest a short term advantage in the first 6 weeks after surgery of the MV approach over the MP approach , but a larger study is required to confirm these findings . This trial is registered with NCT056445 BACKGROUND It has been shown before that when compared with the medial para-patellar approach , the mid-vastus approach for TKR results in less post-operative pain for patients and more rapid recovery of straight leg raise . As far as we are aware the post-operative length of stay of the two groups of patients has not been compared . We postulated that the reduced pain and more rapid recovery of straight leg raise would translate into an earlier , safe , discharge home for the mid-vastus patients compared with those who underwent a traditional medial para-patellar approach . METHODS Twenty patients operated on by each of five established knee arthroplasty surgeons were evaluated prospect ively with regard to their pre and post-operative range of movement , time to achieve straight leg raise post-operatively and length of post-operative hospital stay . Only one of the surgeons performed the mid-vastus approach , and the measurements were recorded by physiotherapists who were blinded as to the approach used on each patient . RESULTS The results were analysed using a st and ard statistical software package , and although the mean length of stay was lower for the mid-vastus patients , the difference did not reach a level of significance ( p = 0.13 ) . The time taken to achieve straight leg raise post-operatively was significantly less in the mid-vastus group ( p<0.001 ) . CONCLUSION Although this study confirms previous findings that the mid-vastus approach reduces the time taken for patients to achieve straight leg raise , when compared with the medial para-patellar approach , on its own it does not translate into a significantly shorter length of hospital stay . In order to reduce the length of post-operative hospital stay with an accelerated rehabilitation program for TKR , a multi-disciplinary approach is required . Patient expectations , GP support , physiotherapists and nursing staff all have a role to play and the mid-vastus approach , in permitting earlier straight leg raising , significantly contributes to this BACKGROUND During total knee arthroplasty ( TKA ) , surgical exposure requires mobilization technique of the patella . With this trial , we intended to investigate the effect of patella eversion on clinical outcome measures in simultaneous bilateral TKA . METHODS We prospect ively enrolled 44 patients ( 88 knees ) from April 2008 to June 20l4.One knee was operated with patella eversion  ( group A ) and the other with patella lateral retraction  ( group B ) r and omly . Follow-up results , including the operation time , complications , and the time of achieving straight leg raise ( SLR ) and 90 ° knee flexion , were recorded . The data of range of motion ( ROM ) and Visual Analogue Scale score were collected separately at 7 days , 3 months , 6 months , and 1 year postoperatively . RESULTS The time of achieving SLR was 2.7 ± 0.8 days in group A and 2.1 ± 0.7 DAYS in group B , which were significantly different ( P = .032 ) . Significant difference was found on active and passive ROM during the follow-up times between groups A and B , except the passive ROM at 6 months postoperatively . No significant difference was found on operation time , complications , patella baja or tilt , time of achieving 90 ° knee flexion , and Visual Analogue Scale score during the follow-up times . CONCLUSIONS Patellar eversion was adverse to the early knee function recovery after TKA ; it would delay the time of achieving SLR and decrease the passive and active ROM . In addition , more carefully and scientifically design ed r and omized controlled trials are still required to further prove the cl aim Background Minimally invasive knee arthroplasty seeks to diminish the problems of traditional extensile exposures aim ing for more rapid rehabilitation of patients after surgery . Questions / purpose s To determine if the subvastus approach results in less perioperative pain and blood loss , shorter hospital stay , and improved function at both early and long-term followup . Methods One hundred patients were enrolled in a prospect i ve , r and omized trial . Fifty were operated on using a minimally invasive subvastus approach and the other 50 by a conventional , peripatellar approach .  Minimum followup was 3 years . A repeated- measures analysis of variance was used to compare the Knee Society score and range of motion during followup . Results The minimally invasive approach result ed in greater perioperative bleeding but no increase in transfusions . No differences were found in postoperative pain between groups nor did hospital stay show any differences . The range of motion on the third day after surgery was greater in the minimally invasive group . No differences were found in surgical time , femoral or tibial component orientation or outliers , or complication rates . Both Knee Society score and range of motion were superior using the minimally invasive subvastus approach during followup out to 36 months . Conclusions The minimally invasive subvastus approach can result in improved long-term Knee Society scores and range of motion of total knee arthroplasty without increased risk of component malalignment , surgical time , or complication rate . Level of Evidence Level I , therapeutic study . See Guidelines for Authors for a complete description of levels of evidence The purpose of this prospect i ve study was to analyze the biochemical markers of muscle damage and inflammation in patients treated with the mini-midvastus approach or the medial parapatellar approach for total knee arthroplasty . Of 60 patients who underwent unilateral total knee arthroplasty , 30 were treated with the mini-midvastus approach ( MMV group ) and 30 were treated with the  medial parapatellar approach ( MPP group ) . Serum creatine kinase , myoglobin , lactate dehydrogenase , glutamic oxaloacetic transaminase , C-reactive protein , interleukin-6 , and interleukin-1β levels were measured preoperatively , immediately postoperatively ( except for C-reactive protein level ) , and on postoperative days 1 , 2 , and 3 . Student 's t test , Pearson 's chi-square test , and Fisher 's exact test were used to compare the outcomes between the 2 groups . Compared with the MPP group , a significant increase in serum creatine kinase level existed in the MMV group on postoperative days 2 ( P=.08 ) and 3 ( P=.09 ) and cumulatively ( P=.02 ) . However , significantly elevated C-reactive protein and interleukin-6 levels existed in the MPP group . According to the serum creatine kinase levels , the mini-midvastus approach has no superiority over the medial parapatellar approach in terms of sparing muscle and may cause more muscle damage . Further study is warranted to determine the correlation between biochemical markers and functional deficits A prospect i ve r and omized study was performed on 20 patients undergoing one-stage bilateral knee arthroplasty . One knee was exposed using a st and ard median parapatellar arthrotomy and the other knee with a subvastus arthrotomy . All patients underwent quantitative strength testing before surgery and at 1 week , 1 month , and 3 months after surgery . The knees were also evaluated for range of motion , and patients , who were blinded as to the approach used , completed question naires at each evaluation period as to their preference , if any , regarding knee pain and level of function . There was no difference in the range of motion between knees exposed with the paramedian or subvastus arthrotomy at any time period . The subvastus knees demonstrated significantly greater strength at the 1-week and 1-month intervals , but there was no strength difference at the 3-month interval . There were more lateral releases performed in the paramedium knees , and three minor complications were related to the subvastus approach . Patients who expressed a preference chose the subvastus knee 4:1 over the paramedian knee . The subvastus approach offers a reasonable alternative to the paramedian arthrotomy and preserves greater quadriceps strength in the early postoperative period Purpose Whether minimally invasive total knee arthroplasty ( MIS-TKA ) could offer better and faster recovery without the deviation of post-operative prosthesis position and limb alignment is still controversial . This prospect i ve and r and omized study was conducted to compare the clinical and radiological outcomes between patients who underwent the mini-subvastus approach of MIS-TKA and those who underwent the medial parapatellar approach of traditional TKA .  Methods Fifty patients , including 50 knees , who required TKA due to osteoarthritis were r and omized to the mini-subvastus group ( group I ) or the medial parapatellar group ( group II ) . All patients accepted the same method of anaesthesia , equal support therapy and identical rehabilitation exercise after surgery . The evaluation system included operation time , tourniquet time , blood loss , skin incision length in flexion , straight leg raising time , the time of lower limb muscle strength up to grade 4 , the time of walking with aid or without aid , the time of walking up and down the stairs , the active flexion angle , range of movement ( ROM ) , the Knee Society Scores ( KSS ) , visual analogue score for pain ( VAS ) , hospital stays and radiographic outcomes . Results The mini-subvastus approach offered smaller skin incision length in flexion , but at the cost of operation time ( P < 0.001 ) . No significant difference was found in tourniquet time and blood loss . The patients in group I could achieve straight leg raising , the lower limb muscle strength up to grade 4 , walking with or without aid , and walking up and down the stairs earlier ( P < 0.001 ) . The active flexion angle , ROM , VAS and KSS in group I were superior to those in group II until six months post-operatively ( P < 0.001 ) , but the differences was not apparent at 12 months post-operatively . More importantly , there was no significant difference between the two groups on radiological outcomes ( P > 0.05 ) . Conclusions The mini-subvastus approach could offer faster recovery , less pain and shorter hospital stays without compromising the principles of proper prosthesis position and limb alignment compared with the medial parapatellar approach & NA ; The purpose of this r and omized study was to compare clinical and surgical outcomes of total knee replacements ( TKRs ) in the early postoperative period using midvastus approach versus medial parapatellar approach in Asian population in a double blind manner . Forty‐two knees each were operated using midvastus approach and the medial parapatellar approach .  Clinical parameters that were evaluated included Knee Society score ( KSS ) ; knee pain using visual analogue scale ( VAS ) on day 1 , 1 week , and 1 month ; time required to straight leg raise ( SLR ) ; patellar tracking ; mean extensor lag at 1 week and 1 month ; and time of discharge from the hospital . Surgical parameters that were evaluated included tourniquet time , incidence of lateral retinacular release , estimated blood loss , and any complications during the surgery . KSS at 1 week and 1 month postoperatively were significantly higher in the midvastus group as compared with medial parapatellar group ; though similar at 3 months , 6 months , and 1 year . The patients in midvastus group required fewer number of lateral retinacular releases ; achieved SLR earlier ; had less mean extensor lag at 1 week ; had less mean VAS score at day 1 , 1 week , and 1 month ; and had shorter hospital stay . There was no significant difference in the mean tourniquet time and estimated blood loss . One patient had patellar maltracking in the medial parapatellar group as compared with none in midvastus group . Midvastus approach to TKR results in quicker functional recovery with early discharge and rehabilitation in the Asian population as compared with medial parapatellar approach Abstract Simultaneous bilateral TKAs subject patients to more arduous and painful functional recovery and increased risk of hemodynamic complications than staged bilateral TKAs . Minimally invasive TKA ( MIS-TKA ) reportedly results in more rapid return of function by limiting the amount of soft tissue disruption . We asked whether bilateral MIS-TKA had advantages over conventional TKA with respect to faster functional recovery . We prospect ively r and omized 30 patients into an MIS group ( mini-medial parapatellar approach , 15 patients ) and a conventional group ( conventional medial parapatellar approach , 15 patients ) . We recorded range of motion and the time required to regain the ability to walk without assistance . Functional recovery in the MIS group was faster in rehabilitation milestones of walking without assistance and gain in range of 
    Output:
    
agent
The MSV approach ranked better concerning clinical scores ( the lowest visual analogic scale , the higher KSS and KSFS ) and functional outcomes ( the shortest straight leg raise , the greatest degree of flexion and range of motion ) .
Concerning perioperative data , the MSV evidence d the shortest hospital stay , while the MPP the shortest surgical duration and lowest estimated blood loss .
According to the main findings of the present study , the mini-subvastus approach for total knee arthroplasty demonstrated superior overall compared to the other approaches .
***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: This pilot double blind r and omised controlled study aim ed to investigate whether the midvastus ( MV ) approach without patellar eversion in total knee arthroplasty ( TKA ) result ed in improved recovery of function compared to the medial parapatellar ( MP ) approach . Patients were r and omly allocated to either the MV approach or the MP approach . Achievements of inpatient mobility milestones were recorded . Knee kinematics , muscle strength , Timed Up and Go , WOMAC , and daily step count were assessed before and up to six months after surgery . Cohen 's effect size d was calculated to inform the sample size in future trials . Twenty-eight participants ( 16 males , 12 females ) participated .  Patient mobility milestones such as straight leg raise were achieved on average 1.3 days ( 95 % CI −3.4 to 0.7 , d = 0.63 ) earlier in the MV group . Knee extensor strength at 6 weeks after surgery was higher ( 95 % CI −0.38 to 0.61 , d = 0.73 ) in the MV group . No trends for differences between the groups were observed in knee kinematics , TUG , WOMAC , or step count . Our results suggest a short term advantage in the first 6 weeks after surgery of the MV approach over the MP approach , but a larger study is required to confirm these findings . This trial is registered with NCT056445 BACKGROUND It has been shown before that when compared with the medial para-patellar approach , the mid-vastus approach for TKR results in less post-operative pain for patients and more rapid recovery of straight leg raise . As far as we are aware the post-operative length of stay of the two groups of patients has not been compared . We postulated that the reduced pain and more rapid recovery of straight leg raise would translate into an earlier , safe , discharge home for the mid-vastus patients compared with those who underwent a traditional medial para-patellar approach . METHODS Twenty patients operated on by each of five established knee arthroplasty surgeons were evaluated prospect ively with regard to their pre and post-operative range of movement , time to achieve straight leg raise post-operatively and length of post-operative hospital stay . Only one of the surgeons performed the mid-vastus approach , and the measurements were recorded by physiotherapists who were blinded as to the approach used on each patient . RESULTS The results were analysed using a st and ard statistical software package , and although the mean length of stay was lower for the mid-vastus patients , the difference did not reach a level of significance ( p = 0.13 ) . The time taken to achieve straight leg raise post-operatively was significantly less in the mid-vastus group ( p<0.001 ) . CONCLUSION Although this study confirms previous findings that the mid-vastus approach reduces the time taken for patients to achieve straight leg raise , when compared with the medial para-patellar approach , on its own it does not translate into a significantly shorter length of hospital stay . In order to reduce the length of post-operative hospital stay with an accelerated rehabilitation program for TKR , a multi-disciplinary approach is required . Patient expectations , GP support , physiotherapists and nursing staff all have a role to play and the mid-vastus approach , in permitting earlier straight leg raising , significantly contributes to this BACKGROUND During total knee arthroplasty ( TKA ) , surgical exposure requires mobilization technique of the patella . With this trial , we intended to investigate the effect of patella eversion on clinical outcome measures in simultaneous bilateral TKA . METHODS We prospect ively enrolled 44 patients ( 88 knees ) from April 2008 to June 20l4.One knee was operated with patella eversion  ( group A ) and the other with patella lateral retraction  ( group B ) r and omly . Follow-up results , including the operation time , complications , and the time of achieving straight leg raise ( SLR ) and 90 ° knee flexion , were recorded . The data of range of motion ( ROM ) and Visual Analogue Scale score were collected separately at 7 days , 3 months , 6 months , and 1 year postoperatively . RESULTS The time of achieving SLR was 2.7 ± 0.8 days in group A and 2.1 ± 0.7 DAYS in group B , which were significantly different ( P = .032 ) . Significant difference was found on active and passive ROM during the follow-up times between groups A and B , except the passive ROM at 6 months postoperatively . No significant difference was found on operation time , complications , patella baja or tilt , time of achieving 90 ° knee flexion , and Visual Analogue Scale score during the follow-up times . CONCLUSIONS Patellar eversion was adverse to the early knee function recovery after TKA ; it would delay the time of achieving SLR and decrease the passive and active ROM . In addition , more carefully and scientifically design ed r and omized controlled trials are still required to further prove the cl aim Background Minimally invasive knee arthroplasty seeks to diminish the problems of traditional extensile exposures aim ing for more rapid rehabilitation of patients after surgery . Questions / purpose s To determine if the subvastus approach results in less perioperative pain and blood loss , shorter hospital stay , and improved function at both early and long-term followup . Methods One hundred patients were enrolled in a prospect i ve , r and omized trial . Fifty were operated on using a minimally invasive subvastus approach and the other 50 by a conventional , peripatellar approach .  Minimum followup was 3 years . A repeated- measures analysis of variance was used to compare the Knee Society score and range of motion during followup . Results The minimally invasive approach result ed in greater perioperative bleeding but no increase in transfusions . No differences were found in postoperative pain between groups nor did hospital stay show any differences . The range of motion on the third day after surgery was greater in the minimally invasive group . No differences were found in surgical time , femoral or tibial component orientation or outliers , or complication rates . Both Knee Society score and range of motion were superior using the minimally invasive subvastus approach during followup out to 36 months . Conclusions The minimally invasive subvastus approach can result in improved long-term Knee Society scores and range of motion of total knee arthroplasty without increased risk of component malalignment , surgical time , or complication rate . Level of Evidence Level I , therapeutic study . See Guidelines for Authors for a complete description of levels of evidence The purpose of this prospect i ve study was to analyze the biochemical markers of muscle damage and inflammation in patients treated with the mini-midvastus approach or the medial parapatellar approach for total knee arthroplasty . Of 60 patients who underwent unilateral total knee arthroplasty , 30 were treated with the mini-midvastus approach ( MMV group ) and 30 were treated with the  medial parapatellar approach ( MPP group ) . Serum creatine kinase , myoglobin , lactate dehydrogenase , glutamic oxaloacetic transaminase , C-reactive protein , interleukin-6 , and interleukin-1β levels were measured preoperatively , immediately postoperatively ( except for C-reactive protein level ) , and on postoperative days 1 , 2 , and 3 . Student 's t test , Pearson 's chi-square test , and Fisher 's exact test were used to compare the outcomes between the 2 groups . Compared with the MPP group , a significant increase in serum creatine kinase level existed in the MMV group on postoperative days 2 ( P=.08 ) and 3 ( P=.09 ) and cumulatively ( P=.02 ) . However , significantly elevated C-reactive protein and interleukin-6 levels existed in the MPP group . According to the serum creatine kinase levels , the mini-midvastus approach has no superiority over the medial parapatellar approach in terms of sparing muscle and may cause more muscle damage . Further study is warranted to determine the correlation between biochemical markers and functional deficits A prospect i ve r and omized study was performed on 20 patients undergoing one-stage bilateral knee arthroplasty . One knee was exposed using a st and ard median parapatellar arthrotomy and the other knee with a subvastus arthrotomy . All patients underwent quantitative strength testing before surgery and at 1 week , 1 month , and 3 months after surgery . The knees were also evaluated for range of motion , and patients , who were blinded as to the approach used , completed question naires at each evaluation period as to their preference , if any , regarding knee pain and level of function . There was no difference in the range of motion between knees exposed with the paramedian or subvastus arthrotomy at any time period . The subvastus knees demonstrated significantly greater strength at the 1-week and 1-month intervals , but there was no strength difference at the 3-month interval . There were more lateral releases performed in the paramedium knees , and three minor complications were related to the subvastus approach . Patients who expressed a preference chose the subvastus knee 4:1 over the paramedian knee . The subvastus approach offers a reasonable alternative to the paramedian arthrotomy and preserves greater quadriceps strength in the early postoperative period Purpose Whether minimally invasive total knee arthroplasty ( MIS-TKA ) could offer better and faster recovery without the deviation of post-operative prosthesis position and limb alignment is still controversial . This prospect i ve and r and omized study was conducted to compare the clinical and radiological outcomes between patients who underwent the mini-subvastus approach of MIS-TKA and those who underwent the medial parapatellar approach of traditional TKA .  Methods Fifty patients , including 50 knees , who required TKA due to osteoarthritis were r and omized to the mini-subvastus group ( group I ) or the medial parapatellar group ( group II ) . All patients accepted the same method of anaesthesia , equal support therapy and identical rehabilitation exercise after surgery . The evaluation system included operation time , tourniquet time , blood loss , skin incision length in flexion , straight leg raising time , the time of lower limb muscle strength up to grade 4 , the time of walking with aid or without aid , the time of walking up and down the stairs , the active flexion angle , range of movement ( ROM ) , the Knee Society Scores ( KSS ) , visual analogue score for pain ( VAS ) , hospital stays and radiographic outcomes . Results The mini-subvastus approach offered smaller skin incision length in flexion , but at the cost of operation time ( P < 0.001 ) . No significant difference was found in tourniquet time and blood loss . The patients in group I could achieve straight leg raising , the lower limb muscle strength up to grade 4 , walking with or without aid , and walking up and down the stairs earlier ( P < 0.001 ) . The active flexion angle , ROM , VAS and KSS in group I were superior to those in group II until six months post-operatively ( P < 0.001 ) , but the differences was not apparent at 12 months post-operatively . More importantly , there was no significant difference between the two groups on radiological outcomes ( P > 0.05 ) . Conclusions The mini-subvastus approach could offer faster recovery , less pain and shorter hospital stays without compromising the principles of proper prosthesis position and limb alignment compared with the medial parapatellar approach & NA ; The purpose of this r and omized study was to compare clinical and surgical outcomes of total knee replacements ( TKRs ) in the early postoperative period using midvastus approach versus medial parapatellar approach in Asian population in a double blind manner . Forty‐two knees each were operated using midvastus approach and the medial parapatellar approach .  Clinical parameters that were evaluated included Knee Society score ( KSS ) ; knee pain using visual analogue scale ( VAS ) on day 1 , 1 week , and 1 month ; time required to straight leg raise ( SLR ) ; patellar tracking ; mean extensor lag at 1 week and 1 month ; and time of discharge from the hospital . Surgical parameters that were evaluated included tourniquet time , incidence of lateral retinacular release , estimated blood loss , and any complications during the surgery . KSS at 1 week and 1 month postoperatively were significantly higher in the midvastus group as compared with medial parapatellar group ; though similar at 3 months , 6 months , and 1 year . The patients in midvastus group required fewer number of lateral retinacular releases ; achieved SLR earlier ; had less mean extensor lag at 1 week ; had less mean VAS score at day 1 , 1 week , and 1 month ; and had shorter hospital stay . There was no significant difference in the mean tourniquet time and estimated blood loss . One patient had patellar maltracking in the medial parapatellar group as compared with none in midvastus group . Midvastus approach to TKR results in quicker functional recovery with early discharge and rehabilitation in the Asian population as compared with medial parapatellar approach Abstract Simultaneous bilateral TKAs subject patients to more arduous and painful functional recovery and increased risk of hemodynamic complications than staged bilateral TKAs . Minimally invasive TKA ( MIS-TKA ) reportedly results in more rapid return of function by limiting the amount of soft tissue disruption . We asked whether bilateral MIS-TKA had advantages over conventional TKA with respect to faster functional recovery . We prospect ively r and omized 30 patients into an MIS group ( mini-medial parapatellar approach , 15 patients ) and a conventional group ( conventional medial parapatellar approach , 15 patients ) . We recorded range of motion and the time required to regain the ability to walk without assistance . Functional recovery in the MIS group was faster in rehabilitation milestones of walking without assistance and gain in range of 
    Output:
    