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Original Paper
Vancomycin powder in the prevention of infection in primary knee and hip arthroplasty: Case–control study with 1151 arthroplasties
Vancomicina en polvo en la prevención de la infección en artroplastia primaria de rodilla y cadera: estudio de casos y controles con 1.151 artroplastias
X. Paredes-Carneroa,
Corresponding author
xavinef@gmail.com

Corresponding author.
, J. Vidal-Camposb, F. Gómez-Suárezc, H. Meijided
a Servicio de Cirurxía Ortopédica e Traumatoloxía, Hospital de Verín, Verín, Ourense, Spain
b Servicio de Cirurxía Ortopédica e Traumatoloxía, Centro Médico El Carmen, Ourense, Spain
c Clínica Lebrato & Grandío, Ourense, Spain
d Servicio de Medicina Interna, Hospital Quirón-Salud, A Coruña, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Infection is one of the most devastating complications of joint replacement surgery&#46; Its incidence has been established between 1&#37; and 4&#37; in total knee arthroplasty &#40;TKA&#41; and between &#37; and 2&#37; in total hip arthroplasty &#40;THA&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">1&#44;2</span></a> The average cost of an infected arthroplasty is &#62;300&#37; that of a primary arthroplasty&#44; as well as double the risk of re-hospitalisation and death&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The main microorganisms causing prosthetic infection are gram-positive cocci&#44; with <span class="elsevierStyleItalic">Staphylococcus aureus</span> and coagulase-negative <span class="elsevierStyleItalic">Staphylococcus</span> &#40;CNS&#41;&#44; contributing to more than 50&#37; of infections&#44; both acute and chronic&#44; while <span class="elsevierStyleItalic">Streptococcus</span> spp&#46; and <span class="elsevierStyleItalic">Enterococcus</span> spp&#46; together barely account for 10&#37;&#46; Under 10&#37; are caused by gram-negative or aerobic bacilli&#44; and up to 30&#37; of cultures are negative&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The struggle against microorganisms that cause prosthetic infections therefore focuses on gram-positive cocci&#44; with vancomycin being one of the most used drugs&#46; Vancomycin is a tricyclic glycopeptide antibiotic&#44; which is highly effective in <span class="elsevierStyleItalic">S&#46; aureus</span> infections&#44; especially in those resistant to beta-lactams&#44; i&#46;e&#46; to methicillin &#40;MRSA&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Vancomycin has been used in different presentations such as&#44; for example&#44; its inclusion in biological cements&#44; providing benefits in the prevention of prosthetic infection&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">6&#44;7</span></a> It has also been used&#44; with broad support&#44; in anterior cruciate ligament reconstruction surgery&#44; in diluted form&#44; bathing the tendon plasty in a vancomycin solution&#44; thus reducing the rate of infections&#44; with level III evidence&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">8</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Its topical use has recently become popular&#44; seeking to increase concentration in the surgical bed and minimising intravenous concentration&#44; with the aim of reducing possible complications derived from it&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">9</span></a> For years&#44; vancomycin powder &#40;VP&#41; has been most widely in spine surgery&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">10&#8211;13</span></a> Numerous retrospective studies have highlighted the advantages of its use in the prevention of surgical infection but only a single prospective study has been published&#44; which is unable to corroborate the aforementioned benefits in reducing surgical infection&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">14</span></a> Furthermore&#44; its use may not be safe&#44; as complications arising from its local use have been described&#46;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">15&#44;16</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The objective of this study was to assess the influence of the use of locally administered VP in primary joint replacement surgery of the hip and knee&#44; also observing its possible long-term adverse effects&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0035" class="elsevierStylePara elsevierViewall">A retrospective observational case&#8211;control study was conducted&#46; The operations were performed between January 2017 and December 2018&#44; including patients who underwent primary hip arthroplasty &#40;THA&#41; and knee arthroplasty &#40;TKA&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">One thousand&#44; one hundred and fifty-one interventions were included&#44; with a minimum follow-up of 5 years&#46; This sample size would enable us to detect as significant a reduction in the percentage of complications in interventions with the use of VP of 2&#46;0&#37; compared to interventions without VP&#44; assuming a unilateral approach with a confidence level of 95&#37; and a statistical power of 80&#37;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Data were collected by two researchers from the computer programme of the health management system used in the public health service of the health area to which the patients belonged&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The patients underwent surgery in one centre&#44; with five surgeons performing it&#46; Three surgeons used VP over the prosthesis bed in their patients&#44; while two did not&#44; all according to their preferences&#46; The five operated on both hip and knee arthroplasties&#44; with a minimum of 100 annual interventions each&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Data were collected for each patient regarding their age&#44; preoperative diagnosis &#40;primary osteoarthritis&#59; inflammatory disease&#59; post-traumatic osteoarthritis&#44; avascular necrosis or hip dysplasia&#41;&#44; their comorbidities &#40;cardiovascular disease&#59; inflammatory disease&#59; diabetes or kidney disease&#41; and their previous treatment &#40;anticoagulant&#47;antiplatelet treatment&#59; antidiabetic treatment or chronic immunosuppressive treatment&#41;&#46; Postoperatively&#44; complications of the surgical process were recorded in the 5 years after the intervention&#46; A deep infection was considered to be a process that met the diagnostic criteria of the International Consensus Meeting on Periprosthetic Joint Infections&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">17</span></a> The consideration of superficial infection or wound complication was that the surgical wound did not meet diagnostic criteria for deep or implant infection&#44; nor presented prolonged post-surgical drainage over time that required dressings beyond the first month&#44; surgical revision and&#47;or empirical antibiotic treatment&#46; The rest of the post-operative complications that affected the operated joint were recorded&#58; aseptic loosening&#59; periprosthetic fracture&#59; dislocation&#59; instability or stiffness&#44; as well as possible death of the patient&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Surgical protocol</span><p id="par0060" class="elsevierStylePara elsevierViewall">The antibiotic prophylaxis protocol used was the same for all patients&#46; Cefazolin &#40;2<span class="elsevierStyleHsp" style=""></span>g&#41; was used as the antibiotic of choice&#44; which was administered intravenously prior to the incision&#44; and a dose of cefazolin IV&#47;1<span class="elsevierStyleHsp" style=""></span>g&#47;every 8<span class="elsevierStyleHsp" style=""></span>h was repeated during the first 24<span class="elsevierStyleHsp" style=""></span>h&#46; In case of allergy to beta-lactams&#44; clindamycin &#40;600<span class="elsevierStyleHsp" style=""></span>mg&#41; was used preoperatively and in three post-operative doses&#47;every 8<span class="elsevierStyleHsp" style=""></span>h&#41;&#46; Pre-surgical skin preparation was carried out with 10&#37; povidone-iodine&#44; as well as post-operative dressings&#46; Vacuum suction drainage was placed in all cases&#44; remaining for 1 or 2 days&#46; In all cases&#44; intravenous tranexamic acid was used as a strategy to minimise perioperative bleeding&#46; An ischaemia cuff was used in TKAs and was removed after closure and bandaging&#46; The approach of choice in the knee was anterior with medial parapatellar arthrotomy and in the hip direct anterior&#44; lateral and posterior approaches were performed&#46; Four different arthroplasties were implanted in the knee&#58; Triathlon PS &#40;Stryker Orthopaedics&#44; Mahwah &#91;NJ&#93;&#41;&#59; Vanguard PS &#40;Zimmer-Biomet&#44; Warsaw &#91;In&#93;&#41; Optetrak PS &#40;Exactech&#44; Gainesville &#91;Fl&#93;&#41; and Apex PS &#40;Corin&#44; Raynham &#91;MA&#93;&#41;&#44; while two implants were used in the hip&#58; Furlong &#40;JRI&#44; London &#91;UK&#93;&#41; and Taperloc-G7 &#40;Zimmer-Biomet&#44; Warsaw &#91;In&#93;&#41;&#44; according to the surgeon&#39;s preference&#46; All knees were postero-stabilised and cemented &#40;the cement was in all cases with vancomycin&#41;&#46; All THAs were cementless&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The VP &#40;1<span class="elsevierStyleHsp" style=""></span>g&#41; was spread over the intra-articular surgical bed&#44; in contact with the prosthesis&#44; immediately before surgical closure&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Patients began walking the next day or after 2 days with the help of English canes&#44; progressively removing them from the 2nd or 3rd week&#46; Wound checks were performed every 2 days until the staples were removed&#44; starting from the 2nd week&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The study was approved by the Galician Research Ethics Committee&#44; with registration code 2018&#47;018&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Statistical analysis</span><p id="par0080" class="elsevierStylePara elsevierViewall">A descriptive analysis of the collected data was carried out&#44; the quantitative variables being expressed with mean value and standard deviation&#44; mean and range&#46; Qualitative variables were described by absolute and relative frequencies&#46; The comparison of means was carried out using parametric tests &#40;Student&#39;s <span class="elsevierStyleItalic">T</span>&#41; or non-parametric tests &#40;Mann&#8211;Whitney test&#41; as appropriate after checking normality with the Kolmogorov&#8211;Smirnov test&#46; The association of qualitative variables was tested with the Chi-square or Fisher&#39;s exact statistic&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Survival from complications was determined using the Kaplan&#8211;Meier methodology&#59; the comparison of the curves was performed with the log-rank test&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0090" class="elsevierStylePara elsevierViewall">The study included 1078 patients who underwent 1151 interventions&#44; 748 &#40;65&#37;&#41; were knee joint replacements and 403 &#40;35&#37;&#41; were hip replacements&#46; The mean age of the patients at the time of the operation was 71&#46;4 years &#40;SD&#58; 9&#46;4&#41;&#44; 60&#46;3&#37; of the surgeries were performed on women&#46; VP was used in 658 &#40;57&#46;2&#37;&#41; interventions&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Sociodemographic and clinical characteristics were compared according to VP use &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; The mean follow-up time was 5 years and 2 months &#40;SD&#58; 8 months&#41;&#46; Sixty-two patients died at the end of follow-up&#44; none of them from causes attributed to the intervention&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">No statistically significant differences were found in the number of infections&#44; or in the number of superficial complications&#44; depending on the use of VP&#46; Two point one per cent of patients during the study period suffered a complication classified as infection or wound complication&#46; Of this percentage&#44; 0&#46;8&#37; could be diagnosed with deep infection&#44; with the previously established criteria&#44; and 1&#46;3&#37; could not&#44; with the complication being considered a superficial infection or wound complication&#46; No differences were detected between both groups of patients in terms of the incidence of infections&#44; neither deep nor superficial&#44; although a tendency to suffer more wound complications was found in the group that used VP &#40;11 versus 4 &#91;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#93;&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">Of the 9 patients diagnosed with deep infection&#44; 3 of them had positive cultures for gram-negative bacilli&#59; 2 for <span class="elsevierStyleItalic">S&#46; aureus</span>&#44; both methicillin sensitive &#40;MSSA&#41;&#59; 2 for CNS and one for <span class="elsevierStyleItalic">Streptococcus</span> spp&#46; In one case there was no microbiological documentation&#44; although there was active drainage with an intra-articular fistula&#46; Regarding the surgical strategy carried out&#44; in five cases a DAIR &#40;debridement<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>antibiotherapy<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>implant retention&#41; was performed&#44; one with one-stage rescue and three with two-stage rescue&#44; of which only one was completed&#46; The other two were not because one patient died before the 2nd intervention after a year of waiting&#44; due to a heart problem&#44; and the other still remains with the spacer and refuses to undergo further surgery&#46; It should be noted that two of the infections attributed to the group without VP were in the same patient&#44; a patient with advanced chronic liver disease&#46; Both infections were resolved with a DAIR&#44; but the patient died 2 years after the 2nd procedure&#44; due to their underlying disease &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">Furthermore&#44; there were 15 superficial infections or wound complications&#44; with patients presenting with active drainage or delayed wound healing in the first month&#46; Four cases underwent surgery&#44; all THA&#44; with a DAIR performed&#44; two with negative cultures&#44; another with a single positive polymicrobial culture&#44; without having had a proven fistula&#44; and the fourth with a single positive culture for MSSA&#44; all of them being cured with the procedure&#46; In the fifth case&#44; a TKA&#44; surgical cleaning of the wound was performed&#44; without changing components&#44; and required over 2 more months of wound care in a diabetic patient&#46; In this case following several superficial cultures&#44; only one was positive for MSSA&#44; and the patient being treated with oral antibiotic therapy&#46; We understand that the case mix shown with little microbiological documentation could have been due to the inappropriate use of prior oral antibiotic treatment by their primary care physician&#44; with no consultation having been made with the corresponding specialist&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0115" class="elsevierStylePara elsevierViewall">Our study did not find any benefit with the use of VP in terms of reducing prosthetic infection&#44; neither acute nor chronic&#46; In contrast we observed a trend towards an increase in superficial or wound complications in patients who received it&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">The popularity of the use of VP in orthopaedic surgery has increased exponentially in recent years&#44; and with it&#44; the studies in this regard&#46; However&#44; results are contradictory&#46; The most recent meta-analyses contradict each other in their final conclusions&#44; Movassaghi et al&#46;&#44; Peng et al&#46; and Liao et al&#46;<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">18&#8211;20</span></a> recommended its use&#44; while Xu et al&#46;&#44; Wong et al&#46; and more recently&#44; Martin et al&#46;<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">21&#8211;23</span></a> conclude that the biases found in the majority of studies may interfere with the recommendation of its use&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">The conclusions we have reached are consistent with the works previously published by Yavuz et al&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">24</span></a> and Hanada et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">16</span></a> who&#44; in patients undergoing primary knee arthroplasty&#44; did not obtain any benefit with the use of VP&#44; but instead warned of the increase in local complications&#46; Previously&#44; Otte et al&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">25</span></a> and Dial et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">26</span></a> had reported a reduction in infection rates with the use of VP in revision arthroplasty and primary hip arthroplasty&#44; respectively&#46; However&#44; their studies included a small number of patients and a short follow-up&#46; Along these lines&#44; the most recent studies&#44; with a greater number of patients recruited&#44; did find differences in favour of the use of VP&#46; Buchalter et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">27</span></a> reviewed more than 18&#44;000 primary arthroplasties from the registry of a single hospital&#44; observing a decrease in the incidence of infections &#40;&#46;8&#37; to &#46;5&#37;&#41; due to MRSA and CNS&#44; without finding differences in gram-negative bacilli&#46; However&#44; the follow-up was only three post-operative months and also included other changes in the hospital&#39;s preventive protocol&#44; such as the use of diluted povidone lavage&#44; which could have represented a bias&#46; Hu et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">28</span></a> recently analysed over 1600 primary arthroplasties&#44; with prospective follow-up&#44; although without randomisation&#46; They also obtained a significant decrease in the incidence of acute infection at 3 months&#44; with a decrease from &#46;8&#37; to 0&#37; with the use of VP&#44; in this case used in a diluted and infiltrated manner after joint closure&#46; Matziolis et al&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">29</span></a> analysed more than 8000 arthroplasties&#44; noting a decrease from 1&#46;3&#37; to &#46;3&#37; in the infection rate&#44; with one year of follow-up&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">The decrease in surgical infection with VP has been published in multiple spinal surgery<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">10&#44;11</span></a> studies&#46; However&#44; only one prospective study has been carried out evaluating its use&#44; and post-operative infection was not reduced in it&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">14</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">The use of vancomycin can&#44; however&#44; cause complications&#44; which have been demonstrated intravenously&#44; but not yet through its topical use&#46; They include ototoxicity&#44; kidney failure and Vancomycin flushing syndrome&#46; We did not observe any cases of systemic complications in our study&#46; In fact&#44; Sweet et al&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">13</span></a> measured blood levels of vancomycin after its local use in spinal surgery&#44; without observing values high enough to cause systemic problems&#46; However&#44; its use in the surgical bed could cause local complications&#44; as has been previously suggested&#44;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">15&#44;16</span></a> due to the increase in local acidity because of excessively low pH levels &#40;pH&#58; 3&#8211;4&#46;5&#41;<a class="elsevierStyleCrossRefs" href="#bib0330"><span class="elsevierStyleSup">30&#44;31</span></a> which would increase the risk of cell necrosis&#44; with its consequent alteration of the reparative capacity of the tissues&#46; Furthermore&#44; a harmful effect on the function of osteoblasts has been observed&#44; which would make the integration of prosthetic implants difficult&#46;<a class="elsevierStyleCrossRefs" href="#bib0330"><span class="elsevierStyleSup">30&#8211;33</span></a> There is some evidence that vancomycin can be toxic to endothelial cells&#44; as well as other types of cells that influence tissue repair&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">34</span></a> The possible creation of loose bodies could also influence the behaviour of prosthetic implants&#44; as a polyethylene-degrading agent or as a pro-inflammatory mediator&#44; which could ultimately facilitate infection&#46; It does not seem that polyethylene is affected &#8220;in vitro&#8221;&#44; although there are no &#8220;in vivo&#8221; studies due to the use of VP&#44; nor are there any chromium&#8211;cobalt alloys&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">35</span></a> These complications have been observed in spine surgery&#44;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">15</span></a> but also in primary knee arthroplasty&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">16</span></a> In our study&#44; a statistically significant increase in the rate of aseptic loosening or any other local complication derived from the use of VP in the surgical bed was not observed&#44; although cases of wound complications did increase in the group that used VP&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">The use of local antibiotics raises several possible problems&#44; not yet well studied&#44; such as&#44; for example&#44; the delay in the moment of action of the same on possible pathogens&#46; It has been studied that the moment of maximum action against pathogens is just before the surgical incision&#44; and the moment of greatest infectious risk is also the one that exceeds 2<span class="elsevierStyleHsp" style=""></span>h after the incision&#46; It seems obvious then that administering the antibiotic just before closure would not be the best option&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">36</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">Vancomycin&#44; like other antibiotics&#44; can contribute to the development of resistance if its use is inappropriate&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Furthermore&#44; it is necessary to consider the phenomenon of &#8220;arthroplasty antibiotic flora&#8221;&#44; according to which the high concentration of antibiotics not only does not reduce infection&#44; but can promote the growth&#44; and therefore infection&#44; of certain pathogens usually resistant to vancomycin&#44; such as gram-negatives or yeasts&#46; Prospective studies are needed to assess these effects&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">27</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">It is interesting to note that there were no differences in the type of isolated microorganisms in the existing infections in our study&#44; regardless of the use or non-use of VP&#46; The possible prevalence of MRSA in our environment is therefore not a factor to take into account for the indiscriminate use of glycopeptides&#46; Additionally&#44; the <span class="elsevierStyleItalic">S&#46; aureus</span> isolated in the diagnosed infections were all MSSA&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">We therefore do not consider the use of VP useful in primary hip and knee joint replacement surgery&#46; Although its cost is not high&#44; we have not been able to verify any benefit with its use&#44; and it is also a possible source of local complications according to the bibliography consulted&#46; In our study we were not able to demonstrate this in any significant way&#44; although there was a tendency towards an increase in complications&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Our study had several limitations such as the fact that the same surgeon always used VP or did not&#46; This may have represented a bias&#44; since a higher infection rate in surgeons who used VP could have been obscured&#46; However&#44; these surgeons also did not have more overall complications than those who did not use VP&#46; The follow-up of the patients by different doctors&#44; other than specialist orthopaedic surgeons&#44; did not favour the drawing of adequate conclusions&#44; since many patients could have been underdiagnosed as a result&#46; This was demonstrated with the significant number of patients being treated with oral antibiotic therapy by their general practitioner&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Further evidence is required for more concise recommendations&#44; although&#44; in our opinion&#44; efforts aimed at reducing the rate of prosthetic infection should be made elsewhere&#44; for which better results will probably be obtained&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Level of evidence</span><p id="par0175" class="elsevierStylePara elsevierViewall">Level of evidence III&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Funding</span><p id="par0180" class="elsevierStylePara elsevierViewall">This study received no funding&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflict of interests</span><p id="par0185" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare&#46;</p></span></span>"
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          "titulo" => "Abstract"
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              "identificador" => "abst0005"
              "titulo" => "Background and objective"
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          "titulo" => "Resumen"
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            0 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Antecedentes y objetivo"
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            1 => array:2 [
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              "titulo" => "M&#233;todos"
            ]
            2 => array:2 [
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              "titulo" => "Resultados"
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            3 => array:2 [
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              "titulo" => "Conclusiones"
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          "titulo" => "Palabras clave"
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          "identificador" => "sec0005"
          "titulo" => "Introduction"
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          "titulo" => "Material and methods"
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              "identificador" => "sec0015"
              "titulo" => "Surgical protocol"
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              "titulo" => "Statistical analysis"
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          "titulo" => "Results"
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          "titulo" => "Discussion"
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          "titulo" => "Level of evidence"
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    "fechaRecibido" => "2023-11-10"
    "fechaAceptado" => "2023-12-14"
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          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1843907"
          "palabras" => array:5 [
            0 => "Vancomycin powder"
            1 => "Prosthetic infection"
            2 => "Total knee arthroplasty"
            3 => "Total hip arthroplasty"
            4 => "Arthroplasty complications"
          ]
        ]
      ]
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          "clase" => "keyword"
          "titulo" => "Palabras clave"
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          "palabras" => array:5 [
            0 => "Vancomicina en polvo"
            1 => "Infecci&#243;n prot&#233;sica"
            2 => "Artroplastia total rodilla"
            3 => "Artroplastia total cadera"
            4 => "Complicaciones artroplastias"
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    "resumen" => array:2 [
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background and objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Vancomycin powder &#40;VP&#41; has been positively used in spinal surgery to reduce the rate of infections&#46; Hardly any data have been published on hip and knee joint replacement surgery&#44; and its usefulness is questioned&#46; Our objective was to investigate the effectiveness of VP in reducing prosthetic infection and its possible complications&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Primary hip &#40;THA&#41; and knee &#40;TKA&#41; arthroplasties were reviewed&#44; performed by five surgeons in one hospital centre&#44; between 2017 and 2018&#46; One gram of VP was used on the implant prior to surgical closure based on the surgeon&#39;s preferences&#46; With a 5-year follow-up in which the infection rate and local complications were analysed&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">One thousand one hundred and fifty-one arthroplasties were performed&#44; 748 were TKA and 403 were THA&#46; Nine patients were diagnosed with prosthetic infection&#44; of which five received VP and four did not &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;555&#41;&#46; Likewise&#44; another 15 patients suffered wound complications&#44; of which 11 received VP and 4 did not &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;412&#41;&#46; There were no differences&#44; either&#44; in the rest of the complications depending on the use or not of VP &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;101&#41;&#46; Likewise&#44; the number of patients who needed reintervention was similar &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;999&#41;&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">No systemic complications were detected due to the use of VP&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">It has not been possible to demonstrate that the use of VP reduces the rates of prosthetic infection in the hip and knee&#44; so we cannot recommend its use&#46;</p></span>"
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      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes y objetivo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">La vancomicina en polvo &#40;VP&#41; ha sido utilizada positivamente en cirug&#237;a de raquis para reducir la tasa de infecciones&#46; Apenas se han publicado datos en cirug&#237;a de reemplazo articular de cadera y rodilla&#44; estando en entredicho su utilidad&#46; Nuestro objetivo fue investigar la eficacia de la VP en la reducci&#243;n de la infecci&#243;n prot&#233;sica&#44; y sus posibles complicaciones&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Fueron revisadas artroplastias primarias de cadera &#40;ATC&#41; y rodilla &#40;ATR&#41;&#44; intervenidas por 5 cirujanos en un centro hospitalario&#44; entre los a&#241;os 2017 y 2018&#46; Se us&#243; 1 g de VP sobre el implante previamente al cierre quir&#250;rgico en funci&#243;n de las preferencias del cirujano&#46; Con un seguimiento de 5 a&#241;os en los que se analiz&#243; la tasa de infecci&#243;n y las complicaciones locales&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Se intervinieron 1&#46;151 artroplastias&#44; 748 fueron ATR y 403 ATC&#46; Nueve pacientes fueron diagnosticados de infecci&#243;n prot&#233;sica&#44; de los que 5 recibieron VP y 4 no &#40;p &#61; 0&#44;555&#41;&#46; As&#237; mismo&#44; otros 15 pacientes sufrieron complicaciones de la herida&#44; de los que 11 recibieron VP y 4 no &#40;p &#61; 0&#44;412&#41;&#46; No hubo diferencias&#44; tampoco&#44; en el resto complicaciones en funci&#243;n del uso o no de VP &#40;p &#61; 0&#44;101&#41;&#46; Del mismo modo&#44; el n&#250;mero de pacientes que necesitaron una reintervenci&#243;n fue semejante &#40;p &#61; 0&#44;999&#41;&#46;</p><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Tampoco se detectaron complicaciones sist&#233;micas por el uso de VP&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">No se ha podido demostrar que el uso de VP reduzca las tasas de infecci&#243;n prot&#233;sica en cadera y rodilla&#44; por lo que no podemos recomendar su uso&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Antecedentes y objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
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          0 => array:3 [
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">S&#58; stroke&#46;</p>"
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            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"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">No vancomycin&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>493&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Vancomycin &#61;<span class="elsevierStyleHsp" style=""></span>658&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>-Value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Blood treatment &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63 &#40;12&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62 &#40;9&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;070&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diabetic treatment &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76 &#40;15&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">88 &#40;13&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;327&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Immunosuppressant treatment &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;1&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;1&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;733&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Comorbidities &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">142 &#40;28&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">141 &#40;21&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diabetes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;102&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Heart disease&#47;vasculopathy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;060&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;466&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Others&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;079&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab3583257.png"
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            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Descriptive data&#46;</p>"
        ]
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      1 => array:8 [
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        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
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        ]
        "tabla" => array:1 [
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            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"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">No vancomycin&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>493&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Vancomycin&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>658&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>-Value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Infection &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;1&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;2&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;342&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Type of infection &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Superficial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;26&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;73&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;412&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Profound&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;44&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;55&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#46;555&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Other complications &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">22 &#40;4&#46;4&#41;&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">39 &#40;5&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&#46;101&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1 &#40;2&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">2 &#40;5&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dysmetria&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;1&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Stiffness&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5 &#40;7&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;10&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">20 &#40;31&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">37 &#40;5&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">32 &#40;6&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">30 &#40;4&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hepatopathy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Fistula&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">DAIR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3583256.png"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Patients diagnosed with profound infection&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:36 [
            0 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Are we winning or losing the battle with periprosthetic joint infection&#58; trends in periprosthetic joint infection and mortality risk for the medicare population"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "S&#46;M&#46; Kurtz"
                            1 => "E&#46;C&#46; Lau"
                            2 => "M&#46;S&#46; Son"
                            3 => "E&#46;T&#46; Chang"
                            4 => "W&#46; Zimmerli"
                            5 => "J&#46; Parvizi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.arth.2018.05.042"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Arthroplasty"
                        "fecha" => "2018"
                        "volumen" => "33"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29914821"
                            "web" => "Medline"
                          ]
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                      ]
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                ]
              ]
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              "identificador" => "bib0190"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Periprosthetic joint infection"
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                          "etal" => false
                          "autores" => array:6 [
                            0 => "B&#46;H&#46; Kapadia"
                            1 => "R&#46;A&#46; Berg"
                            2 => "J&#46;A&#46; Daley"
                            3 => "J&#46; Fritz"
                            4 => "A&#46; Bhave"
                            5 => "M&#46;A&#46; Mont"
                          ]
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(14)61798-0"
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                        "tituloSerie" => "Lancet"
                        "fecha" => "2016"
                        "volumen" => "387"
                        "paginaInicial" => "386"
                        "paginaFinal" => "394"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26135702"
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                          ]
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              "identificador" => "bib0195"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The impact of surgical-site infections following orthopedic surgery at a community hospital and a university hospital&#58; adverse quality of life&#44; excess length of stay&#44; and extra cost"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46;D&#46; Whitehouse"
                            1 => "N&#46;D&#46; Friedman"
                            2 => "K&#46;B&#46; Kirkland"
                            3 => "W&#46;J&#46; Richardson"
                            4 => "D&#46;J&#46; Sexton"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1086/502033"
                      "Revista" => array:6 [
                        "tituloSerie" => "Infect Control Hosp Epidemiol"
                        "fecha" => "2002"
                        "volumen" => "23"
                        "paginaInicial" => "183"
                        "paginaFinal" => "189"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12002232"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prosthetic joint infection"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46;J&#46; Tande"
                            1 => "R&#46; Patel"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1128/CMR.00111-13"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Microbiol Rev"
                        "fecha" => "2014"
                        "volumen" => "27"
                        "paginaInicial" => "302"
                        "paginaFinal" => "345"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24696437"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Vancomycin prophylaxis for total joint arthroplasty&#58; incorrectly dosed and has a higher rate of periprosthetic infection than cefazolin"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46;M&#46; Kheir"
                            1 => "T&#46;L&#46; Tan"
                            2 => "I&#46; Azboy"
                            3 => "D&#46;D&#46; Tan"
                            4 => "J&#46; Parvizi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s11999-017-5302-0"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Orthop Relat Res"
                        "fecha" => "2017"
                        "volumen" => "475"
                        "paginaInicial" => "1767"
                        "paginaFinal" => "1774"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28401341"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Efficacy of antibiotic-impregnated cement in total hip replacement"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46; Parvizi"
                            1 => "K&#46;J&#46; Saleh"
                            2 => "P&#46;S&#46; Ragland"
                            3 => "A&#46;E&#46; Pour"
                            4 => "M&#46;A&#46; Mont"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1080/17453670710015229"
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Orthop"
                        "fecha" => "2008"
                        "volumen" => "79"
                        "paginaInicial" => "335"
                        "paginaFinal" => "341"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18622836"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Antibiotic-impregnated cement in revision total knee arthroplasty&#46; A prospective cohort study of one hundred and eighty-three knees"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "F&#46;Y&#46; Chiu"
                            1 => "C&#46;F&#46; Lin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2106/JBJS.G.01570"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Bone Joint Surg Am"
                        "fecha" => "2009"
                        "volumen" => "91"
                        "paginaInicial" => "628"
                        "paginaFinal" => "633"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19255223"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0220"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The role of vancomycin-soaking of the graft in anterior cruciate ligament reconstruction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "E&#46;C&#46; Rodriguez-Merchan"
                            1 => "W&#46;J&#46; Ribbans"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J ISAKOS"
                        "fecha" => "2022"
                        "volumen" => "7"
                        "paginaInicial" => "94"
                        "paginaFinal" => "98"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Vancomycin powder in total joint replacement&#58; what is the evidence&#44; and is it good enough to support its routine use&#63;"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "F&#46; Mancino"
                            1 => "V&#46; Gant"
                            2 => "D&#46;R&#46;M&#46; Meek"
                            3 => "F&#46;S&#46; Haddad"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Bone Joint J"
                        "fecha" => "2023"
                        "volumen" => "105B"
                        "paginaInicial" => "833"
                        "paginaFinal" => "836"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "10"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of intra-wound vancomycin for spinal surgery&#58; a systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46;L&#46; Xie"
                            1 => "J&#46; Zhu"
                            2 => "M&#46;S&#46; Yang"
                            3 => "C&#46;Y&#46; Yang"
                            4 => "S&#46;H&#46; Luo"
                            5 => "Y&#46; Xie"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/os.12356"
                      "Revista" => array:6 [
                        "tituloSerie" => "Orthop Surg"
                        "fecha" => "2017"
                        "volumen" => "9"
                        "paginaInicial" => "350"
                        "paginaFinal" => "358"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29178308"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The use of vancomycin powder in modern spine surgery&#58; systematic review and meta-analysis of the clinical evidence"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46; Bakhsheshian"
                            1 => "N&#46;S&#46; Dahdaleh"
                            2 => "S&#46;K&#46; Lam"
                            3 => "J&#46;W&#46; Savage"
                            4 => "Z&#46;A&#46; Smith"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.wneu.2014.12.033"
                      "Revista" => array:6 [
                        "tituloSerie" => "World Neurosurg"
                        "fecha" => "2015"
                        "volumen" => "83"
                        "paginaInicial" => "816"
                        "paginaFinal" => "823"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25535069"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0240"
              "etiqueta" => "12"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lumbar laminectomy and fusion with routine local application of vancomycin powder&#58; decreased infection rate in instrumented and non-instrumented cases"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "R&#46;G&#46; Strom"
                            1 => "D&#46; Pacione"
                            2 => "S&#46;P&#46; Kalhorn"
                            3 => "A&#46;K&#46; Frempong-Boadu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.clineuro.2013.04.005"
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                        "tituloSerie" => "Clin Neurol Neurosurg"
                        "fecha" => "2013"
                        "volumen" => "115"
                        "paginaInicial" => "1766"
                        "paginaFinal" => "1769"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23622935"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0245"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Intrawound application of vancomycin for prophylaxis in instrumented thoracolumbar fusions"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "F&#46;A&#46; Sweet"
                            1 => "M&#46; Roh"
                            2 => "C&#46; Silva"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
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                        "tituloSerie" => "Spine"
                        "fecha" => "2011"
                        "volumen" => "36"
                        "paginaInicial" => "2084"
                        "paginaFinal" => "2088"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21304438"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "14"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effects of using intravenous antibiotic only versus local intrawound vancomycin antibiotic powder application in addition to intravenous antibiotics on postoperative infection in spine surgery in 907 patients"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
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                            1 => "S&#46; Rajasekaran"
                            2 => "A&#46;P&#46; Shetty"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/BRS.0000000000000015"
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                        "tituloSerie" => "Spine &#40;Phila Pa 1976&#41;"
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                        "paginaInicial" => "2149"
                        "paginaFinal" => "2155"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24048091"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "15"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Complications from the use of intrawound vancomycin in lumbar spinal surgery&#58; a systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "G&#46;M&#46; Ghobrial"
                            1 => "D&#46;W&#46; Cadotte"
                            2 => "K&#46; Williams Jr&#46;"
                            3 => "M&#46;G&#46; Fehlings"
                            4 => "J&#46;S&#46; Harrop"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3171/2015.9.FOCUS15383"
                      "Revista" => array:5 [
                        "tituloSerie" => "Neurosurg Focus"
                        "fecha" => "2015"
                        "volumen" => "39"
                        "paginaInicial" => "E11"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26621409"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Intrawound vancomycin powder increases post-operative wound complications and does not decrease periprosthetic joint infection in primary total and unicompartmental knee arthroplasties"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46; Hanada"
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                            2 => "K&#46; Hotta"
                            3 => "H&#46; Furuhashi"
                            4 => "H&#46; Hoshino"
                            5 => "Y&#46; Matsuyama"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
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                        "tituloSerie" => "Knee Surg Sports Traumatol Arthrosc"
                        "fecha" => "2019"
                        "volumen" => "27"
                        "paginaInicial" => "2322"
                        "paginaFinal" => "2327"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30968239"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0265"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Proceedings of the international consensus on periprosthetic joint infection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
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                            1 => "T&#46; Gehrke"
                            2 => "A&#46;F&#46; Chen"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Bone Joint J"
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                        "volumen" => "95B"
                        "paginaInicial" => "450"
                        "paginaFinal" => "452"
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0270"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Systematic review and meta-analysis of intrawound vancomycin in total hip and total knee arthroplasty&#58; a continued call for a prospective randomized trial"
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                        0 => array:2 [
                          "etal" => true
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                            2 => "B&#46;S&#46; Gettleman"
                            3 => "C&#46;K&#46; Mayfield"
                            4 => "D&#46;A&#46; Oakes"
                            5 => "J&#46;R&#46; Lieberman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.arth.2022.03.047"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Arthroplasty"
                        "fecha" => "2022"
                        "volumen" => "37"
                        "paginaInicial" => "1405"
                        "paginaFinal" => "1415"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35314283"
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                          ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "The application of topical vancomycin powder for the prevention of surgical site infections in primary total hip and knee arthroplasty&#58; a meta-analysis"
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                        0 => array:2 [
                          "etal" => false
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                            4 => "S&#46; Lu"
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                        ]
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                    0 => array:2 [
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                        "tituloSerie" => "Orthop Traumatol Surg Res"
                        "fecha" => "2021"
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                        "paginaInicial" => "102741"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33257290"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
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                ]
              ]
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                    0 => array:2 [
                      "titulo" => "Effects of different doses of vancomycin powder in total knee and hip arthroplasty on the periprosthetic joint infection rate&#58; a systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "S&#46; Liao"
                            1 => "Z&#46; Yang"
                            2 => "X&#46; Li"
                            3 => "J&#46; Chen"
                            4 => "J&#46;-G&#46; Liu"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/s13018-022-03445-2"
                      "Revista" => array:5 [
                        "tituloSerie" => "J Orthop Surg Res"
                        "fecha" => "2022"
                        "volumen" => "17"
                        "paginaInicial" => "546"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/36527075"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "etiqueta" => "21"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Efficacy and safety of intrawound vancomycin in primary hip and knee arthroplasty"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "H&#46; Xu"
                            1 => "J&#46; Yang"
                            2 => "J&#46; Xie"
                            3 => "Z&#46; Huang"
                            4 => "Q&#46; Huang"
                            5 => "G&#46; Cao"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1302/2046-3758.911.BJR-2020-0190.R2"
                      "Revista" => array:6 [
                        "tituloSerie" => "Bone Joint Res"
                        "fecha" => "2020"
                        "volumen" => "9"
                        "paginaInicial" => "778"
                        "paginaFinal" => "788"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33135425"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0290"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Can topical vancomycin prevent periprosthetic joint infection in hip and knee arthroplasty&#63; A systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46;T&#46; Wong"
                            1 => "S&#46;S&#46; Sridharan"
                            2 => "E&#46;M&#46; Davison"
                            3 => "R&#46; Ng"
                            4 => "N&#46;M&#46; Desy"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/CORR.0000000000001777"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Orthop Relat Res"
                        "fecha" => "2021"
                        "volumen" => "479"
                        "paginaInicial" => "1655"
                        "paginaFinal" => "1664"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33929342"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "etiqueta" => "23"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A systematic review and meta-analysis comparing intrawound vancomycin powder and povidone iodine lavage in the prevention of periprosthetic joint infection of hip and knee arthroplasties"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "V&#46;T&#46; Martin"
                            1 => "Y&#46; Zhang"
                            2 => "Z&#46; Wang"
                            3 => "Q&#46;-L&#46; Liu"
                            4 => "B&#46; Yu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jos.2022.11.013"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Orthop Sci"
                        "fecha" => "2024"
                        "volumen" => "29"
                        "paginaInicial" => "165"
                        "paginaFinal" => "176&#46;"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/36470703"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0300"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "No effect of vancomycin powder to prevent infection in primary total knee arthroplasty&#58; a retrospective review of 976 cases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "I&#46;A&#46; Yavuz"
                            1 => "O&#46;F&#46; Oken"
                            2 => "A&#46;O&#46; Yildirim"
                            3 => "F&#46; Inci"
                            4 => "E&#46; Ceyhan"
                            5 => "U&#46; Gurhan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Knee Surg Sports Traumatol Arthrosc"
                        "fecha" => "2019"
                        "volumen" => "28"
                        "paginaInicial" => "3055"
                        "paginaFinal" => "3060"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0305"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Intrawound vancomycin powder reduces early prosthetic joint infections in revision hip and knee arthroplasty"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;E&#46; Otte"
                            1 => "J&#46;R&#46; Politi"
                            2 => "B&#46; Chambers"
                            3 => "C&#46;A&#46; Smith"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Surg Technol Int"
                        "fecha" => "2017"
                        "volumen" => "30"
                        "paginaInicial" => "284"
                        "paginaFinal" => "289"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28182821"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0310"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Intrawound vancomycin powder in primary total hip arthroplasty increases rate of sterile wound complications"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "B&#46;L&#46; Dial"
                            1 => "A&#46;J&#46; Lampley"
                            2 => "C&#46;L&#46; Green"
                            3 => "R&#46; Hallows"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.5371/hp.2018.30.1.37"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hip Pelvis"
                        "fecha" => "2018"
                        "volumen" => "30"
                        "paginaInicial" => "37"
                        "paginaFinal" => "44"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29564296"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0315"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Does the organism profile of periprosthetic joint infections change with a topical vancomycin powder and dilute povidone-iodine lavage protocol&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "D&#46;B&#46; Buchalter"
                            1 => "G&#46;M&#46; Teo"
                            2 => "D&#46;J&#46; Kirby"
                            3 => "R&#46; Schwarzkopf"
                            4 => "V&#46;K&#46; Aggarwal"
                            5 => "W&#46;J&#46; Long"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.arth.2020.12.036"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Arthroplasty"
                        "fecha" => "2021"
                        "volumen" => "36"
                        "paginaInicial" => "S314"
                        "paginaFinal" => "S319"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33526397"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0320"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Intraarticular vancomycin decreased the risk of acute postoperative periprosthetic joint infection without increasing complication in primary total joint arthroplasty &#8211; a prospective study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46; Hu"
                            1 => "Y&#46; Zhang"
                            2 => "X&#46; Yang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ijid.2023.09.004"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Infect Dis"
                        "fecha" => "2023"
                        "volumen" => "136"
                        "paginaInicial" => "64"
                        "paginaFinal" => "69"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/37714404"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0325"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Intraarticular vancomycin powder is effective in preventing infections following total hip and knee arthroplasty"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "G&#46; Matziolis"
                            1 => "S&#46; Brodt"
                            2 => "S&#46; B&#246;hle"
                            3 => "J&#46; Kirschberg"
                            4 => "B&#46; Jacob"
                            5 => "E&#46; R&#246;hner"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Sci Rep"
                        "fecha" => "2020"
                        "volumen" => "10"
                        "paginaInicial" => "13053"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0330"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Severe local vancomycin induced skin necrosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "D&#46;W&#46; Hoelen"
                            1 => "D&#46;H&#46; Tjan"
                            2 => "R&#46; van Vugt"
                            3 => "Y&#46;G&#46; van der Meer"
                            4 => "A&#46;R&#46; van Zanten"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2125.2007.02897.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Clin Pharmacol"
                        "fecha" => "2007"
                        "volumen" => "64"
                        "paginaInicial" => "553"
                        "paginaFinal" => "554"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17425624"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0335"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of cefazolin and vancomycin on osteoblast in vitro"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:5 [
                            0 => "M&#46;L&#46; Edin"
                            1 => "T&#46; Miclau"
                            2 => "G&#46;E&#46; Lester"
                            3 => "R&#46;W&#46; Lindsey"
                            4 => "L&#46;E&#46; Dahners"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Clin Orthop"
                        "fecha" => "1996"
                        "volumen" => "333"
                        "paginaInicial" => "245"
                        "paginaFinal" => "251"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0340"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Does intrawound application of vancomycin influence bone healing in spinal surgery&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Eder"
                            1 => "S&#46; Stefan"
                            2 => "J&#46; Trifinopoulos"
                            3 => "B&#46; K&#252;lekci"
                            4 => "M&#46; Kienzl"
                            5 => "S&#46; Schildb&#246;ck"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00586-015-3943-9"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Spine J"
                        "fecha" => "2016"
                        "volumen" => "25"
                        "paginaInicial" => "1021"
                        "paginaFinal" => "1028"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25904413"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0345"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of various concentrations of antibiotics on osteogenic cell viability and activity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46;R&#46; Rathbone"
                            1 => "J&#46;D&#46; Cross"
                            2 => "K&#46;V&#46; Brown"
                            3 => "C&#46;K&#46; Murray"
                            4 => "J&#46;C&#46; Wenke"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/jor.21343"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Orthop Res"
                        "fecha" => "2011"
                        "volumen" => "29"
                        "paginaInicial" => "1070"
                        "paginaFinal" => "1074"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21567453"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0350"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Toxic effect of vancomycin on viability and functionality of different cells involved in tissue regeneration"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46; Braun"
                            1 => "S&#46; Eckes"
                            2 => "P&#46;M&#46; Rommens"
                            3 => "K&#46; Schmitz"
                            4 => "D&#46; Nickel"
                            5 => "U&#46; Ritz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3390/antibiotics9050238"
                      "Revista" => array:6 [
                        "tituloSerie" => "Antibiotics &#40;Basel&#41;"
                        "fecha" => "2020"
                        "volumen" => "9"
                        "paginaInicial" => "238"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32397094"
                            "web" => "Medline"
                          ]
                        ]
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                          "pii" => "S0140673611602420"
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                          "issn" => "01406736"
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                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0355"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Establishing a role for vancomycin poder application for prosthetic joint infection prevention &#8211; results of a wear simulation study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
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                            1 => "J&#46;L&#46; Ochsner"
                            2 => "G&#46;F&#46; Chimento"
                            3 => "M&#46;S&#46; Meyer"
                            4 => "B&#46; Waddell"
                            5 => "J&#46;M&#46; Zavatsky"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Arthroplasty"
                        "fecha" => "2014"
                        "volumen" => "29"
                        "paginaInicial" => "1449"
                        "paginaFinal" => "1456"
                        "itemHostRev" => array:3 [
                          "pii" => "S0085253815609930"
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                  ]
                ]
              ]
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            35 => array:3 [
              "identificador" => "bib0360"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Use of intrawound antibiotics in orthopaedic surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46;F&#46; Chen"
                            1 => "A&#46; Fleischman"
                            2 => "M&#46;S&#46; Austin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.5435/JAAOS-D-17-00003"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Orthop Surg"
                        "fecha" => "2018"
                        "volumen" => "26"
                        "paginaInicial" => "e371"
                        "paginaFinal" => "e378"
                        "link" => array:1 [
                          0 => array:2 [
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Article information
ISSN: 18884415
Original language: English
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos