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Analysis of correlation between medial joint line change and lower limb coronal alignment after Oxford unicompartmental knee arthroplasty
Kung-Tseng Hunga,b, Kuo-Yao Hsua,b, Chieh-Ming Chenga,b, Yi-Jou Chena,b, Chih-Hao Chiua,b, Yi-Shen Chanb,c, Alvin Chao-Yu Chena,b, Cheng Pang Yanga,b,
Corresponding author
ronnie80097@gmail.com

Corresponding author.
a Department of Orthopaedic Surgery, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan (ROC)
b Bone and Joint Research Center, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan (ROC)
c Department of Orthopedic Surgery, Keelung Chang Gung Memorial Hospital, Keelung City, Taiwan
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0005">Introduction</span><p id="para0004" class="elsevierStylePara elsevierViewall">Unicompartmental Knee Arthroplasty &#40;UKA&#41; serves as a viable solution for isolated compartmental knee osteoarthritis&#46; UKA is characterized by the preservation of bone and ligaments&#44; faster recovery&#44; improved function&#44; and reduced invasiveness &#91;<a class="elsevierStyleCrossRef" href="#bib0001">1</a>&#44;<a class="elsevierStyleCrossRef" href="#bib0002">2</a>&#93;&#46; The current phase 3 Oxford medial Unicompartmental Knee Arthroplasty &#40;OUKA&#41; has demonstrated positive survivorship&#44; with a 94&#37; success rate at 10 years across various populations &#91;<a class="elsevierStyleCrossRefs" href="#bib0001">1-3</a>&#93;&#46; In the realm of UKA&#44; the most common failure modes include aseptic loosening&#44; osteoarthritis progression in the contralateral compartment&#44; and bearing dislocation in mobile-bearing systems &#91;<a class="elsevierStyleCrossRefs" href="#bib0001">1-4</a>&#93;&#46;</p><p id="para0005" class="elsevierStylePara elsevierViewall">Valgus malalignment&#44; which places excessive load on the lateral compartment&#44; has been identified as a risk factor for lateral cartilage damage and the progression of knee osteoarthritis &#91;<a class="elsevierStyleCrossRef" href="#bib0005">5</a>&#93;&#46; The coronal alignment of the lower limb&#44; particularly the hip-knee-ankle angle&#44; has been reported as a more critical determinant of UKA outcomes than tibial component alignment &#91;<a class="elsevierStyleCrossRef" href="#bib0006">6</a>&#93;&#46; In fact&#44; postoperative minor to moderate varus alignment has been associated with positive long-term outcomes&#44; in contrast to severe undercorrection or overcorrection &#91;<a class="elsevierStyleCrossRef" href="#bib0007">7</a>&#44;<a class="elsevierStyleCrossRef" href="#bib0008">8</a>&#93;&#46; Furthermore&#44; it has been reported that the degree of tibiofemoral angle correction positively correlates with the thickness of the tibial implant in fixed-bearing UKA systems &#91;<a class="elsevierStyleCrossRef" href="#bib0009">9</a>&#93;&#46; Postoperative limb alignment in OUKA has also been found to correlate more with the thickness of the insert rather than the alignments of the femoral and tibial components &#91;<a class="elsevierStyleCrossRef" href="#bib0010">10</a>&#93;&#46;</p><p id="para0006" class="elsevierStylePara elsevierViewall">On another note&#44; variations in implant size and the thickness of intraoperative bony resection could lead to changes in the medial joint line&#44; potentially affecting limb alignment &#91;<a class="elsevierStyleCrossRef" href="#bib0009">9</a>&#44;<a class="elsevierStyleCrossRef" href="#bib0011">11</a>&#44;<a class="elsevierStyleCrossRef" href="#bib0012">12</a>&#93;&#46; To our knowledge&#44; no study has yet evaluated the relationship between changes in the medial joint line and limb alignment in mobile-bearing UKA&#46; This study hypothesized that joint line changes induced by OUKA correlate with limb coronal alignment and may be associated with the development of valgus deformity&#46;</p></span><span id="sec0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0006">Materials and methods</span><span id="sec0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0007">Patient characteristics</span><p id="para0007" class="elsevierStylePara elsevierViewall">This study was approved by the local medical foundation institutional review board with IRB Approval n&#176; 202001568B0C101&#46; Between February 2019 and January 2021&#44; a consecutive series of 103 Oxford UKAs performed by a single senior surgeon was retrospectively reviewed&#46;</p><p id="para0008" class="elsevierStylePara elsevierViewall">UKA was indicated for patients with radiographic evidence of Anteromedial Osteoarthritis &#40;AMOA&#41;&#44; functionally intact cruciate and collateral ligaments&#44; passively correctable varus deformity of less than 15&#176;&#44; flexion contracture of less than 15&#176;&#44; a range of motion exceeding 90&#176;&#44; and an asymptomatic patellofemoral joint&#46; Patients with inflammatory arthritis were contraindicated&#46; For comprehensive knee assessment and preoperative surgical planning&#44; each patient underwent Magnetic Resonance Imaging &#40;MRI&#41; to evaluate cartilage loss&#44; anterior cruciate ligament condition&#44; and meniscal lesions&#46; Functional outcomes were assessed postoperatively at two years using the Lysholm score&#44; Oxford Knee Score&#44; and Western Ontario and McMaster University Arthritis &#40;WOMAC&#41; index&#46; The endpoint was set for July 2023&#46;</p></span><span id="sec0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0008">Surgical procedure</span><p id="para0009" class="elsevierStylePara elsevierViewall">All surgeries were conducted under general anesthesia using the minimally invasive technique with the mobile-bearing medial Oxford UKA &#40;Zimmer Biomet&#44; Warsaw&#44; IN&#44; USA&#41;&#46; Both femoral and tibial components were cemented in each case&#46; The intraoperative tibial resection thickness was measured with a caliper during the operation and recorded in the operative record&#46; Specifically&#44; the anteromedial part of the resected tibia was measured&#44; as this area typically exhibits full-thickness cartilage wear in AMOA&#46; The actual tibial resection thickness was determined by adding 0&#46;89 mm to the recorded thickness to account for the saw blade thickness&#46;</p></span><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0009">Radiographic evaluation</span><p id="para0010" class="elsevierStylePara elsevierViewall">Plain films included lower extremity split scanography&#44; knee anteroposterior&#44; lateral&#44; and Merchant radiographs&#46; Preoperatively&#44; a valgus stress view was routinely used to assess deformity correctability and Medial Collateral Ligament &#40;MCL&#41; tension &#91;<a class="elsevierStyleCrossRef" href="#bib0013">13</a>&#44;<a class="elsevierStyleCrossRef" href="#bib0014">14</a>&#93;&#46; For lower limb coronal alignment&#44; the following indices were measured&#58; 1&#41; Hip Knee Ankle Angle &#40;HKAA&#41;&#44; 2&#41; Mechanical Lateral Distal Femoral Angle &#40;LDFA&#41;&#44; 3&#41; Mechanical medial Proximal Tibial Angle &#40;MPTA&#41;&#46; HKAA was measured by the angle between the mechanical axes of the femur and tibia&#44; with valgus deformity defined as HKAA &#62; 180&#176;&#46; LDFA was determined by the lateral angle between the distal femoral joint line and the mechanical axis of the femur&#44; while MPTA was defined as the medial angle between the tibial joint line and the mechanical axis of the tibia&#46; Postoperatively&#44; the tibial joint line was measured as a line parallel to the tibial tray &#40;<a class="elsevierStyleCrossRefs" href="#fig0001">Figs&#46; 1 and 2</a>&#41;&#46; Coronal alignment change was calculated by subtracting the preoperative value from the postoperative value &#91;<a class="elsevierStyleCrossRefs" href="#bib0015">15-17</a>&#93;&#46;</p><elsevierMultimedia ident="fig0001"></elsevierMultimedia><elsevierMultimedia ident="fig0002"></elsevierMultimedia></span><span id="sec0006" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0010">Joint line assessment</span><p id="para0011" class="elsevierStylePara elsevierViewall">Medial Tibial Joint Line Change &#40;MTJLC&#41; was defined as the tibial implant thickness &#40;comprising the tibial tray and insert&#41; minus the actual tibial resection thickness&#46; All tibial trays had a uniform thickness of 2&#46;95 mm&#44; and all inserts had an additional thickness of 0&#46;5 mm&#44; according to the manufacturer&#39;s specifications&#46; A positive MTJLC value indicated joint line elevation or proximalization&#46; Medial Femoral Joint Line Change &#40;MFJLC&#41; was defined as the distal femoral implant thickness minus the final spigot number&#46; A positive MFJLC value indicated joint line distalization&#44; while a negative value indicated joint line proximalization or reduction &#91;<a class="elsevierStyleCrossRef" href="#bib0012">12</a>&#44;<a class="elsevierStyleCrossRef" href="#bib0018">18</a>&#93;&#46;</p><p id="para0012" class="elsevierStylePara elsevierViewall">The lateral tibial and femoral cartilage thickness was measured on the preoperative MRI at the T2 coronal slice where intact full-thickness cartilage could be identified &#40;<a class="elsevierStyleCrossRef" href="#fig0003">Fig&#46; 3</a>&#41;&#46; The authors also calculated the simulated joint line&#44; taking cartilage thickness into account&#44; to represent the healthy condition of the operated knee&#46; The simulated Medial Tibial Joint Line Change &#40;sMTJLC&#41; was defined as MTJLC minus the simulated medial tibial cartilage thickness&#44; which was calculated as the preoperative lateral tibial thickness divided by 1&#46;37&#44; following the study by Eckstein F et al&#46; &#91;<a class="elsevierStyleCrossRef" href="#bib0019">19</a>&#93; The simulated Medial Femoral Joint Line Change &#40;sMFJLC&#41; was defined as MFJLC minus the preoperative lateral femoral cartilage thickness since no significant difference between medial and lateral femoral cartilage thicknesses was found in previous studies &#91;<a class="elsevierStyleCrossRef" href="#bib0019">19</a>&#44;<a class="elsevierStyleCrossRef" href="#bib0020">20</a>&#93;&#46;</p><elsevierMultimedia ident="fig0003"></elsevierMultimedia></span><span id="sec0007" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0011">Statistical analysis</span><p id="para0013" class="elsevierStylePara elsevierViewall">Data were reported as means &#177; Standard Deviations &#40;SDs&#41;&#46; The Shapiro-Wilk test was used to assess data normality &#91;<a class="elsevierStyleCrossRef" href="#bib0021">21</a>&#93;&#46; Pearson&#39;s correlation coefficient &#40;<span class="elsevierStyleItalic">r</span>&#41; was applied for normally distributed data&#44; while Spearman&#39;s rank correlation was used for nonparametric data&#46; A threshold of &#945; &#61; 0&#46;05 was set for statistical significance&#46; Data analysis was conducted using SPSS 20 &#40;IBM Corp&#46;&#44; Armonk&#44; NY&#44; USA&#41;&#46;</p></span></span><span id="sec0008" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0012">Results</span><span id="sec0009" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0013">Patient characteristics</span><p id="para0014" class="elsevierStylePara elsevierViewall">A total of 90 knees from 81 patients with complete data were eligible for analysis&#46; The average follow-up duration was 3&#46;3 years &#40;range&#58; 2&#46;5 to 4&#46;4 years&#41;&#46; The average age of the patients was 68&#46;8&#177;7&#46;56 years &#40;range&#58; 50 to 85 years&#41;&#46; One patient experienced bearing dislocation at two years&#44; which necessitated conversion to total knee arthroplasty&#46; Demographic details are presented in <a class="elsevierStyleCrossRef" href="#tbl0001">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0001"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0014">Radiographic evaluation</span><p id="para0015" class="elsevierStylePara elsevierViewall">The HKAA changed from a preoperative average of 171&#46;6&#176;&#177;3&#46;96&#176; to 176&#46;4&#176;&#177;3&#46;84&#176; postoperatively&#46; The average preoperative and postoperative MPTAs were 85&#46;6&#176;&#177;2&#46;80&#176; and 86&#46;6&#176; &#177; 2&#46;98&#176;&#44; respectively&#46; The LDFA changed from 89&#46;0&#176; &#177; 2&#46;50&#176; preoperatively to 86&#46;7&#176; &#177; 3&#46;03&#176; postoperatively &#40;<a class="elsevierStyleCrossRef" href="#tbl0001">Table 1</a>&#41;&#46; All patients showed significant changes in HKAA&#44; LDFA&#44; and MPTA &#40;p &#60; 0&#46;05&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0002">Table 2</a>&#41;&#46; Twelve patients had a postoperative HKAA greater than 180&#176;&#44; but no early failures were recorded&#46;</p><elsevierMultimedia ident="tbl0002"></elsevierMultimedia></span><span id="sec0011" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0015">Joint line assessment</span><p id="para0016" class="elsevierStylePara elsevierViewall">The mean medial tibial joint line elevation was 2&#46;3 &#177; 0&#46;68 mm&#44; and the mean medial femoral joint line proximalization was 0&#46;8 &#177; 1&#46;38 mm&#46; The simulated tibial joint line elevation was 0&#46;9 &#177; 0&#46;72 mm&#44; and the simulated femoral joint line reduction was 2&#46;6 &#177; 1&#46;44 mm &#40;<a class="elsevierStyleCrossRef" href="#tbl0001">Table 1</a>&#41;&#46;</p><p id="para0017" class="elsevierStylePara elsevierViewall">In terms of correlation with postoperative HKAA&#44; preoperative HKAA showed a strong correlation &#40;<span class="elsevierStyleItalic">r</span> &#61; 0&#46;777&#44; p &#60; 0&#46;001&#41;&#46; Preoperative LDFA had moderate negative correlations with postoperative HKAA &#40;<span class="elsevierStyleItalic">r</span> &#61; -0&#46;549&#44; p &#60; 0&#46;001&#41;&#46; Preoperative MPTA demonstrated positive correlations with postoperative HKAA &#40;<span class="elsevierStyleItalic">r</span> &#61; 0&#46;637&#44; p &#60; 0&#46;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0003">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0003"></elsevierMultimedia><p id="para0018" class="elsevierStylePara elsevierViewall">Regarding the correlation with HKAA change &#40;<a class="elsevierStyleCrossRef" href="#tbl0004">Table 4</a>&#41;&#44; spigot size&#44; medial femoral joint line change&#44; postoperative LDFA&#44; and LDFA change were statistically significant factors &#40;<span class="elsevierStyleItalic">r</span> &#61; -0&#46;272&#44; p &#61; 0&#46;009&#59; <span class="elsevierStyleItalic">r</span> &#61; 0&#46;300&#44; p &#61; 0&#46;004&#59; <span class="elsevierStyleItalic">r</span> &#61; -0&#46;251&#44; p &#61; 0&#46;017&#59; <span class="elsevierStyleItalic">r</span> &#61; -0&#46;252&#44; p &#61; 0&#46;016&#44; respectively&#41;&#46;</p><elsevierMultimedia ident="tbl0004"></elsevierMultimedia></span></span><span id="sec0012" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0016">Discussion</span><p id="para0019" class="elsevierStylePara elsevierViewall">In this study&#44; changes in the medial tibial and femoral joint lines&#44; implant size&#44; and tibial resection thickness were not significant factors for the postoperative Hip Knee Ankle Angle &#40;HKAA&#41;&#46; However&#44; both preoperative mechanical Lateral Distal Femoral Angle &#40;LDFA&#41; and Mechanical Medial Proximal Tibial Angle &#40;MPTA&#41; correlated with postoperative HKAA&#46; Additionally&#44; spigot size&#44; medial femoral joint line change&#44; and LDFA change were identified as factors correlated with HKAA change&#46;</p><p id="para0020" class="elsevierStylePara elsevierViewall">The joint line represents the physiological status of an individual knee&#46; Malposition of the knee joint line during arthroplasty can result in instability&#44; decreased range of motion&#44; and altered stress in other knee compartments &#91;<a class="elsevierStyleCrossRef" href="#bib0018">18</a>&#93;&#46; Finite element models on mobile-bearing UKA have shown that contact stress in the insert and lateral articular cartilage was sensitive to changes in the joint line &#91;<a class="elsevierStyleCrossRef" href="#bib0022">22</a>&#93;&#46; Furthermore&#44; Takayama K et al&#46; reported that medial tibial joint line elevation over 5 mm could restrict knee extension and may cause postoperative flexion contracture &#91;<a class="elsevierStyleCrossRef" href="#bib0023">23</a>&#93;&#46;</p><p id="para0021" class="elsevierStylePara elsevierViewall">The hypothesis that medial tibial joint line elevation correlated with postoperative coronal limb alignment&#44; potentially leading to valgus alignment&#44; was disproven by the present results&#46; It was assumed that MCL tension was the most important factor&#44; as the flexion-extension gap and joint stability after UKA were primarily affected by the MCL&#46; If the tibial joint line was elevated by the implant&#44; femoral milling must be adjusted to achieve optimal MCL tension&#44; thereby keeping the postoperative HKAA within the patient&#39;s neutral knee condition&#46; In some cases&#44; a 0&#46;5 mm increment of spigot was used&#44; though not in an officially proven way&#44; to attain optimal gap balance&#46; The overall dislocation rate was 1&#46;1&#37; in the limited case series&#44; which is satisfactory compared to the average 2&#46;4&#37; in the East Asian population who have a higher prevalence of dislocation &#91;<a class="elsevierStyleCrossRef" href="#bib0024">24</a>&#93;&#46;</p><p id="para0022" class="elsevierStylePara elsevierViewall">Lower limb coronal alignment has been found to be a more determining factor for UKA outcomes than implant component alignments &#91;<a class="elsevierStyleCrossRef" href="#bib0006">6</a>&#93;&#46; In terms of mobile-bearing UKA&#44; Kim KT et al&#46; reported that a postoperative femorotibial angle of 4 to 6 degrees of valgus had the highest survival rate &#91;<a class="elsevierStyleCrossRef" href="#bib0025">25</a>&#93;&#46; In previous studies&#44; Kuwashima et al&#46; concluded that femorotibial angle change and medial joint line elevation of the tibia &#40;MJLET&#41; had a significant correlation &#91;<a class="elsevierStyleCrossRef" href="#bib0011">11</a>&#93;&#46; Kuroda et al&#46; reported that a 5&#46;0&#176; change in HKAA was moderately correlated with an MJLET of 4&#46;4 mm &#91;<a class="elsevierStyleCrossRef" href="#bib0012">12</a>&#93;&#46; The results differed from the present study&#59; however&#44; the measurement methods for joint line elevation varied&#46; In Kuwashima&#39;s study&#44;&#91;<a class="elsevierStyleCrossRef" href="#bib0011">11</a>&#93; the measurement was based solely on radiographic findings&#44; which could be affected by image quality&#44; angular projection&#44; and measurement bias&#46; In Kuroda&#39;s study&#44;&#91;<a class="elsevierStyleCrossRef" href="#bib0012">12</a>&#93; although intraoperative bony resection thickness was measured as in this study&#44; they did not specify which part of the resected bone was measured&#44; leading to potential measurement bias&#46; In these cases&#44; the authors measured the anteromedial part of the tibia&#44; where full-thickness cartilage wear was noted&#46;</p><p id="para0023" class="elsevierStylePara elsevierViewall">The differences in joint line change measurements&#44; and the fact that the studies by Kuroda and Kuwashima were conducted on fixed-bearing UKAs&#44;&#91;<a class="elsevierStyleCrossRef" href="#bib0011">11</a>&#44;<a class="elsevierStyleCrossRef" href="#bib0012">12</a>&#93; were noteworthy&#46; While both procedures resurface the damaged compartment&#44; mobile-bearing UKA and fixed-bearing UKA have different traits&#46; Inoue A et al&#46; found that the femorotibial angle changed differently between the two UKA systems&#44; with MCL tension being a determining factor &#91;<a class="elsevierStyleCrossRef" href="#bib0026">26</a>&#93;&#46; In mobile-bearing UKA&#44; adequate MCL tension and integrity are essential to provide knee stability and prevent insert dislocation&#46; Using the Oxford knee instrument&#44; incremental milling of the femur could be made to meet the optimal MCL tension and gap balance&#46; However&#44; the fixed-bearing design uses cutting jigs and saw blades for bony resection&#44; which could make it difficult to make accurate adjustments for gap balance&#46;</p><p id="para0024" class="elsevierStylePara elsevierViewall">In this study&#44; the medial tibial joint line elevated by approximately 2&#46;3&#177;0&#46;68 mm&#44; which was less than previously reported &#91;<a class="elsevierStyleCrossRef" href="#bib0011">11</a>&#44;<a class="elsevierStyleCrossRef" href="#bib0012">12</a>&#93;&#46; However&#44; when accounting for healthy cartilage thickness&#44; the simulated medial tibial joint line was only about 0&#46;9&#177;0&#46;72 mm&#46; Thus&#44; the medial tibial joint line was reconstructed to within less than 1 mm deviation from the simulated healthy knee condition&#46; Additionally&#44; femoral resection in OUKA was performed by milling&#44; allowing surgeons to adjust the depth of femoral milling in a more controlled way&#46; It was found that spigot size&#44; LDFA change&#44; and femoral joint line change all correlated with HKAA change&#46; These findings suggested that the major change in HKAA in OUKA originated from the femoral side rather than the tibial side in this limited case series&#44; contrary to previous studies where tibial joint line change correlated with HKAA change &#91;<a class="elsevierStyleCrossRef" href="#bib0011">11</a>&#44;<a class="elsevierStyleCrossRef" href="#bib0012">12</a>&#93;&#46;</p><p id="para0025" class="elsevierStylePara elsevierViewall">In this series&#44; the only factor that had a strong correlation with postoperative HKAA was preoperative HKAA &#40;<span class="elsevierStyleItalic">r</span> &#61; 0&#46;777&#44; p &#60; 0&#46;001&#41;&#44; suggesting that inherent individual deformity largely determined postoperative alignment&#46; Mullaji AB et al&#46; reported that only preoperative HKAA was predictive of postoperative HKAA &#91;<a class="elsevierStyleCrossRef" href="#bib0027">27</a>&#93;&#46; Since UKA mainly involves resurfacing&#44; it was reasonable that more severe preoperative varus deformities tended to remain in varus alignment postoperatively&#46; Additionally&#44; LDFA and MPTA were found to correlate mildly to moderately with postoperative HKAA&#44; with LDFA showing a negative correlation&#46; LDFA and MPTA reflected individual bony morphology&#59; smaller LDFA and larger MPTA biomechanically led to more valgus alignment&#46; In this study&#44; the preoperative LDFA and MPTA were both within normal ranges&#44; but the LDFA of 89&#46;0&#176; was closer to the upper limit&#44; while the MPTA of 85&#46;6&#176; was closer to the lower limit&#44; indicating a preoperative imbalance &#91;<a class="elsevierStyleCrossRef" href="#bib0015">15</a>&#93;&#46; Postoperatively&#44; the MPTA and LDFA were 86&#46;6&#176; and 86&#46;7&#176;&#44; respectively&#44; suggesting that the imbalance and malalignment from cartilage wear were greatly reduced by bony resection and implant thickness&#46; Zhang Q et al&#46; also revealed that preoperative smaller LDFA&#44; larger MPTA&#44; and less medial tibial cut thickness were associated with postoperative valgus deformity with HKAA &#62; 180&#176; in mobile-bearing UKA &#91;<a class="elsevierStyleCrossRef" href="#bib0028">28</a>&#93;&#46; Although similar findings were noted in this study&#44; a comparison of the patients into postoperative valgus versus non-valgus groups was not performed&#44; as only twelve of the patients had postoperative HKAA greater than 180&#176;&#44; with an average of 182&#46;0&#176;&#44; representing only a small population&#46;</p><p id="para0026" class="elsevierStylePara elsevierViewall">There were limitations to this study&#46; It was a non-randomized retrospective study with a relatively small sample size&#46; Preoperative functional outcomes of the patients were not presented due to incompleteness&#46; However&#44; all patients underwent comprehensive preoperative studies to confirm isolated compartmental damage with full-thickness cartilage wear&#46; Although the short-term outcomes were favorable&#44; long-term outcomes may differ&#44; and further follow-up is needed&#46; Moreover&#44; while a simulated healthy joint line was proposed through MRI measurements of cartilage thickness&#44; there could still be significant variance&#46; The most accurate method would involve using a three-dimensional analysis model&#44; but this was too costly for routine use&#44; and currently&#44; no available model can simulate the entire healthy knee cartilage from a damaged medial compartment&#46;</p></span><span id="sec0013" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0017">Conclusion</span><p id="para0027" class="elsevierStylePara elsevierViewall">The medial joint line change&#44; the thickness of tibial resection&#44; and the tibial implant had no correlation with postoperative hip knee ankle angle in Oxford UKA&#46; The only factor of positive strong correlation with postoperative HKAA was preoperative HKAA&#59; while preoperative smaller LDFA and larger MPTA also had moderate correlation with postoperative HKAA&#46; With regard to the HKAA change&#44; femoral joint line change and LDFA change had a weak to moderate correlation&#46;</p></span></span>"
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    "fechaRecibido" => "2024-04-23"
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            0 => "Unicompartmental knee aArthroplasty"
            1 => "Joint line"
            2 => "Hip knee ankle angle"
            3 => "Correlation"
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          "clase" => "abr"
          "titulo" => "Abbreviations"
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          "palabras" => array:13 [
            0 => "UKA"
            1 => "OUKA"
            2 => "AMOA"
            3 => "MRI"
            4 => "MCL"
            5 => "HKAA"
            6 => "LDFA"
            7 => "MPTA"
            8 => "MTJLC"
            9 => "MFJLC"
            10 => "sMTJLC"
            11 => "sMFJLC"
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    "highlights" => array:2 [
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      "resumen" => "<span id="abss0001" class="elsevierStyleSection elsevierViewall"><p id="spara012" class="elsevierStyleSimplePara elsevierViewall"><ul class="elsevierStyleList" id="celist0001"><li class="elsevierStyleListItem" id="celistitem0001"><span class="elsevierStyleLabel">&#8226;</span><p id="para0001" class="elsevierStylePara elsevierViewall">Postoperative HKAA in Oxford UKA had no correlation with the medial joint line change&#44; the thickness of tibial resection and tibial implant&#46;</p></li><li class="elsevierStyleListItem" id="celistitem0002"><span class="elsevierStyleLabel">&#8226;</span><p id="para0002" class="elsevierStylePara elsevierViewall">Preoperative HKAA had a strong correlation with postoperative HKAA in Oxford UKA&#46;</p></li><li class="elsevierStyleListItem" id="celistitem0003"><span class="elsevierStyleLabel">&#8226;</span><p id="para0003" class="elsevierStylePara elsevierViewall">Preoperative smaller LDFA and larger MPTA had a moderate correlation with postoperative HKAA in Oxford UKA&#46;</p></li></ul></p></span>"
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        "titulo" => "ABSTRACT"
        "resumen" => "<span id="abss0002" class="elsevierStyleSection elsevierViewall"><p id="spara013" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Background</span>&#58; Lower limb coronal alignment was thought to be a predictive factor for Unicompartmental Knee Arthroplasty &#40;UKA&#41; result&#46; The tibial bony resection and implant position lead to joint line change postoperatively&#46; Analysis was done to find out the correlation between these factors&#46;</p><p id="spara014" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Methods</span>&#58; From 2019 to 2021&#44; 90 medial Oxford UKA were implanted by a single surgeon&#46; Hip Knee Ankle Angle &#40;HKAA&#41;&#44; Lateral Distal Femoral Angle &#40;LDFA&#41;&#44; Medial Proximal Tibial Angle &#40;MPTA&#41;&#44; and intraoperative bony resection thickness were measured&#46; The medial joint line change was calculated&#46; The correlation between joint line change and alignment change was evaluated&#46;</p><p id="spara015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Results</span>&#58; The mean tibial resection thickness was 4&#46;3 mm&#46; The mean tibial joint line was elevated by 2&#46;3 mm&#44; while the mean femoral joint line proximalized by 0&#46;8 mm&#46; HKAA changed from 8&#46;4&#176; varus preoperatively to 3&#46;6&#176; varus postoperatively&#46; LDFA changed from 89&#46;0&#176; to 86&#46;7&#176;&#46; MPTA changed from 85&#46;6&#176; to 86&#46;6&#176;&#46; Preoperative HKAA showed a strong correlation with postoperative HKAA &#40;p &#60; 0&#46;001&#41;&#44; and preoperative MPTA showed a positive correlation with postoperative HKAA &#40;p &#60; 0&#46;001&#41;&#46; While preoperative LDFA had a negative correlation with postoperative HKAA &#40;p &#60; 0&#46;001&#41;&#46; The femoral joint line change and LDFA change had a significant correlation with HKAA change &#40;p &#60; 0&#46;05&#41;&#46;</p><p id="spara016" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Conclusion</span>&#58; The change of joint line had no correlation with postoperative HKAA in Oxford UKA&#46; Preoperative HKAA strongly correlated with postoperative HKAA&#59; while preoperative smaller LDFA and larger MPTA had a moderate correlation with postoperative HKAA&#46; The femoral joint line change and LDFA change had a weak to moderate correlation with HKAA change&#46;</p></span>"
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "alt0006"
            "detalle" => "Fig "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara002" class="elsevierStyleSimplePara elsevierViewall">Demonstration of pre-OP and post-OP LDFA and MPTA measurement&#46; LDFA was determined by the lateral angle between the distal femoral joint line and the mechanical axis of the femur&#44; while MPTA was defined as the medial angle between the tibial joint line and the mechanical axis of the tibia&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "fig0003"
        "etiqueta" => "Fig&#46; 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1813
            "Ancho" => 1752
            "Tamanyo" => 192234
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "alt0007"
            "detalle" => "Fig "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara003" class="elsevierStyleSimplePara elsevierViewall">Demonstration of MRI measurement&#46; The lateral femoral and tibial cartilage thickness was measured on T2 coronal slice where cartilage-to-cartilage contact point was noticed&#46; The measurement was made from the contact point to individual subchondral bone plate as red line&#46; Note that medial compartment full cartilage wear with meniscus extrusion was highlighted by the yellow circle&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0001"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "alt0001"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spara005" class="elsevierStyleSimplePara elsevierViewall">SD&#44; Standard Deviation&#59; BMI&#44; Body Mass Index&#59; HKAA&#44; Hip-Knee-Ankle Angle&#59; LDFA&#44; Lateral Distal Femoral Angle&#59; MPTA&#44; Medial Proximal Tibial Angle&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><a name="en0001"></a><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0002"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleBold">All patients &#40;n &#61; 90&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0003"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Demographics</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0004"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0005"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Male &#47; Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0006"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">27 &#47; 63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0007"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Age&#44; year&#44; mean &#177; SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0008"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">68&#46;8 &#177; 7&#46;56 &#40;50 &#8764; 85&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0009"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">BMI&#44; kg&#47;m<span class="elsevierStyleSup">2</span>&#44; mean &#177; SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0010"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">27&#46;7 &#177; 3&#46;73 &#40;21&#46;2 &#8764; 39&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0011"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Lateral femoral cartilage thickness&#44; mm&#44; mean &#177; SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0012"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&#46;8 &#177; 0&#46;36 &#40;1&#46;0 &#8764; 3&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0013"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Lateral tibial cartilage thickness&#44; mm&#44; mean &#177; SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0014"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2&#46;0 &#177; 0&#46;40 &#40;1&#46;0 &#8764; 2&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0015"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Simulated medial tibial cartilage thickness&#44; mm&#44; mean &#177; SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0016"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&#46;4 &#177; 0&#46;29 &#40;0&#46;8 &#8764; 2&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0017"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Intraoperative findings</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0018"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0019"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleItalic">Tibial implant size</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0020"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0021"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">AA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0022"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0023"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0024"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0025"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0026"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0027"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0028"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0029"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">D&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0030"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0031"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">E&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0032"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0033"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleItalic">Femoral implant size</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0034"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0035"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">XS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0036"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0037"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0038"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0039"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0040"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0041"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0042"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0043"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleItalic">Spigot size&#44; mm&#44; mean &#177; SD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0044"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;1 &#177; 1&#46;39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0045"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0046"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0047"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">1&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0048"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0049"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0050"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0051"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">2&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0052"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0053"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0054"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0055"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">3&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0056"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0057"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0058"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0059"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">4&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0060"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0061"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0062"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0063"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">5&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0064"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0065"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0066"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0067"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0068"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0069"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0070"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0071"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleItalic">Insert size&#44; mm&#44; mean &#177; SD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0072"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3&#46;2 &#177; 0&#46;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0073"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0074"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0075"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0076"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0077"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0078"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0079"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleItalic">Tibial resection with saw blade thickness&#44; mm&#44; mean &#177; SD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0080"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;3 &#177; 0&#46;64 &#40;2&#46;9 &#8764; 5&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0081"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleItalic">Tibial implant thickness&#44; mm&#44; mean &#177; SD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0082"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">6&#46;6 &#177; 0&#46;40 &#40;6&#46;5 &#8764; 8&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0083"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleItalic">Femoral implant distal thickness</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0084"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3&#46;3 &#177; 0&#46;18 &#40;3&#46;0 &#8764; 3&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0085"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Joint line change</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0086"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0087"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Medial Tibial Joint Line Change &#40;MTJLC&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0088"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2&#46;3 &#177; 0&#46;68 &#40;0&#46;6 &#8764; 3&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0089"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Medial Femoral Joint Line Change &#40;MFJLC&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0090"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">-0&#46;8 &#177; 1&#46;38 &#40;-4&#46;7 &#8764; 2&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0091"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Simulated Medial Tibial Joint Line Change &#40;sMTJLC&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0092"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;9 &#177; 0&#46;72 &#40;-1&#46;1 &#8764; 2&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0093"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Simulated Medial Femoral Joint Line Change &#40;sMFJLC&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0094"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">-2&#46;6 &#177; 1&#46;44 &#40;-7&#46;2 &#8764; 0&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0095"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Preoperative radiographic measurement</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0096"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0097"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">HKAA&#44; degrees&#44; mean &#177; SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0098"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">171&#46;6 &#177; 3&#46;96 &#40;162&#46;0&#8764;180&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0099"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">LDFA&#44; degrees&#44; mean &#177; SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0100"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">89&#46;0 &#177; 2&#46;50 &#40;82&#46;9&#8764;94&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0101"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">MPTA&#44; degrees&#44; mean &#177; SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0102"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">85&#46;6 &#177; 2&#46;80 &#40;77&#46;3&#8764;93&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0103"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Postoperative radiographic measurement</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0104"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0105"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">HKAA&#44; degrees&#44; mean &#177; SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0106"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">176&#46;4 &#177; 3&#46;84 &#40;166&#46;2&#8764;185&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0107"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">LDFA&#44; degrees&#44; mean &#177; SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0108"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">86&#46;7 &#177; 3&#46;03 &#40;80&#46;3&#8764;95&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0109"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">MPTA&#44; degrees&#44; mean &#177; SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0110"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">86&#46;6 &#177; 2&#46;98 &#40;80&#46;2&#8764;94&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0111"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Postoperative functional score</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0112"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0113"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Lysholm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0114"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">88&#46;7 &#177; 11&#46;81 &#40;24&#8764;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0115"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Oxford&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0116"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">41&#46;5 &#177; 4&#46;35 &#40;24&#8764;47&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0117"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">WOMAC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0118"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">91&#46;1 &#177; 6&#46;60 &#40;56&#8764;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab3711885.png"
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        "descripcion" => array:1 [
          "en" => "<p id="spara004" class="elsevierStyleSimplePara elsevierViewall">Descriptive statistics&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0002"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "alt0002"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spara007" class="elsevierStyleSimplePara elsevierViewall">HKAA&#44; Hip-Knee-Ankle Angle&#59; LDFA&#44; Lateral Distal Femoral Angle&#59; MPTA&#44; Medial Proximal Tibial Angle&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><a name="en0119"></a><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0120"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleBold">All patients &#40;n &#61; 63&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0121"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleBold">p-value</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0122"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">HKAA change</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0123"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;8 &#177; 2&#46;61 &#40;-1&#46;1&#8764;11&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0124"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0125"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">LDFA change</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0126"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">-2&#46;3 &#177; 2&#46;98 &#40;-8&#46;8&#8764;5&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0127"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0128"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">MPTA change</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0129"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&#46;0 &#177; 3&#46;54 &#40;-6&#46;9&#8764;11&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0130"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3711882.png"
              ]
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara006" class="elsevierStyleSimplePara elsevierViewall">Coronal alignment change&#46;</p>"
        ]
      ]
      5 => array:8 [
        "identificador" => "tbl0003"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "alt0003"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spara009" class="elsevierStyleSimplePara elsevierViewall">BMI&#44; Body Mass Index&#59; HKAA&#44; Hip-Knee-Ankle Angle&#59; LDFA&#44; Lateral Distal Femoral Angle&#59; MPTA&#44; Medial Proximal Tibial Angle&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><a name="en0131"></a><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0132"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleBold">Coefficient of correlation &#40;<span class="elsevierStyleItalic">r</span>&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0133"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleBold">p-value</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0134"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Tibial resection with saw blade thickness</span><a class="elsevierStyleCrossRef" href="#tb3fn1"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0135"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">-0&#46;072&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0136"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;502&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Insert size</span><a class="elsevierStyleCrossRef" href="#tb3fn1"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0138"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">-0&#46;048&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0139"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;654&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0140"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Tibial implant thickness</span><a class="elsevierStyleCrossRef" href="#tb3fn1"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0141"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">-0&#46;048&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;654&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0143"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Spigot</span><a class="elsevierStyleCrossRef" href="#tb3fn1"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0144"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;909&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0146"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Femoral implant distal thickness</span><a class="elsevierStyleCrossRef" href="#tb3fn1"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0147"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">-0&#46;096&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0148"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;367&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0149"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Medial Tibial Joint Line Change &#40;MTJLC&#41;</span><a class="elsevierStyleCrossRef" href="#tb3fn1"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0150"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;062&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0151"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;563&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0152"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Medial Femoral Joint Line Change &#40;MFJLC&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0153"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0154"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;962&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0155"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Simulated Medial Tibial Joint Line Change &#40;sMTJLC&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0156"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;162&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0157"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;127&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0158"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Simulated Medial Femoral Joint Line Change &#40;sMFJLC&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0159"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;052&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0160"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;623&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0161"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Pre-OP HKAA</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0162"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;777&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0163"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0164"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">HKAA change</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0165"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;293&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0166"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0167"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Pre-OP LDFA</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0168"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">-0&#46;549&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0169"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0170"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Post-OP LDFA</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0171"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">-0&#46;389&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0172"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0173"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">LDFA change</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0174"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;063&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0175"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;555&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Pre-OP MPTA</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0177"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;637&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;297&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0182"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">MPTA change</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;016&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleBold">Coefficient of correlation</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Spigot</span><a class="elsevierStyleCrossRef" href="#tb4fn1"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0200"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Femoral implant distal thickness</span><a class="elsevierStyleCrossRef" href="#tb4fn1"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0201"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</td><a name="en0202"></a><td class="td" title="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0203"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Medial tibial joint line change &#40;MTJLC&#41;</span><a class="elsevierStyleCrossRef" href="#tb4fn1"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><a name="en0205"></a><td class="td" title="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0206"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Medial femoral joint line change &#40;MFJLC&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;300&nbsp;\t\t\t\t\t\t\n
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