Elective primary total hip arthroplasty in octogenarians. A case–control study | Revista Española de Cirugía Ortopédica y Traumatología (English Edition)

array:24 ["pii" => "S1988885613000321" "issn" => "19888856" "doi" => "10.1016/j.recote.2013.06.002" "estado" => "S300" "fechaPublicacion" => "2013-05-01" "aid" => "394" "copyright" => "SECOT" "copyrightAnyo" => "2012" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Rev Esp Cir Ortop Traumatol. 2013;57:186-93" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 507 "formatos" => array:2 [ "HTML" => 377 "PDF" => 130 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S1888441513000283" "issn" => "18884415" "doi" => "10.1016/j.recot.2013.02.003" "estado" => "S300" "fechaPublicacion" => "2013-05-01" "aid" => "394" "copyright" => "SECOT" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Rev Esp Cir Ortop Traumatol. 2013;57:186-93" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1556 "formatos" => array:3 [ "EPUB" => 8 "HTML" => 1229 "PDF" => 319 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original" "titulo" => "Artroplastia total de cadera primaria electiva no cementada en octogenarios. Estudio de caso-control" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "186" "paginaFinal" => "193" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Elective primary total hip arthroplasty in octogenarians. A case-control study" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1380 "Ancho" => 1533 "Tamanyo" => 77734 ] ] "descripcion" => array:1 [ "es" => "Supervivencia acumulada (Kaplan-Meier) para la mortalidad (p=0,360)." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Lizaur-Utrilla, J. Sanz-Reig" "autores" => array:2 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Lizaur-Utrilla" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Sanz-Reig" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1988885613000321" "doi" => "10.1016/j.recote.2013.06.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1988885613000321?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1888441513000283?idApp=UINPBA00004N" "url" => "/18884415/0000005700000003/v1_201307311245/S1888441513000283/v1_201307311245/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1988885613000382" "issn" => "19888856" "doi" => "10.1016/j.recote.2013.03.006" "estado" => "S300" "fechaPublicacion" => "2013-05-01" "aid" => "401" "copyright" => "SECOT" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Rev Esp Cir Ortop Traumatol. 2013;57:194-200" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 937 "formatos" => array:2 [ "HTML" => 729 "PDF" => 208 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Hip arthroplasty with conventional stem as rescue treatment after failed treatment of intertrochanteric hip fractures" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "194" "paginaFinal" => "200" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Artroplastia de cadera con vástago convencional en fracasos de osteosíntesis de fracturas del fémur proximal" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1219 "Ancho" => 1000 "Tamanyo" => 122256 ] ] "descripcion" => array:1 [ "en" => "Failure of osteosynthesis. Cut-out." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "P. Castillón, A. Bartra, G. Vallejo, J. Salvador, R. Torres, F. Anglés" "autores" => array:6 [ 0 => array:2 [ "nombre" => "P." "apellidos" => "Castillón" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Bartra" ] 2 => array:2 [ "nombre" => "G." "apellidos" => "Vallejo" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Salvador" ] 4 => array:2 [ "nombre" => "R." "apellidos" => "Torres" ] 5 => array:2 [ "nombre" => "F." "apellidos" => "Anglés" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1888441513000404" "doi" => "10.1016/j.recot.2013.03.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1888441513000404?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1988885613000382?idApp=UINPBA00004N" "url" => "/19888856/0000005700000003/v1_201307260034/S1988885613000382/v1_201307260034/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S198888561300031X" "issn" => "19888856" "doi" => "10.1016/j.recote.2013.02.001" "estado" => "S300" "fechaPublicacion" => "2013-05-01" "aid" => "393" "copyright" => "SECOT" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Rev Esp Cir Ortop Traumatol. 2013;57:178-85" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 921 "formatos" => array:2 [ "HTML" => 817 "PDF" => 104 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Growing rods in early-onset scoliosis. Do they really help to control the deformity and spinal and thoracic growth?" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "178" "paginaFinal" => "185" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Barras de crecimiento en escoliosis de inicio precoz ¿Permiten realmente el control de la deformidad y el crecimiento vertebral y torácico?" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 1164 "Ancho" => 2139 "Tamanyo" => 151165 ] ] "descripcion" => array:1 [ "en" => "Estimated T1-T12 distance values in the patients with early-onset scoliosis and in the control group (patients with cystic fibrosis). Note the different line slopes, with greater increase in the estimated thorax length in the control group." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.M. Sánchez Márquez, F.J. Sánchez Pérez-Grueso, N. Fernández-Baíllo, A. García Fernández" "autores" => array:4 [ 0 => array:2 [ "nombre" => "J.M." "apellidos" => "Sánchez Márquez" ] 1 => array:2 [ "nombre" => "F.J." "apellidos" => "Sánchez Pérez-Grueso" ] 2 => array:2 [ "nombre" => "N." "apellidos" => "Fernández-Baíllo" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "García Fernández" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1888441513000271" "doi" => "10.1016/j.recot.2013.02.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1888441513000271?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S198888561300031X?idApp=UINPBA00004N" "url" => "/19888856/0000005700000003/v1_201307260034/S198888561300031X/v1_201307260034/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Elective primary total hip arthroplasty in octogenarians. A case–control study" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "186" "paginaFinal" => "193" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A. Lizaur-Utrilla, J. Sanz-Reig" "autores" => array:2 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Lizaur-Utrilla" "email" => array:1 [ 0 => "lizaur1@telefonica.net" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "¿" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Sanz-Reig" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Cirugía Ortopédica, Hospital Universitario de Elda, Elda, Alicante, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Artroplastia total de cadera primaria electiva no cementada en octogenarios. Estudio de caso-control" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1378 "Ancho" => 1526 "Tamanyo" => 73034 ] ] "descripcion" => array:1 [ "en" => "Cumulative survival rate (Kaplan–Meier) for the acetabular component (P=.599)." ] ] ] "textoCompleto" => "IntroductionTotal hip arthroplasty (THA) is a common surgical procedure, especially in elderly people, with highly satisfactory results. Cemented fixation is still considered the reference standard due to the longer follow-up.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> The increase in life expectancy has made it so that elderly patients are more frequently candidates for THA. In younger patients, the advantage of a cementless prosthesis favors biological fixation through osseointegration so that the prosthetic lasts longer.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> In elderly patients, other potential advantages have been proposed, such as reducing the risk of embolism admitted in cemented prostheses, operative time, and blood loss.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> All of these factors are relevant for patients in a more fragile health state. Despite the fact that the objective of THA is to relieve pain and facilitate functioning, other decision factors have been introduced in the selection of implants for elderly patients, such as cost containment,<a class="elsevierStyleCrossRef" href="#bib0020">4</a> even though there is evidence advising against making a selection based solely on age.<a class="elsevierStyleCrossRef" href="#bib0010">2</a>Even though many studies have been published regarding the benefits of primary THA in octogenarian patients, most of them used cemented prostheses.<a class="elsevierStyleCrossRefs" href="#bib0025">5,6</a> The use of cementless primary prostheses in patients older than 80 years continues to be controversial,<a class="elsevierStyleCrossRef" href="#bib0035">7</a> even though there are few studies in this respect. We only found 3 studies involving case series of primary arthroplasties,<a class="elsevierStyleCrossRefs" href="#bib0010">2,8,9</a> and none of them were comparative. Another study,<a class="elsevierStyleCrossRef" href="#bib0035">7</a> although it presented results involving fixation in octogenarians, was weak in its design as it was a descriptive study based on a national registry of arthroplasties. Therefore, it did not present an adequate selection of cohorts for result comparison.The objective of this study was to assess the results, complications, and efficacy of elective cementless primary THA in a population 80 years or older.Material and methodsThis work was designed as a retrospective, comparative, observational matched case–control study, approved by our institution's clinical research ethics committee. A minimum of 5 years of postoperative follow-up was required for the results analysis.From our department's computerized arthroplasty registry, we identified a total of 712 cementless primary THAs performed by the 2 authors (ALU and JSR) in patients with hip osteoarthritis between January 2004 and December 2007. Of these, 55 consecutive THAs had been implanted in 54 patients 80 years or older. In our department, the use of both cementless components was routine in coxarthrosis, except in patients whose preoperative functional state predicted very limited ambulatory ability after the intervention. Three octogenarian patients were found to be in this situation; they received a cemented THA and were consequently not included in the study.Using the same database, a control cohort was selected of patients aged 70–79 years that underwent a cementless THA operation due to hip osteoarthritis, 69 years being the median age for patients undergoing this surgery in our department. The study was initially designed with 1:2 matching (2 controls for each case) according to different preoperative variables (sex, body mass index [BMI], previous health state, previous functioning, bone quality of the proximal femur, etc.). However, given the difficulty in obtaining 2 appropriate controls, we decided to match with respect to only the following variables: sex, diagnosis, prosthesis design, surgery, and implantation date. The controls were 2 patients that complied with the criteria, undergoing the operation immediately after their respective case. Even though this matching was not very strict, the control group was comparable to that of the study group in many characteristics (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>The mean age of the 54 octogenarian patients (55 hips) was 81.7 years (range: 80–87; standard deviation [SD]: 1.9), with 35 females and 19 males. The right hip was affected in 28 patients, the left in 23, and both in 2. The control cohort consisted of 110 hips in 106 patients, with a mean age of 74.2 years (range: 70–79; SD: 2.6), including 68 females and 38 males. The right hip was affected in 69 patients, the left in 33, and both in 4. As expected, there were significant differences between both cohorts with respect to age, American Society of Anesthesiologists (ASA) grades,<a class="elsevierStyleCrossRef" href="#bib0050">10</a> number of comorbidities, and preoperative hip functioning; but not regarding sex, BMI, Charnley categories,<a class="elsevierStyleCrossRef" href="#bib0005">1</a> or proximal femur types according to Dorr<a class="elsevierStyleCrossRef" href="#bib0055">11</a> (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).Previous health state was assessed using ASA grades<a class="elsevierStyleCrossRef" href="#bib0050">10</a> and the number of significant comorbidities for hip surgery in elderly patients, defined by Holt et al.<a class="elsevierStyleCrossRef" href="#bib0060">12</a> Of the octogenarians, 50 hips were associated with 1 comorbidity or none at all, and 5 with 2 comorbidities, the most common being hypertension (85%), heart disease (7%), and chronic obstructive pulmonary disease (5%). Of the controls, 105 had 1 pre-existing comorbidity or none at all, and 5 had 2 comorbidities; the most common were hypertension (50%), chronic obstructive pulmonary disease (6%), and heart disease (3%). Based on comorbidity presence, the odds ratio for octogenarians was 3.52 (95% confidence interval [CI]: 1.70–7.24) and 0.63 (95% CI: 0.52–0.77) for controls. The octogenarians showed a 5.5 times higher risk of presenting comorbidity (P=.001). Preoperatively (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>), the octogenarians had a lower level of hemoglobin than the controls (P=.014), even though the 2 groups shared a similar hematocrit level (P=.061).Surgical protocolAll surgeries were carried out in a laminar flow clean room, using low spinal anesthesia, and with the same standard surgical technique using a modified Hardinge<a class="elsevierStyleCrossRef" href="#bib0065">13</a> lateral approach. In all cases, both cementless components were used. Two THA systems were implanted according to the surgeon's preference. One was the Duofit® system (cup and stem; Samo, Bologna, Italy) and the other was a Vitalock® cup with a Meridian® stem (both from Stryker, Mahwah, USA). Both systems had similar geometry. The stems were straight and without a neck, composed of titanium alloy, the upper third coated in circumferential plasma-spray, and they had holes for additional stability with screws. In all cases – octogenarian and control – 2 divergent screws were used. All femoral heads were 28mm, modular, and made of cobalt chromium. All the inserts were polyethylene with a high molecular weight and 12° elevation, sterilized by gamma irradiation.All patients followed the same standard postoperative protocol. Perioperative antibiotic prophylaxis with first generation cephalosporin was done within 24h. Thromboprophylaxis with low molecular weight heparin was given within 1 month. Patients underwent a postoperative blood transfusion if their hemoglobin was less than 8g/dl. Prophylaxis was not used for heterotopic ossification in any cases. Patients were allowed ambulatory freedom the day following the intervention, if tolerated.EvaluationsOur department's registry of arthroplasties has clinical and radiographic data for all patients treated with arthroplasties. Follow-up was prospective and standardized, with postoperative assessments at 6 weeks, 1 year, and then annually until at least 5 years after the operation. Medical registries of patients were reviewed to extract relevant information regarding diagnosis, surgery details, postoperative hospital stay, functional and radiographic results, complications, and mortality. With respect to the last factor, all patients were also contacted by telephone.Before their operations, all patients were examined – and medically treated if necessary – by an internal medicine doctor and an anesthesiologist. Preoperative health state was defined by ASA grades<a class="elsevierStyleCrossRef" href="#bib0050">10</a> and the number of pre-existing comorbidities.<a class="elsevierStyleCrossRef" href="#bib0060">12</a> Patients were classified by their functioning according to the Charnley categories.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> The objective preoperative assessments and the postoperative follow-ups were done by trained residents. For clinical functioning, the Harris<a class="elsevierStyleCrossRef" href="#bib0070">14</a> and Merle d’Aubigné<a class="elsevierStyleCrossRef" href="#bib0075">15</a> scales were used. Anterior thigh pain was assessed as absent, mild, moderate, or severe using the same criterion as that used in the pain category from the Harris scale.Standard AP and lateral X-rays were taken preoperatively and at each postoperative evaluation. Before the operation, bone quality and proximal femur morphology were determined according to Dorr et al.<a class="elsevierStyleCrossRef" href="#bib0055">11</a> The 6-week postoperative X-rays were compared to those from the last evaluation done in order to determine component stability. To localize radiolucent lines, osteolysis, or bone remodeling, DeLee and Charnley zones<a class="elsevierStyleCrossRef" href="#bib0080">16</a> were used for the acetabular component, while Gruen<a class="elsevierStyleCrossRef" href="#bib0085">17</a> zones were used for the femoral component. Radiolucent lines were categorized as absent or greater than 1mm, and osteolyses were considered to be greater than 5mm. The position of the cup was determined according to the Massin et al.<a class="elsevierStyleCrossRef" href="#bib0090">18</a> criteria, and its stability according to criteria proposed by González Della Valle et al.<a class="elsevierStyleCrossRef" href="#bib0095">19</a> for cementless cups. Acetabular weakening was considered when there was a position change of at least 2mm or 2°, continuous radiolucency of 1mm or greater, or periacetabular osteolysis or osteolysis around the screws. With respect to the femoral component, stability was determined according to criteria from Engh et al.<a class="elsevierStyleCrossRef" href="#bib0100">20</a> for cementless stems. They were considered weak if there was progressive subsidence greater than 5mm, angular position change of 3° or more, radiolucency width greater than 2mm, or osteolysis. Heterotopic ossification was evaluated according to Brooker et al.<a class="elsevierStyleCrossRef" href="#bib0105">21</a>Statistical analysisThis analysis was done using version 15.0 of the SPSS® program (SPSS Inc., Chicago, USA). P values equal to or less than 0.05 were considered significant. In order to determine normal distribution, the Kolmogorov–Smirnov test was used. For comparisons between cohorts, univariate analyses were carried out for categorical variables using the Chi-squared test in variables with normal distribution, or the Mantel–Haenszel test for non-parametric data. The Student t or Mann–Whitney U tests were used for continuous variables. In comparing pre- and postoperative data, the Student t (for paired samples) or Wilcoxon Signed-Rank tests were used. Multivariate analyses were then carried out, using the variables that showed a significant difference in the univariate analysis as independent variables and mortality, resultant functioning, or prosthetic failures as dependent variables. Logistic regression analysis was used when the independent variable was dichotomous, while Cox regression was used when it was not. The odds ratio (OR) or hazard ratio (HR) were calculated with 95% confidence intervals. Kaplan–Meier analysis was used to calculate cumulative survival and the log-rank test was used to compare survival curves.ResultsWe reviewed 54 octogenarian patients (55 hips), of which 1 died of colon cancer 5 months after the operation without premature hip complications. This patient was excluded from the results analysis. In the control cohort, there were 106 patients (110 hips), of which 4 died within 5 postoperative years (range: 3.0–4.7 years) from causes unrelated to the hip (lung cancer, digestive cancer, leukemia, heart attack). These 4 patients were also excluded from analysis. Other octogenarian and control patients died after 5 postoperative years. However, given the initial advanced age of these patients, they were not excluded from results analysis, as they complied with the minimum criteria. There were no other follow-up losses. Therefore, 53 octogenarian patients (54 hips) and 102 controls (106 hips) remained for analysis of results. The average postoperative follow-up was 7.1 years (range: 5–12; SD: 1.2) among the octogenarians and 7.3 years (range 5–12; SD: 1.4) in the controls (P=.366) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>The mean hospital stay for the octogenarians was 7.5 days (range: 4–13), and 7.3 days (range: 3–16) for the control cohort (P=.701). All patients came from their homes and were sent directly to them afterward.Medical complications and postoperative mortalityPreoperatively, no blood transfusions were necessary for any patient. Postoperatively, transfusions were required in 12 (12.8%) octogenarians and in 18 (16.3%) control patients (P=.399).The postoperative medical complication rate was not significantly different between the 2 cohorts (P=.601). Complications were present in 2 (3.7%) octogenarians (2 urinary infections) and in 2 (1.9%) controls (pneumonia and deep vein thrombosis without pulmonary embolism). As for the presence of medical complications, with the limited number of patients available, neither cohort was influenced by sex, ASA grade, or number of pre-existing comorbidities (P>.05).There were no perioperative deaths in either cohort. In the octogenarian group, 7 patients (12.9%) died in a mean postoperative period of 6.5 years (range: 5 months to 9 years), of which 6 patients died 5 or more years after the operation. In the control cohort, 9 patients (8.4%) died in a mean postoperative period of 6.0 years (range: 3–9 years), of which 5 patients died 5 or more years after the operation. No patient died from causes related to the hip surgery. The odds ratio (OR) for death in the octogenarian cohort was 1.35 (95% CI: 0.74–2.48), and it was 0.84 (95% CI: 0.53–1.29) for the controls, the difference being non-significant (P=.406). With the Kaplan–Meier analysis (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), and considering death from whatever cause as an ending point, the cumulative survival rate was 98.1% (95% CI: 96.1–100) in the octogenarians between 1 and 5 postoperative years, and 78.4% (95% CI: 61.7–96.3) at 9 postoperative years. Furthermore, the rates for the controls were 99.0% (95% CI: 97.2–100) between 1 and 5 postoperative years and 85.5% (95% CI: 33.4–98.3) at 9 postoperative years. The log-rank analysis showed no significant differences between the cohorts (P=.360). Cox regression analysis revealed that, in both cohorts, the following were not significant independent predictors of mortality: sex, BMI, ASA grade, number of comorbidities, necessity for transfusion, postoperative medical complications, and type of prosthetic (P<.05).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Hip function resultsThe mean Merle d’Aubigné<a class="elsevierStyleCrossRef" href="#bib0075">15</a> score increased from 4.3 (range: 2–7) preoperatively to 10.2 (range: 8–12) for the octogenarians in the last postoperative follow-up (P=.001), while the mean score on the Harris<a class="elsevierStyleCrossRef" href="#bib0070">14</a> scale went from 35.8 points (range 20–54) to 87.5 (range: 77–96) (P=.001). According to the Harris criteria, 14 hips were classified as having excellent results, 38 with good results, 1 fair, and 1 poor result. Five patients reported mild thigh pain that did not affect their daily activities. Of the sample, 51 patients could walk outside of their home and 2 could only walk inside; 48 (90.5%) patients used walking support before the operation and 26 (49%) after the operation (P=.001).The mean score for the control cohort on the Merle d’Aubigné scale increased from 4.8 (range: 2–8) preoperatively to 10.4 (range: 4–12) in the last postoperative follow-up (P=.001), while the mean Harris score went from 40.2 points (range: 24–53) to 87.3 (range: 44–98) (P=.001). According to the Harris criteria, 64 hips were classified as having excellent results, 36 with good results, 3 fair, and 3 poor results. Five patients reported mild thigh pain and 4 reported moderate or continuous pain that affected their functioning. Of the sample, 99 patients were able to walk outside of the house and 3 could only walk inside; 70 (66%) patients used walking support before the operation and 31 (29.2%) after the operation (P=.001).There were no significant differences between the 2 cohorts in relation to thigh pain (P=.471), ability to walk (P=.399), or use of walking support (P=.175). In addition, there were no significant differences found in relation to postoperative Harris score (P=.899), Merle d’Aubigné score (P=.525), or type of prosthetic (P=.761). However, the octogenarians showed a significantly higher postoperative increase on the hip function scales compared to the controls (P=.002).Radiographic resultsAccording to the classification used by Dorr et al.,<a class="elsevierStyleCrossRef" href="#bib0055">11</a> there were 12 type A hips, 32 type B, and 10 type C among the 54 valid octogenarian hips; and among the 106 controls, there were 21, 71, and 14, respectively (P=.850). Clinical results were independent of bone type in both cohorts (P>.05).In the octogenarians, the mean postoperative acetabular angle was 43.6° (range: 42–62°). In the acetabular components, there were no radiolucent lines greater than 1mm. Migration of the acetabular component was observed in 1 patient that had had a cup fracture during the operation, which resulted in the cup being considered unstable. There were no cases of osteolysis or screw breaks. Osseointegration was observed in the rest of the acetabular components. There were no radiolucent lines or osteolysis surrounding the femoral component, but 2 stems presented subsidence greater than 5mm, and were consequently considered unstable. According to the Engh et al.<a class="elsevierStyleCrossRef" href="#bib0100">20</a> criteria, the other 52 stems presented osseointegration.In the control group, the mean postoperative acetabular angle was 42.9° (range: 38–62°). There were radiolucent lines less than 1mm in 4 acetabular components, all of them confined to a single zone (1 and 2) and none of them were progressive. Another acetabular component had continuous radiolucency greater than 1mm, and still another showed migration, causing both to be deemed unstable. There were no cases of osteolysis or screw breaks. At the femoral level, there were radiolucencies less than 2mm in 12 stems, of which 4 were located in zone 1, 5 in zone 3, and 3 in zone 7. Four other stems showed progressive radiolucencies greater than 2mm. Two of those presented 3° migration and the other 2 showed subsidence of 5 and 6mm, all of them consequently considered unstable. According to the Engh et al.<a class="elsevierStyleCrossRef" href="#bib0100">20</a> criteria, the rest of the femoral components were stable, 101 with osseointegration and 1 with asymptomatic stable fibrous fixation at 8 years.In the octogenarians, there was 1 patient with Brooker et al.<a class="elsevierStyleCrossRef" href="#bib0105">21</a> grade II heterotopic ossification, while the control cohort presented 2 cases of grade I ossification, 1 grade II, and 1 grade III. The ossifications presented in both groups had no clinical significance.Orthopedic complications and surgical reviewsOne octogenarian patient had persistent drainage of the wound, which required early superficial cleaning and antibiotics, resulting in a final score of 91 points on the Harris<a class="elsevierStyleCrossRef" href="#bib0070">14</a> scale. In the control cohort, 1 patient had a deep infection, treated with 2-step revision at 16 months, with a final functional result of 44 points.Among the octogenarians, there was 1 patient with early dislocation treated using closed reduction, with a final functional result of 80 points. Another patient presented recurrent dislocation that only required switching from the acetabular to a well-placed cementless component at 2 months after the operation, with a functional result of 86 points. There were no dislocations in the control cohort.There were intraoperative fractures in 2 octogenarian patients. In 1 case, it was an acetabular fracture seen at 1 month after the operation, which just required switching from the acetabular to a cementless component, resulting in a score of 80 points. The other was a diaphyseal fracture treated with cerclage, which resulted in 6mm stem subsidence at 2 years postoperative and with a functional result of 77 points. This patient rejected stem replacement. A third patient presented subsidence and femoral radiolucencies at 7.6 years after the operation, with a functional score of 80 points, and refused surgical revision.In the control cohort, there were no intraoperative fractures. One patient suffered a periprosthetic femoral fracture from a fall 2 years after the operation, which was treated with open reduction and internal fixation, resulting in a functional score of 66 points. Of the other 4 stems considered unstable, 1 was revised at 11 months postoperatively with a functional result of 43 points. In the other 3, instability was detected at 5.4, 7.3, and 9.0 years postoperatively and the cups were not revised due to the patients’ refusal. These patients had functional scores of 61, 72, and 68 points, respectively. At the acetabular level, the 2 cups considered unstable were revised using cementless cups at 3.5 and 10.7 years postoperatively, with a final functional result of 66 and 62 points, respectively.In summary, there were 4 (7%) hips (2 cups and 2 stems) in the octogenarian cohort and 7 (6.6%) hips (2 cups and 5 stems) in the control cohort with aseptic revision or need of it. The survival rate of the prosthesis at 9 years, with the final point being revision or need of it – not including the cases of septic revision or periprosthetic fracture – was 89.2% (95% CI: 78–100) in the octogenarian cohort and 86.3% (95% CI: 69.6–100) in the control cohort (log-rank, P=.728). For the acetabular component (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), the survival rate was 96.4% (95% CI: 91–100) in the octogenarians and 97.4% (95% CI: 91.3–100) in the control cohort (log-rank, P=.599). For the femoral component (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>), the survival rate was 92.6% (95% CI: 82–100) in the octogenarians and 94.0% (95% CI: 88–100) in the control cohort (log-rank, P=.978). Cox regression analysis revealed that prosthesis failure, sex, BMI, Dorr category, and prosthesis type were not significant independent predictors in either cohort (P>.05).<elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia>DiscussionWe have not found comparative studies on the efficacy of the primary cementless prosthetic hip in patients older than 80 years. Consequently, our results could only be discussed with respect to other case series studies. The main weakness in our study was its retrospective design. Furthermore, even though our patients were consecutive, there could be an implicit selection process in the surgery indication, given that patients showed relatively good preoperative medical condition overall: 86% fell under grades 1 and 2 of the ASA.<a class="elsevierStyleCrossRef" href="#bib0050">10</a>Total hip replacement has shown to be greatly advantageous in elderly patients,<a class="elsevierStyleCrossRef" href="#bib0005">1</a> which is why it has been advised that the selection of candidates for this surgery not be done solely based on age.<a class="elsevierStyleCrossRefs" href="#bib0110">22,23</a> In previous studies carried out in our institution, we observed satisfactory results with cementless prostheses in young patients, at both the acetabular<a class="elsevierStyleCrossRef" href="#bib0120">24</a> and femoral<a class="elsevierStyleCrossRef" href="#bib0125">25</a> component levels. Nonetheless, there is controversy<a class="elsevierStyleCrossRef" href="#bib0035">7</a> surrounding the type of fixation used in elderly patients. The convenience of cemented fixation at an arbitrary age has been postulated because of poor bone quality,<a class="elsevierStyleCrossRefs" href="#bib0055">11,26</a> as well as for economic reasons<a class="elsevierStyleCrossRef" href="#bib0020">4</a> based on less physical demand and lower life expectancy for the patient. Our study indicated that the patient's age does not have to be a deciding factor in selecting the type of fixation for THA, as the increase in functional results showed its efficacy and the complication rates were similar in patients whose ages were within the range of our normal surgical practice.Economic arguments for restricting the use of cementless prostheses in elderly patients have been refuted by other studies. Barrack et al.<a class="elsevierStyleCrossRef" href="#bib0020">4</a> and Laupacis et al.<a class="elsevierStyleCrossRef" href="#bib0135">27</a> determined the difference in costs between a cementless and cemented prosthesis to be irrelevant with the current cementation systems (costs of cementing, mixing device, pressurization, gun, cement cap, pulsating irrigation device). They also posited that in many cases, the current cost of a modern cemented prosthesis may be higher than a cementless one. Furthermore, cementless prostheses reduce intervention time and rates of hypotensive crisis, embolism, and, in general, adverse effects known as bone cement implantation syndrome.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> The increase in costs derived from the potential failure rate and consequential surgical revision for the cementless prosthetic in octogenarians is not supported by the lack of significant difference between that cohort and these rates in younger patients, as shown in our study and in those by other authors.<a class="elsevierStyleCrossRef" href="#bib0010">2</a>In our study, there were no differences between the 2 groups regarding the risk of requiring postoperative transfusion, and the medical complications rate was similar, as reported by other authors.<a class="elsevierStyleCrossRefs" href="#bib0010">2,9</a> No perioperative deaths were observed and the mortality rate in the octogenarians after a mean follow-up of 7 years was 12.9%, which was not significantly different from that of the control group. Using cementless prostheses in octogenarians, Badhe et al.<a class="elsevierStyleCrossRef" href="#bib0045">9</a> reported an 11% mortality rate at 7 years in 60 patients, and Keisu et al.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> reported no perioperative deaths and a mortality rate of 6% at 2 years in 114 patients. Using cemented prostheses in octogenarians, Ekelund et al.<a class="elsevierStyleCrossRef" href="#bib0140">28</a> reported a 2% mortality rate in the first 3 months after the operation in a series of 162 patients.In our octogenarian cohort, there were no cases of deep infection, 2 dislocations, 2 intraoperative fractures, and no weakening of acetabulum or aseptic stem weakening, all these figures being similar to those in the control cohort. There was a 7% rate of surgical revision or need of it. All this was similar to other studies with cementless prostheses in octogenarians.<a class="elsevierStyleCrossRefs" href="#bib0010">2,8,9</a> Other authors<a class="elsevierStyleCrossRef" href="#bib0060">12</a> reported that there might have been defects in fixation due to poor bone quality. In our octogenarian group, all of the acetabulum showed osseointegration and only 1 stem was unstable because of subsidence. Badhe et al.<a class="elsevierStyleCrossRef" href="#bib0045">9</a> reported 57 osseointegrated stems and 2 with subsidence, although asymptomatic, in their series of 59 octogenarians with a mean postoperative follow-up period of 7 years. In this study, all the cups were stable except for 2 asymptomatic fibrous ones. Keisu et al.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> reported that all acetabular and femoral components showed osseointegration in their series of 114 octogenarians with a mean follow-up of 7 years.In our octogenarian group, the survival rate at 7 years, for aseptic reasons, was 96% for the acetabular component and 98% for the stem. Badhe et al.<a class="elsevierStyleCrossRef" href="#bib0045">9</a> found a survival rate of 98% and 100%, respectively, at 7 years. Keisu et al.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> found a survival rate of 100% for both components at 5 years. Using cementless prostheses in younger patients, 65 years or older, Engh et al.<a class="elsevierStyleCrossRef" href="#bib0100">20</a> reported a survival rate of 98% for the prosthesis at 8 years, and McAuley et al.<a class="elsevierStyleCrossRef" href="#bib0145">29</a> reported 92% at 12 years. Ogino et al.<a class="elsevierStyleCrossRef" href="#bib0035">7</a> carried out a descriptive study of the Finnish registry of arthroplasties, finding 6989 registered THA implants in patients older than 80 years between 1980 and 2004. Of this sample, there was some information regarding 195 (2.8%) that resulted in revision due to failure, the principal causes being aseptic weakening (1.2%), recurrent dislocation (0.5%), periprosthetic fracture (0.3%), and deep infection (0.3%). However, no data were provided as to the initial diagnosis or the type of fixation used in the primary prosthesis in which the failure occurred. According to those data, they found that the survival rate for the prosthesis at 5 years after using hybrid fixation was 98%, 97% for cemented, and 96% for cementless; although they reported no significant difference between the latter 2 types, there was a significant difference between the hybrids and the cementless. They therefore recommended using cemented stems for patients with advanced age. However, the study presented significant weaknesses in our opinion, as the data available were limited and incomplete. Furthermore, 392 different prosthetic systems were used in the study, and 30% of the procedures were done with prostheses designed at least 20 years ago.In our study, the mean score increase among the octogenarians, between pre- and postoperative scores, was 6 points on the Merle d’Aubigné scale and 52 points on the Harris scale. All of the octogenarians, except for 2, had excellent or good results, which was similar to the control group. In our study, this demonstrated the efficacy of cementless prostheses in patients in this age range. Other authors reported similar increases on the hip function scales for octogenarians with cementless prostheses.<a class="elsevierStyleCrossRefs" href="#bib0010">2,8,9</a> Several authors<a class="elsevierStyleCrossRefs" href="#bib0150">30,31</a> found no differences in incidence of anterior thigh pain from using cementless stems or cemented ones in elderly patients,. With cemented THA in octogenarians, a recent study<a class="elsevierStyleCrossRef" href="#bib0160">32</a> reported a 48% rate of satisfactory results after a mean follow-up of 2.5 years, finding that regular and poor function results were associated with concomitant affectation of other joints.In our study, cementless total hip arthroplasty was shown to be safe and effective in octogenarian patients with coxarthrosis, with a component survival rate similar to that in younger patients. The notable increase found in functional results justifies the continued use of cementless prostheses in patients with advanced age.Ethical responsibilitiesHuman and animal protectionThe authors declare that no experiments were carried out on humans or animals for this study.Data confidentialityThe authors declare that they followed the protocols of their work center regarding publication of patient data, and that all patients included in the study received sufficient information and gave their informed consent in writing to participate in the study.Right to privacy and informed consentThe authors declare that this article does not present any patient data.Conflict of interestThe authors have no conflict of interests to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:2 [ "identificador" => "xres231469" "titulo" => array:6 [ 0 => "Abstract" 1 => "Objective" 2 => "Material and methods" 3 => "Results" 4 => "Discussion" 5 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec217974" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres231470" "titulo" => array:6 [ 0 => "Resumen" 1 => "Objetivo" 2 => "Material y métodos" 3 => "Resultados" 4 => "Discusión" 5 => "Conclusiones" ] ] 3 => array:2 [ "identificador" => "xpalclavsec217973" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and methods" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Surgical protocol" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Evaluations" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Statistical analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0030" "titulo" => "Results" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0035" "titulo" => "Medical complications and postoperative mortality" ] 1 => array:2 [ "identificador" => "sec0040" "titulo" => "Hip function results" ] 2 => array:2 [ "identificador" => "sec0045" "titulo" => "Radiographic results" ] 3 => array:2 [ "identificador" => "sec0050" "titulo" => "Orthopedic complications and surgical reviews" ] ] ] 7 => array:2 [ "identificador" => "sec0055" "titulo" => "Discussion" ] 8 => array:3 [ "identificador" => "sec0060" "titulo" => "Ethical responsibilities" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0065" "titulo" => "Human and animal protection" ] 1 => array:2 [ "identificador" => "sec0070" "titulo" => "Data confidentiality" ] 2 => array:2 [ "identificador" => "sec0075" "titulo" => "Right to privacy and informed consent" ] ] ] 9 => array:2 [ "identificador" => "sec0080" "titulo" => "Conflict of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2012-12-06" "fechaAceptado" => "2013-02-07" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec217974" "palabras" => array:3 [ 0 => "Octogenarian" 1 => "Total hip arthroplasty" 2 => "Osteoarthritis" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec217973" "palabras" => array:3 [ 0 => "Octogenarios" 1 => "Artroplastia total de cadera" 2 => "Artrosis" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "ObjectiveTo evaluate the results and efficacy of cementless total hip arthroplasty (THA) in octogenarians with osteoarthritis. Material and methodsMatched case–control study with ratio 1:2. Consecutive selection of 54 octogenarians (55 hips), and 106 control patients (110 hips) with age ranging from 70 to 79 years. Mean follow-up of 7 years (range, 5–12). Before 5 postoperative years, 1 and 4 patients, respectively, died and they were excluded. Clinical assessment was performed using ASA grade, comorbidities, and Harris and Merle d’Aubigné hip scores, and radiographic, complications, and mortality evaluations were made. ResultsThere were no perioperative deaths in either cohort. The rates of postoperative medical complications (P=.601) and survival (P=.360) were similar. The survival at 7 years was 89.8% in octogenarian and 95.3% in controls, with no influence of the preoperative variables. There were no differences in postoperative functional outcomes (P=.761), but improvement with respect to the preoperative was higher in octogenarian (P=.002). In octogenarians there were 2 intraoperative fractures, 2 dislocations and 2 unstable stems, and in control patients 1 deep infection, 1 peri-prosthetic femoral fracture, 2 unstable cups and 4 unstable stems. The rates of aseptic complications, the need for revision, and arthroplasty survival (94% at 7 years) were similar in both cohorts. DiscussionDue to improvement in health status, the octogenarian may have a life expectancy of at least 10 years. The cost arguments and an arbitrary age should not influence the selection of candidates for cementless THA. ConclusionsCementless THA has been shown to be safe and effective in octogenarian patients with osteoarthritis. The notable increase found in functional outcomes justifies the continued use in these patients." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "ObjetivoValorar resultados y eficacia de la artroplastia total de cadera (ATC) no cementada en octogenarios con coxartrosis. Material y métodosEstudio de caso-control con emparejamiento 1:2. Selección consecutiva de 54 octogenarios (55 caderas) y 106 controles (110 caderas) con edad 70-79 años. Seguimiento medio de 7 años (rango, 5-12). Antes de 5 años de seguimiento murieron 1 y 4 pacientes, respectivamente, siendo excluidos. Se realizó valoración clínica mediante ASA, comorbilidades, escalas de Harris y Merle D’Aubigné, y valoración radiográfica, de complicaciones y de mortalidad. ResultadosEn ambas cohortes no hubo muertes perioperatorias, siendo similar la tasa de complicaciones médicas (p=0,601) y la supervivencia (p=0,360) que a 7 años fue 89,8% en octogenarios y 95,3% en controles, no influyendo las variables preoperatorias. No hubo diferencias en los resultados funcionales postoperatorios (p=0,761) pero los octogenarios tuvieron mayor incremento (p=0,002) respecto al preoperatorio. En octogenarios hubo 2 fracturas intraoperatorias, 2 luxaciones y 2 vástagos inestables. En los controles, 1 infección profunda, 1 fractura periprotésica femoral, e inestabilidad en 2 cotilos y 4 vástagos. Las tasas de complicaciones asépticas, de necesidad de revisión y de supervivencia de la artroplastia (94% a 7 años) fueron similares en ambas cohortes. DiscusiónEl incremento en el estado de salud hace que los octogenarios tengan una expectativa de vida de al menos 10 años. El argumento de costes y una edad arbitraria no debe influir en la selección de candidatos a ATC no cementada. ConclusionesLa ATC no cementada se ha mostrado segura y efectiva en los octogenarios con coxartrosis. El notable incremento encontrado en los resultados funcionales justifica el continuar utilizándola en estos pacientes." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Lizaur-Utrilla A, Sanz-Reig J. Artroplastia total de cadera primaria electiva no cementada en octogenarios. Estudio de caso-control. Rev Esp Cir Ortop Traumatol. 2013;57:186–93." ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1379 "Ancho" => 1533 "Tamanyo" => 73761 ] ] "descripcion" => array:1 [ "en" => "Cumulative survival rate (Kaplan–Meier) for mortality (P=.360)." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1378 "Ancho" => 1526 "Tamanyo" => 73034 ] ] "descripcion" => array:1 [ "en" => "Cumulative survival rate (Kaplan–Meier) for the acetabular component (P=.599)." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1347 "Ancho" => 1495 "Tamanyo" => 72355 ] ] "descripcion" => array:1 [ "en" => "Cumulative survival rate (Kaplan–Meier) for the femoral component (P=.978)." ] ] 3 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "For continuous variables, the data are presented as mean (SD)." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td 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" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Octogenarians \t\t\t\t\t\t\n \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Controls \t\t\t\t\t\t\n \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">P value \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><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">Age \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">81.7 (1.9) \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">74.2 (2.6) \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">.001 \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 " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female/male \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">35/19 \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">68/38 \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">.916 \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 " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BMI \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">29.3 (4.0) \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">29.1 (3.8) \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">.866 \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 " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ASA (1/2/3) \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">3/44/8 \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">10/95/5 \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">.038 \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 " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No. of comorbidities \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">0.9 (0.4) \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">0.6 (0.5) \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">.001 \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 " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hemoglobin \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">13.3 (1.0) \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">13.9 (1.2) \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">.014 \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 " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hematocrit \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">39.7 (3.3) \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">41.0 (3.3) \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">.061 \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 " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dorr (A/B/C) \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">13/32/10 \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">23/73/14 \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">.850 \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 " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Charnley (A/B/C) \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">34/15/6 \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">71/24/15 \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">.698 \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 " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Harris \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">35.8 (8.4) \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">40.2 (6.1) \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">.001 \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 " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Merle d’Aubigné \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">4.3 (1.2) \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">4.8 (1.1) \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">.028 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab347196.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Preoperative and demographic data." ] ] 4 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "Survival rate (95% CI); SD: standard deviation; N/C: cannot be calculated." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td 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" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Octogenarians \t\t\t\t\t\t\n \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Controls \t\t\t\t\t\t\n \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">P value \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><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">No. of transfusions \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">12 \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">18 \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">.399 \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 " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No. of medical complications \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">2 \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">2 \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">.601 \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 " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mortality at 9 years \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">21.6% (38–4) \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">14.5% (67–2) \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">.360 \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 " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Merle d’Aubigné \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">10.2 (SD: 1.0) \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">10.4 (SD: 1.9) \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">.525 \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 " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Harris \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">87.5 (SD: 4.8) \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">87.3 (SD: 14.0) \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">.899 \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 " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Deep infection \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">0 \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">1 \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">N/C \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 " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Intraoperative fracture \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">2 \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">0 \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">N/C \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 " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dislocation \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">2 \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">0 \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">N/C \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 " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Unstable cup \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">0 \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">2 \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">N/C \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 " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Unstable stem \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">2 \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 \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">.560 \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 " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No. of revisions \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">2 \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 \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">.560 \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 " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cup survival at 9 years \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">96.3% (91–100) \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">97.4 (91–100) \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">.599 \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 " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Stem survival at 9 years \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">92.6% (82–100) \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">94.0% (88–100) \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">.978 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab347197.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Postoperative results and complications." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:32 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The nine and ten year results of the low-friction arthroplasty of the hip" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. Charnley" 1 => "Z. Cupic" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Orthop Relat Res" "fecha" => "1973" "volumen" => "95" "paginaInicial" => "9" "paginaFinal" => "25" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4754221" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary cementless total hip arthroplasty in octogenarians: two to eleven-year follow-up" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "K.S. Keisu" 1 => "F. Orozco" 2 => "P.F. Sharkey" 3 => "W.J. Hozack" 4 => "R.H. Rothman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Bone Joint Surg Am" "fecha" => "2001" "volumen" => "83" "paginaInicial" => "359" "paginaFinal" => "363" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11263639" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bone cement implantation syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A.J. Donaldson" 1 => "H.E. Thomson" 2 => "N.J. Harper" 3 => "N.W. Kenny" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/bja/aen328" "Revista" => array:6 [ "tituloSerie" => "Br J Anaesth" "fecha" => "2009" "volumen" => "102" "paginaInicial" => "12" "paginaFinal" => "22" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19059919" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cost of implanting a cemented versus cementless femoral stem" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R.L. Barrack" 1 => "F. Castro" 2 => "S. Guinn" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Arthroplasty" "fecha" => "1996" "volumen" => "11" "paginaInicial" => "373" "paginaFinal" => "376" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8792242" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Total joint arthroplasty in the extremely elderly: hip and knee arthroplasty after entering the 89th year of life" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.E. Berend" 1 => "A.E. Thong" 2 => "G.W. Faris" 3 => "G. Newbern" 4 => "J.L. Pierson" 5 => "M.A. Ritter" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Arthroplasty" "fecha" => "2003" "volumen" => "18" "paginaInicial" => "817" "paginaFinal" => "821" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14566733" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The outcome of primary total hip and knee arthroplasty in patients aged 80 years or more" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "N.D. Clement" 1 => "D. MacDonald" 2 => "C.R. Howie" 3 => "L.C. Biant" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1302/0301-620X.93B9.25962" "Revista" => array:6 [ "tituloSerie" => "J Bone Joint Surg Br" "fecha" => "2011" "volumen" => "93" "paginaInicial" => "1265" "paginaFinal" => "1270" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21911540" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Total hip replacement in patients eighty years of age and older" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Ogino" 1 => "H. Kawaji" 2 => "L. Konttinen" 3 => "M. Lehto" 4 => "P. Rantanen" 5 => "A. Malmivaara" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2106/JBJS.G.00147" "Revista" => array:6 [ "tituloSerie" => "J Bone Joint Surg Am" "fecha" => "2008" "volumen" => "90" "paginaInicial" => "1884" "paginaFinal" => "1890" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18762648" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cementless total hip arthroplasty in patients older than 80 years of age" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "H. Pieringer" 1 => "G. Labek" 2 => "V. Auersperg" 3 => "N. Böhler" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Bone Joint Surg Br" "fecha" => "2003" "volumen" => "85" "paginaInicial" => "641" "paginaFinal" => "645" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12892182" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The uncemented Bicontact total hip arthroplasty in octogenarians" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "N.P. Badhe" 1 => "R.C. Quinnell" 2 => "P.W. Howard" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Eur J Orthop Surg Traumatol" "fecha" => "2002" "volumen" => "12" "paginaInicial" => "192" "paginaFinal" => "197" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Relative value guide" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "American Society of Anesthesiologists" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:1 [ "fecha" => "2008" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Functional results in total hip replacement in patients 65 years and older" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L.D. Dorr" 1 => "Z. Wan" 2 => "T. Gruen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Orthop Relat Res" "fecha" => "1997" "volumen" => "336" "paginaInicial" => "143" "paginaFinal" => "151" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9060498" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Outcomes after surgery for fractures of the hip in patients aged over 95 years" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "G. Holt" 1 => "D. Macdonald" 2 => "M. Fraser" 3 => "A.T. Reece" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1302/0301-620X.88B8.17398" "Revista" => array:6 [ "tituloSerie" => "J Bone Joint Surg Br" "fecha" => "2006" "volumen" => "88" "paginaInicial" => "1060" "paginaFinal" => "1064" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16877606" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The direct lateral approach to the hip" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "K. Hardinge" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Bone Joint Surg Br" "fecha" => "1982" "volumen" => "64B" "paginaInicial" => "17" "paginaFinal" => "19" ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "W.H. Harris" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Bone Joint Surg Am" "fecha" => "1969" "volumen" => "51" "paginaInicial" => "737" "paginaFinal" => "755" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/5783851" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Functional results of hip arthroplasty with acrylic prosthesis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R. Merle d’Aubigné" 1 => "M. Postel" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Bone Joint Surg Am" "fecha" => "1954" "volumen" => "36" "paginaInicial" => "451" "paginaFinal" => "475" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/13163078" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Radiologic demarcation of cemented sockets in total hip replacement" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.S. DeLee" 1 => "J. Charnley" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Orthop Relat Res" "fecha" => "1976" "volumen" => "121" "paginaInicial" => "20" "paginaFinal" => "32" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/991504" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "“Modes of failures” of cemented stem-type femoral component: a radiographic analysis of loosening" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "T.A. Gruen" 1 => "G.M. McNiece" 2 => "H.C. Amstutz" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Orthop Relat Res" "fecha" => "1979" "volumen" => "141" "paginaInicial" => "17" "paginaFinal" => "27" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/477100" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evaluation of cementless acetabular component migration: an experimental study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P. Massin" 1 => "L. Schmidt" 2 => "C.A. Engh" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Arthroplasty" "fecha" => "1989" "volumen" => "4" "paginaInicial" => "245" "paginaFinal" => "251" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2795031" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical and radiographic results associated with a modern, cementless modular cup design in total hip arthroplasty" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. González Della Valle" 1 => "A. Zoppi" 2 => "M.G.E. Peterson" 3 => "E.A. Salvati" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Bone Joint Surg Am" "fecha" => "2004" "volumen" => "86" "paginaInicial" => "1998" "paginaFinal" => "2003" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15342763" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Porous-coated hip replacement: the factors governing bone ingrowth, stress shielding, and clinical results" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C.A. Engh" 1 => "J.D. Bobyn" 2 => "A.H. Glassman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Bone Joint Surg Br" "fecha" => "1987" "volumen" => "69" "paginaInicial" => "45" "paginaFinal" => "55" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3818732" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ectopic ossification following total hip replacement" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A.F. Brooker" 1 => "J.W. Bowerman" 2 => "R.A. Robinson" 3 => "L.H. Riley" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Bone Joint Surg Am" "fecha" => "1973" "volumen" => "551" "paginaInicial" => "629" "paginaFinal" => "632" ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0110" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The effect of age on pain, function, and quality of life after total hip and knee arthroplasty" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C.A. Jones" 1 => "D.C. Voaklander" 2 => "D.W. Johnston" 3 => "M.E. Suarez-Almazor" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Intern Med" "fecha" => "2001" "volumen" => "161" "paginaInicial" => "454" "paginaFinal" => "460" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11176772" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0115" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Patient characteristics affecting the prognosis of total hip and knee joint arthroplasty: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P.L. Santaguida" 1 => "G.A. Hawker" 2 => "P.L. Hudak" 3 => "R. Glazier" 4 => "N.N. Mahomed" 5 => "H.J. Kreder" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Can J Surg" "fecha" => "2008" "volumen" => "51" "paginaInicial" => "428" "paginaFinal" => "436" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19057730" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0120" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Supervivencia del componente acetabular no cementado con par polietileno-metal en pacientes jóvenes: estudio prospectivo con seguimiento de 8 a 13 años" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J. Sanz Reig" 1 => "A. Lizaur Utrilla" 2 => "J. Plazola Gutiérrez" 3 => "R. Cebrián Gómez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Esp Cir Ortop Traumatol" "fecha" => "2009" "volumen" => "53" "paginaInicial" => "83" "paginaFinal" => "89" ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0125" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Resultados del vástago femoral no cementado Meridian: estudio prospectivo de 109 casos" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Sanz Reig" 1 => "A. Lizaur Utrilla" 2 => "I. Llamas Merino" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Esp Cir Ortop Traumatol" "fecha" => "2011" "volumen" => "55" "paginaInicial" => "346" "paginaFinal" => "351" ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0130" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparison of a hybrid with an uncemented total hip replacement: a retrospective matched-pair study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "W.J. Maloney" 1 => "W.H. Harris" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Bone Joint Surg Am" "fecha" => "1990" "volumen" => "72" "paginaInicial" => "1349" "paginaFinal" => "1352" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2229111" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0135" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Costs of elective total hip arthroplasty during first year: cemented versus non-cemented" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Laupacis" 1 => "R. Bourne" 2 => "C. Rorabeck" 3 => "D. Feeny" 4 => "C. Wong" 5 => "P. Tugwell" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Arthroplasty" "fecha" => "1994" "volumen" => "9" "paginaInicial" => "481" "paginaFinal" => "487" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7807104" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0140" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Total hip arthroplasty in patients 80 years of age and older" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Ekelund" 1 => "N. Rydell" 2 => "O.S. Nilsson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Orthop Relat Res" "fecha" => "1992" "volumen" => "281" "paginaInicial" => "101" "paginaFinal" => "106" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1499193" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0145" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Total hip arthroplasty with porous-coated prosthesis fixed without cement in-patients who are sixty five years of age or older" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.P. McAuley" 1 => "D.K. Moore" 2 => "W.J. Culpepper" 3 => "A. Engh" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Bone Joint Surg Am" "fecha" => "1998" "volumen" => "80" "paginaInicial" => "1648" "paginaFinal" => "1655" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9840634" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0150" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Total hip arthroplasty with uncemented femoral stem" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.R. McLaughlin" 1 => "K.R. Lee" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Bone Joint Surg Br" "fecha" => "1997" "volumen" => "79" "paginaInicial" => "900" "paginaFinal" => "907" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9393901" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0155" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term results of Charnley total hip replacement: review of 92 patients at 15 to 20 years" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L. Neumann" 1 => "K.G. Freund" 2 => "K.H. Sorenson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Bone Joint Surg Br" "fecha" => "1994" "volumen" => "76" "paginaInicial" => "245" "paginaFinal" => "251" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8113285" "web" => "Medline" ] ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0160" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Total hip arthroplasty for osteoarthritis in patients aged 80 years or older: influence of co-morbidities on final outcome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "E. De Thomasson" 1 => "I. Caux" 2 => "O. Guingand" 3 => "R. Terracher" 4 => "C. Mazel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.otsr.2009.03.011" "Revista" => array:6 [ "tituloSerie" => "Orthop Traumatol Surg Res" "fecha" => "2009" "volumen" => "95" "paginaInicial" => "249" "paginaFinal" => "253" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19443286" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/19888856/0000005700000003/v1_201307260034/S1988885613000321/v1_201307260034/en/main.assets" "Apartado" => array:4 [ "identificador" => "7577" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/19888856/0000005700000003/v1_201307260034/S1988885613000321/v1_201307260034/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1988885613000321?idApp=UINPBA00004N"]

Statistics

Original article

Elective primary total hip arthroplasty in octogenarians. A case–control study

Artroplastia total de cadera primaria electiva no cementada en octogenarios. Estudio de caso-control

A. Lizaur-Utrilla

Corresponding author

lizaur1@telefonica.net

Corresponding author.

, J. Sanz-Reig

Servicio de Cirugía Ortopédica, Hospital Universitario de Elda, Elda, Alicante, Spain

Read

1522

Times
was read the article

366

Total PDF

1156

Total HTML

Share statistics

 array:24 [
  "pii" => "S1988885613000321"
  "issn" => "19888856"
  "doi" => "10.1016/j.recote.2013.06.002"
  "estado" => "S300"
  "fechaPublicacion" => "2013-05-01"
  "aid" => "394"
  "copyright" => "SECOT"
  "copyrightAnyo" => "2012"
  "documento" => "article"
  "crossmark" => 0
  "subdocumento" => "fla"
  "cita" => "Rev Esp Cir Ortop Traumatol. 2013;57:186-93"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 507
    "formatos" => array:2 [
      "HTML" => 377
      "PDF" => 130
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S1888441513000283"
      "issn" => "18884415"
      "doi" => "10.1016/j.recot.2013.02.003"
      "estado" => "S300"
      "fechaPublicacion" => "2013-05-01"
      "aid" => "394"
      "copyright" => "SECOT"
      "documento" => "article"
      "crossmark" => 0
      "subdocumento" => "fla"
      "cita" => "Rev Esp Cir Ortop Traumatol. 2013;57:186-93"
      "abierto" => array:3 [
        "ES" => false
        "ES2" => false
        "LATM" => false
      ]
      "gratuito" => false
      "lecturas" => array:2 [
        "total" => 1556
        "formatos" => array:3 [
          "EPUB" => 8
          "HTML" => 1229
          "PDF" => 319
        ]
      ]
      "es" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Original</span>"
        "titulo" => "Artroplastia total de cadera primaria electiva no cementada en octogenarios&#46; Estudio de caso-control"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "186"
            "paginaFinal" => "193"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Elective primary total hip arthroplasty in octogenarians&#46; A case-control study"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0005"
            "etiqueta" => "Figura 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr1.jpeg"
                "Alto" => 1380
                "Ancho" => 1533
                "Tamanyo" => 77734
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Supervivencia acumulada &#40;Kaplan-Meier&#41; para la mortalidad &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;360&#41;&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "A&#46; Lizaur-Utrilla, J&#46; Sanz-Reig"
            "autores" => array:2 [
              0 => array:2 [
                "nombre" => "A&#46;"
                "apellidos" => "Lizaur-Utrilla"
              ]
              1 => array:2 [
                "nombre" => "J&#46;"
                "apellidos" => "Sanz-Reig"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S1988885613000321"
          "doi" => "10.1016/j.recote.2013.06.002"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1988885613000321?idApp=UINPBA00004N"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1888441513000283?idApp=UINPBA00004N"
      "url" => "/18884415/0000005700000003/v1_201307311245/S1888441513000283/v1_201307311245/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S1988885613000382"
    "issn" => "19888856"
    "doi" => "10.1016/j.recote.2013.03.006"
    "estado" => "S300"
    "fechaPublicacion" => "2013-05-01"
    "aid" => "401"
    "copyright" => "SECOT"
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "fla"
    "cita" => "Rev Esp Cir Ortop Traumatol. 2013;57:194-200"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 937
      "formatos" => array:2 [
        "HTML" => 729
        "PDF" => 208
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
      "titulo" => "Hip arthroplasty with conventional stem as rescue treatment after failed treatment of intertrochanteric hip fractures"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "194"
          "paginaFinal" => "200"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Artroplastia de cadera con v&#225;stago convencional en fracasos de osteos&#237;ntesis de fracturas del f&#233;mur proximal"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1219
              "Ancho" => 1000
              "Tamanyo" => 122256
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Failure of osteosynthesis&#46; <span class="elsevierStyleItalic">Cut-out</span>&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "P&#46; Castill&#243;n, A&#46; Bartra, G&#46; Vallejo, J&#46; Salvador, R&#46; Torres, F&#46; Angl&#233;s"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "P&#46;"
              "apellidos" => "Castill&#243;n"
            ]
            1 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Bartra"
            ]
            2 => array:2 [
              "nombre" => "G&#46;"
              "apellidos" => "Vallejo"
            ]
            3 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Salvador"
            ]
            4 => array:2 [
              "nombre" => "R&#46;"
              "apellidos" => "Torres"
            ]
            5 => array:2 [
              "nombre" => "F&#46;"
              "apellidos" => "Angl&#233;s"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S1888441513000404"
        "doi" => "10.1016/j.recot.2013.03.004"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1888441513000404?idApp=UINPBA00004N"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1988885613000382?idApp=UINPBA00004N"
    "url" => "/19888856/0000005700000003/v1_201307260034/S1988885613000382/v1_201307260034/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S198888561300031X"
    "issn" => "19888856"
    "doi" => "10.1016/j.recote.2013.02.001"
    "estado" => "S300"
    "fechaPublicacion" => "2013-05-01"
    "aid" => "393"
    "copyright" => "SECOT"
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "fla"
    "cita" => "Rev Esp Cir Ortop Traumatol. 2013;57:178-85"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 921
      "formatos" => array:2 [
        "HTML" => 817
        "PDF" => 104
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
      "titulo" => "Growing rods in early-onset scoliosis&#46; Do they really help to control the deformity and spinal and thoracic growth&#63;"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "178"
          "paginaFinal" => "185"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Barras de crecimiento en escoliosis de inicio precoz &#191;Permiten realmente el control de la deformidad y el crecimiento vertebral y tor&#225;cico&#63;"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0025"
          "etiqueta" => "Figure 5"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr5.jpeg"
              "Alto" => 1164
              "Ancho" => 2139
              "Tamanyo" => 151165
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Estimated T1-T12 distance values in the patients with early-onset scoliosis and in the control group &#40;patients with cystic fibrosis&#41;&#46; Note the different line slopes&#44; with greater increase in the estimated thorax length in the control group&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "J&#46;M&#46; S&#225;nchez M&#225;rquez, F&#46;J&#46; S&#225;nchez P&#233;rez-Grueso, N&#46; Fern&#225;ndez-Ba&#237;llo, A&#46; Garc&#237;a Fern&#225;ndez"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "J&#46;M&#46;"
              "apellidos" => "S&#225;nchez M&#225;rquez"
            ]
            1 => array:2 [
              "nombre" => "F&#46;J&#46;"
              "apellidos" => "S&#225;nchez P&#233;rez-Grueso"
            ]
            2 => array:2 [
              "nombre" => "N&#46;"
              "apellidos" => "Fern&#225;ndez-Ba&#237;llo"
            ]
            3 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Garc&#237;a Fern&#225;ndez"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S1888441513000271"
        "doi" => "10.1016/j.recot.2013.02.002"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1888441513000271?idApp=UINPBA00004N"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S198888561300031X?idApp=UINPBA00004N"
    "url" => "/19888856/0000005700000003/v1_201307260034/S198888561300031X/v1_201307260034/en/main.assets"
  ]
  "en" => array:20 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
    "titulo" => "Elective primary total hip arthroplasty in octogenarians&#46; A case&#8211;control study"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "186"
        "paginaFinal" => "193"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "A&#46; Lizaur-Utrilla, J&#46; Sanz-Reig"
        "autores" => array:2 [
          0 => array:4 [
            "nombre" => "A&#46;"
            "apellidos" => "Lizaur-Utrilla"
            "email" => array:1 [
              0 => "lizaur1&#64;telefonica&#46;net"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">¿</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:2 [
            "nombre" => "J&#46;"
            "apellidos" => "Sanz-Reig"
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Servicio de Cirug&#237;a Ortop&#233;dica&#44; Hospital Universitario de Elda&#44; Elda&#44; Alicante&#44; Spain"
            "identificador" => "aff0005"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Artroplastia total de cadera primaria electiva no cementada en octogenarios&#46; Estudio de caso-control"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1378
            "Ancho" => 1526
            "Tamanyo" => 73034
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Cumulative survival rate &#40;Kaplan&#8211;Meier&#41; for the acetabular component &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;599&#41;&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Total hip arthroplasty &#40;THA&#41; is a common surgical procedure&#44; especially in elderly people&#44; with highly satisfactory results&#46; Cemented fixation is still considered the reference standard due to the longer follow-up&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The increase in life expectancy has made it so that elderly patients are more frequently candidates for THA&#46; In younger patients&#44; the advantage of a cementless prosthesis favors biological fixation through osseointegration so that the prosthetic lasts longer&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In elderly patients&#44; other potential advantages have been proposed&#44; such as reducing the risk of embolism admitted in cemented prostheses&#44; operative time&#44; and blood loss&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> All of these factors are relevant for patients in a more fragile health state&#46; Despite the fact that the objective of THA is to relieve pain and facilitate functioning&#44; other decision factors have been introduced in the selection of implants for elderly patients&#44; such as cost containment&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> even though there is evidence advising against making a selection based solely on age&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Even though many studies have been published regarding the benefits of primary THA in octogenarian patients&#44; most of them used cemented prostheses&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a> The use of cementless primary prostheses in patients older than 80 years continues to be controversial&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> even though there are few studies in this respect&#46; We only found 3 studies involving case series of primary arthroplasties&#44;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;8&#44;9</span></a> and none of them were comparative&#46; Another study&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> although it presented results involving fixation in octogenarians&#44; was weak in its design as it was a descriptive study based on a national registry of arthroplasties&#46; Therefore&#44; it did not present an adequate selection of cohorts for result comparison&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The objective of this study was to assess the results&#44; complications&#44; and efficacy of elective cementless primary THA in a population 80 years or older&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Material and methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">This work was designed as a retrospective&#44; comparative&#44; observational matched case&#8211;control study&#44; approved by our institution&#39;s clinical research ethics committee&#46; A minimum of 5 years of postoperative follow-up was required for the results analysis&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">From our department&#39;s computerized arthroplasty registry&#44; we identified a total of 712 cementless primary THAs performed by the 2 authors &#40;ALU and JSR&#41; in patients with hip osteoarthritis between January 2004 and December 2007&#46; Of these&#44; 55 consecutive THAs had been implanted in 54 patients 80 years or older&#46; In our department&#44; the use of both cementless components was routine in coxarthrosis&#44; except in patients whose preoperative functional state predicted very limited ambulatory ability after the intervention&#46; Three octogenarian patients were found to be in this situation&#59; they received a cemented THA and were consequently not included in the study&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Using the same database&#44; a control cohort was selected of patients aged 70&#8211;79 years that underwent a cementless THA operation due to hip osteoarthritis&#44; 69 years being the median age for patients undergoing this surgery in our department&#46; The study was initially designed with 1&#58;2 matching &#40;2 controls for each case&#41; according to different preoperative variables &#40;sex&#44; body mass index &#91;BMI&#93;&#44; previous health state&#44; previous functioning&#44; bone quality of the proximal femur&#44; etc&#46;&#41;&#46; However&#44; given the difficulty in obtaining 2 appropriate controls&#44; we decided to match with respect to only the following variables&#58; sex&#44; diagnosis&#44; prosthesis design&#44; surgery&#44; and implantation date&#46; The controls were 2 patients that complied with the criteria&#44; undergoing the operation immediately after their respective case&#46; Even though this matching was not very strict&#44; the control group was comparable to that of the study group in many characteristics &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">The mean age of the 54 octogenarian patients &#40;55 hips&#41; was 81&#46;7 years &#40;range&#58; 80&#8211;87&#59; standard deviation &#91;SD&#93;&#58; 1&#46;9&#41;&#44; with 35 females and 19 males&#46; The right hip was affected in 28 patients&#44; the left in 23&#44; and both in 2&#46; The control cohort consisted of 110 hips in 106 patients&#44; with a mean age of 74&#46;2 years &#40;range&#58; 70&#8211;79&#59; SD&#58; 2&#46;6&#41;&#44; including 68 females and 38 males&#46; The right hip was affected in 69 patients&#44; the left in 33&#44; and both in 4&#46; As expected&#44; there were significant differences between both cohorts with respect to age&#44; American Society of Anesthesiologists &#40;ASA&#41; grades&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> number of comorbidities&#44; and preoperative hip functioning&#59; but not regarding sex&#44; BMI&#44; Charnley categories&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> or proximal femur types according to Dorr<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Previous health state was assessed using ASA grades<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> and the number of significant comorbidities for hip surgery in elderly patients&#44; defined by Holt et al&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Of the octogenarians&#44; 50 hips were associated with 1 comorbidity or none at all&#44; and 5 with 2 comorbidities&#44; the most common being hypertension &#40;85&#37;&#41;&#44; heart disease &#40;7&#37;&#41;&#44; and chronic obstructive pulmonary disease &#40;5&#37;&#41;&#46; Of the controls&#44; 105 had 1 pre-existing comorbidity or none at all&#44; and 5 had 2 comorbidities&#59; the most common were hypertension &#40;50&#37;&#41;&#44; chronic obstructive pulmonary disease &#40;6&#37;&#41;&#44; and heart disease &#40;3&#37;&#41;&#46; Based on comorbidity presence&#44; the odds ratio for octogenarians was 3&#46;52 &#40;95&#37; confidence interval &#91;CI&#93;&#58; 1&#46;70&#8211;7&#46;24&#41; and 0&#46;63 &#40;95&#37; CI&#58; 0&#46;52&#8211;0&#46;77&#41; for controls&#46; The octogenarians showed a 5&#46;5 times higher risk of presenting comorbidity &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46; Preoperatively &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#44; the octogenarians had a lower level of hemoglobin than the controls &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;014&#41;&#44; even though the 2 groups shared a similar hematocrit level &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;061&#41;&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Surgical protocol</span><p id="par0045" class="elsevierStylePara elsevierViewall">All surgeries were carried out in a laminar flow clean room&#44; using low spinal anesthesia&#44; and with the same standard surgical technique using a modified Hardinge<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> lateral approach&#46; In all cases&#44; both cementless components were used&#46; Two THA systems were implanted according to the surgeon&#39;s preference&#46; One was the Duofit<span class="elsevierStyleSup">&#174;</span> system &#40;cup and stem&#59; Samo&#44; Bologna&#44; Italy&#41; and the other was a Vitalock<span class="elsevierStyleSup">&#174;</span> cup with a Meridian<span class="elsevierStyleSup">&#174;</span> stem &#40;both from Stryker&#44; Mahwah&#44; USA&#41;&#46; Both systems had similar geometry&#46; The stems were straight and without a neck&#44; composed of titanium alloy&#44; the upper third coated in circumferential plasma-spray&#44; and they had holes for additional stability with screws&#46; In all cases &#8211; octogenarian and control &#8211; 2 divergent screws were used&#46; All femoral heads were 28<span class="elsevierStyleHsp" style=""></span>mm&#44; modular&#44; and made of cobalt chromium&#46; All the inserts were polyethylene with a high molecular weight and 12&#176; elevation&#44; sterilized by gamma irradiation&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">All patients followed the same standard postoperative protocol&#46; Perioperative antibiotic prophylaxis with first generation cephalosporin was done within 24<span class="elsevierStyleHsp" style=""></span>h&#46; Thromboprophylaxis with low molecular weight heparin was given within 1 month&#46; Patients underwent a postoperative blood transfusion if their hemoglobin was less than 8<span class="elsevierStyleHsp" style=""></span>g&#47;dl&#46; Prophylaxis was not used for heterotopic ossification in any cases&#46; Patients were allowed ambulatory freedom the day following the intervention&#44; if tolerated&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Evaluations</span><p id="par0055" class="elsevierStylePara elsevierViewall">Our department&#39;s registry of arthroplasties has clinical and radiographic data for all patients treated with arthroplasties&#46; Follow-up was prospective and standardized&#44; with postoperative assessments at 6 weeks&#44; 1 year&#44; and then annually until at least 5 years after the operation&#46; Medical registries of patients were reviewed to extract relevant information regarding diagnosis&#44; surgery details&#44; postoperative hospital stay&#44; functional and radiographic results&#44; complications&#44; and mortality&#46; With respect to the last factor&#44; all patients were also contacted by telephone&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Before their operations&#44; all patients were examined &#8211; and medically treated if necessary &#8211; by an internal medicine doctor and an anesthesiologist&#46; Preoperative health state was defined by ASA grades<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> and the number of pre-existing comorbidities&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Patients were classified by their functioning according to the Charnley categories&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The objective preoperative assessments and the postoperative follow-ups were done by trained residents&#46; For clinical functioning&#44; the Harris<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> and Merle d&#8217;Aubign&#233;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> scales were used&#46; Anterior thigh pain was assessed as absent&#44; mild&#44; moderate&#44; or severe using the same criterion as that used in the pain category from the Harris scale&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Standard AP and lateral X-rays were taken preoperatively and at each postoperative evaluation&#46; Before the operation&#44; bone quality and proximal femur morphology were determined according to Dorr et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> The 6-week postoperative X-rays were compared to those from the last evaluation done in order to determine component stability&#46; To localize radiolucent lines&#44; osteolysis&#44; or bone remodeling&#44; DeLee and Charnley zones<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> were used for the acetabular component&#44; while Gruen<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> zones were used for the femoral component&#46; Radiolucent lines were categorized as absent or greater than 1<span class="elsevierStyleHsp" style=""></span>mm&#44; and osteolyses were considered to be greater than 5<span class="elsevierStyleHsp" style=""></span>mm&#46; The position of the cup was determined according to the Massin et al&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> criteria&#44; and its stability according to criteria proposed by Gonz&#225;lez Della Valle et al&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> for cementless cups&#46; Acetabular weakening was considered when there was a position change of at least 2<span class="elsevierStyleHsp" style=""></span>mm or 2&#176;&#44; continuous radiolucency of 1<span class="elsevierStyleHsp" style=""></span>mm or greater&#44; or periacetabular osteolysis or osteolysis around the screws&#46; With respect to the femoral component&#44; stability was determined according to criteria from Engh et al&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> for cementless stems&#46; They were considered weak if there was progressive subsidence greater than 5<span class="elsevierStyleHsp" style=""></span>mm&#44; angular position change of 3&#176; or more&#44; radiolucency width greater than 2<span class="elsevierStyleHsp" style=""></span>mm&#44; or osteolysis&#46; Heterotopic ossification was evaluated according to Brooker et al&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Statistical analysis</span><p id="par0070" class="elsevierStylePara elsevierViewall">This analysis was done using version 15&#46;0 of the SPSS<span class="elsevierStyleSup">&#174;</span> program &#40;SPSS Inc&#46;&#44; Chicago&#44; USA&#41;&#46; P values equal to or less than 0&#46;05 were considered significant&#46; In order to determine normal distribution&#44; the Kolmogorov&#8211;Smirnov test was used&#46; For comparisons between cohorts&#44; univariate analyses were carried out for categorical variables using the Chi-squared test in variables with normal distribution&#44; or the Mantel&#8211;Haenszel test for non-parametric data&#46; The Student <span class="elsevierStyleItalic">t</span> or Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> tests were used for continuous variables&#46; In comparing pre- and postoperative data&#44; the Student t &#40;for paired samples&#41; or Wilcoxon Signed-Rank tests were used&#46; Multivariate analyses were then carried out&#44; using the variables that showed a significant difference in the univariate analysis as independent variables and mortality&#44; resultant functioning&#44; or prosthetic failures as dependent variables&#46; Logistic regression analysis was used when the independent variable was dichotomous&#44; while Cox regression was used when it was not&#46; The odds ratio &#40;OR&#41; or hazard ratio &#40;HR&#41; were calculated with 95&#37; confidence intervals&#46; Kaplan&#8211;Meier analysis was used to calculate cumulative survival and the log-rank test was used to compare survival curves&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Results</span><p id="par0075" class="elsevierStylePara elsevierViewall">We reviewed 54 octogenarian patients &#40;55 hips&#41;&#44; of which 1 died of colon cancer 5 months after the operation without premature hip complications&#46; This patient was excluded from the results analysis&#46; In the control cohort&#44; there were 106 patients &#40;110 hips&#41;&#44; of which 4 died within 5 postoperative years &#40;range&#58; 3&#46;0&#8211;4&#46;7 years&#41; from causes unrelated to the hip &#40;lung cancer&#44; digestive cancer&#44; leukemia&#44; heart attack&#41;&#46; These 4 patients were also excluded from analysis&#46; Other octogenarian and control patients died after 5 postoperative years&#46; However&#44; given the initial advanced age of these patients&#44; they were not excluded from results analysis&#44; as they complied with the minimum criteria&#46; There were no other follow-up losses&#46; Therefore&#44; 53 octogenarian patients &#40;54 hips&#41; and 102 controls &#40;106 hips&#41; remained for analysis of results&#46; The average postoperative follow-up was 7&#46;1 years &#40;range&#58; 5&#8211;12&#59; SD&#58; 1&#46;2&#41; among the octogenarians and 7&#46;3 years &#40;range 5&#8211;12&#59; SD&#58; 1&#46;4&#41; in the controls &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;366&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">The mean hospital stay for the octogenarians was 7&#46;5 days &#40;range&#58; 4&#8211;13&#41;&#44; and 7&#46;3 days &#40;range&#58; 3&#8211;16&#41; for the control cohort &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;701&#41;&#46; All patients came from their homes and were sent directly to them afterward&#46;</p><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Medical complications and postoperative mortality</span><p id="par0085" class="elsevierStylePara elsevierViewall">Preoperatively&#44; no blood transfusions were necessary for any patient&#46; Postoperatively&#44; transfusions were required in 12 &#40;12&#46;8&#37;&#41; octogenarians and in 18 &#40;16&#46;3&#37;&#41; control patients &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;399&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The postoperative medical complication rate was not significantly different between the 2 cohorts &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;601&#41;&#46; Complications were present in 2 &#40;3&#46;7&#37;&#41; octogenarians &#40;2 urinary infections&#41; and in 2 &#40;1&#46;9&#37;&#41; controls &#40;pneumonia and deep vein thrombosis without pulmonary embolism&#41;&#46; As for the presence of medical complications&#44; with the limited number of patients available&#44; neither cohort was influenced by sex&#44; ASA grade&#44; or number of pre-existing comorbidities &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">There were no perioperative deaths in either cohort&#46; In the octogenarian group&#44; 7 patients &#40;12&#46;9&#37;&#41; died in a mean postoperative period of 6&#46;5 years &#40;range&#58; 5 months to 9 years&#41;&#44; of which 6 patients died 5 or more years after the operation&#46; In the control cohort&#44; 9 patients &#40;8&#46;4&#37;&#41; died in a mean postoperative period of 6&#46;0 years &#40;range&#58; 3&#8211;9 years&#41;&#44; of which 5 patients died 5 or more years after the operation&#46; No patient died from causes related to the hip surgery&#46; The odds ratio &#40;OR&#41; for death in the octogenarian cohort was 1&#46;35 &#40;95&#37; CI&#58; 0&#46;74&#8211;2&#46;48&#41;&#44; and it was 0&#46;84 &#40;95&#37; CI&#58; 0&#46;53&#8211;1&#46;29&#41; for the controls&#44; the difference being non-significant &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;406&#41;&#46; With the Kaplan&#8211;Meier analysis &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#44; and considering death from whatever cause as an ending point&#44; the cumulative survival rate was 98&#46;1&#37; &#40;95&#37; CI&#58; 96&#46;1&#8211;100&#41; in the octogenarians between 1 and 5 postoperative years&#44; and 78&#46;4&#37; &#40;95&#37; CI&#58; 61&#46;7&#8211;96&#46;3&#41; at 9 postoperative years&#46; Furthermore&#44; the rates for the controls were 99&#46;0&#37; &#40;95&#37; CI&#58; 97&#46;2&#8211;100&#41; between 1 and 5 postoperative years and 85&#46;5&#37; &#40;95&#37; CI&#58; 33&#46;4&#8211;98&#46;3&#41; at 9 postoperative years&#46; The log-rank analysis showed no significant differences between the cohorts &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;360&#41;&#46; Cox regression analysis revealed that&#44; in both cohorts&#44; the following were not significant independent predictors of mortality&#58; sex&#44; BMI&#44; ASA grade&#44; number of comorbidities&#44; necessity for transfusion&#44; postoperative medical complications&#44; and type of prosthetic &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Hip function results</span><p id="par0100" class="elsevierStylePara elsevierViewall">The mean Merle d&#8217;Aubign&#233;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> score increased from 4&#46;3 &#40;range&#58; 2&#8211;7&#41; preoperatively to 10&#46;2 &#40;range&#58; 8&#8211;12&#41; for the octogenarians in the last postoperative follow-up &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#44; while the mean score on the Harris<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> scale went from 35&#46;8 points &#40;range 20&#8211;54&#41; to 87&#46;5 &#40;range&#58; 77&#8211;96&#41; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46; According to the Harris criteria&#44; 14 hips were classified as having excellent results&#44; 38 with good results&#44; 1 fair&#44; and 1 poor result&#46; Five patients reported mild thigh pain that did not affect their daily activities&#46; Of the sample&#44; 51 patients could walk outside of their home and 2 could only walk inside&#59; 48 &#40;90&#46;5&#37;&#41; patients used walking support before the operation and 26 &#40;49&#37;&#41; after the operation &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">The mean score for the control cohort on the Merle d&#8217;Aubign&#233; scale increased from 4&#46;8 &#40;range&#58; 2&#8211;8&#41; preoperatively to 10&#46;4 &#40;range&#58; 4&#8211;12&#41; in the last postoperative follow-up &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#44; while the mean Harris score went from 40&#46;2 points &#40;range&#58; 24&#8211;53&#41; to 87&#46;3 &#40;range&#58; 44&#8211;98&#41; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46; According to the Harris criteria&#44; 64 hips were classified as having excellent results&#44; 36 with good results&#44; 3 fair&#44; and 3 poor results&#46; Five patients reported mild thigh pain and 4 reported moderate or continuous pain that affected their functioning&#46; Of the sample&#44; 99 patients were able to walk outside of the house and 3 could only walk inside&#59; 70 &#40;66&#37;&#41; patients used walking support before the operation and 31 &#40;29&#46;2&#37;&#41; after the operation &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">There were no significant differences between the 2 cohorts in relation to thigh pain &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;471&#41;&#44; ability to walk &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;399&#41;&#44; or use of walking support &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;175&#41;&#46; In addition&#44; there were no significant differences found in relation to postoperative Harris score &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;899&#41;&#44; Merle d&#8217;Aubign&#233; score &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;525&#41;&#44; or type of prosthetic &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;761&#41;&#46; However&#44; the octogenarians showed a significantly higher postoperative increase on the hip function scales compared to the controls &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;002&#41;&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Radiographic results</span><p id="par0115" class="elsevierStylePara elsevierViewall">According to the classification used by Dorr et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> there were 12 type A hips&#44; 32 type B&#44; and 10 type C among the 54 valid octogenarian hips&#59; and among the 106 controls&#44; there were 21&#44; 71&#44; and 14&#44; respectively &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;850&#41;&#46; Clinical results were independent of bone type in both cohorts &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">In the octogenarians&#44; the mean postoperative acetabular angle was 43&#46;6&#176; &#40;range&#58; 42&#8211;62&#176;&#41;&#46; In the acetabular components&#44; there were no radiolucent lines greater than 1<span class="elsevierStyleHsp" style=""></span>mm&#46; Migration of the acetabular component was observed in 1 patient that had had a cup fracture during the operation&#44; which resulted in the cup being considered unstable&#46; There were no cases of osteolysis or screw breaks&#46; Osseointegration was observed in the rest of the acetabular components&#46; There were no radiolucent lines or osteolysis surrounding the femoral component&#44; but 2 stems presented subsidence greater than 5<span class="elsevierStyleHsp" style=""></span>mm&#44; and were consequently considered unstable&#46; According to the Engh et al&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> criteria&#44; the other 52 stems presented osseointegration&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">In the control group&#44; the mean postoperative acetabular angle was 42&#46;9&#176; &#40;range&#58; 38&#8211;62&#176;&#41;&#46; There were radiolucent lines less than 1<span class="elsevierStyleHsp" style=""></span>mm in 4 acetabular components&#44; all of them confined to a single zone &#40;1 and 2&#41; and none of them were progressive&#46; Another acetabular component had continuous radiolucency greater than 1<span class="elsevierStyleHsp" style=""></span>mm&#44; and still another showed migration&#44; causing both to be deemed unstable&#46; There were no cases of osteolysis or screw breaks&#46; At the femoral level&#44; there were radiolucencies less than 2<span class="elsevierStyleHsp" style=""></span>mm in 12 stems&#44; of which 4 were located in zone 1&#44; 5 in zone 3&#44; and 3 in zone 7&#46; Four other stems showed progressive radiolucencies greater than 2<span class="elsevierStyleHsp" style=""></span>mm&#46; Two of those presented 3&#176; migration and the other 2 showed subsidence of 5 and 6<span class="elsevierStyleHsp" style=""></span>mm&#44; all of them consequently considered unstable&#46; According to the Engh et al&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> criteria&#44; the rest of the femoral components were stable&#44; 101 with osseointegration and 1 with asymptomatic stable fibrous fixation at 8 years&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">In the octogenarians&#44; there was 1 patient with Brooker et al&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> grade II heterotopic ossification&#44; while the control cohort presented 2 cases of grade I ossification&#44; 1 grade II&#44; and 1 grade III&#46; The ossifications presented in both groups had no clinical significance&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Orthopedic complications and surgical reviews</span><p id="par0135" class="elsevierStylePara elsevierViewall">One octogenarian patient had persistent drainage of the wound&#44; which required early superficial cleaning and antibiotics&#44; resulting in a final score of 91 points on the Harris<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> scale&#46; In the control cohort&#44; 1 patient had a deep infection&#44; treated with 2-step revision at 16 months&#44; with a final functional result of 44 points&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Among the octogenarians&#44; there was 1 patient with early dislocation treated using closed reduction&#44; with a final functional result of 80 points&#46; Another patient presented recurrent dislocation that only required switching from the acetabular to a well-placed cementless component at 2 months after the operation&#44; with a functional result of 86 points&#46; There were no dislocations in the control cohort&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">There were intraoperative fractures in 2 octogenarian patients&#46; In 1 case&#44; it was an acetabular fracture seen at 1 month after the operation&#44; which just required switching from the acetabular to a cementless component&#44; resulting in a score of 80 points&#46; The other was a diaphyseal fracture treated with cerclage&#44; which resulted in 6<span class="elsevierStyleHsp" style=""></span>mm stem subsidence at 2 years postoperative and with a functional result of 77 points&#46; This patient rejected stem replacement&#46; A third patient presented subsidence and femoral radiolucencies at 7&#46;6 years after the operation&#44; with a functional score of 80 points&#44; and refused surgical revision&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">In the control cohort&#44; there were no intraoperative fractures&#46; One patient suffered a periprosthetic femoral fracture from a fall 2 years after the operation&#44; which was treated with open reduction and internal fixation&#44; resulting in a functional score of 66 points&#46; Of the other 4 stems considered unstable&#44; 1 was revised at 11 months postoperatively with a functional result of 43 points&#46; In the other 3&#44; instability was detected at 5&#46;4&#44; 7&#46;3&#44; and 9&#46;0 years postoperatively and the cups were not revised due to the patients&#8217; refusal&#46; These patients had functional scores of 61&#44; 72&#44; and 68 points&#44; respectively&#46; At the acetabular level&#44; the 2 cups considered unstable were revised using cementless cups at 3&#46;5 and 10&#46;7 years postoperatively&#44; with a final functional result of 66 and 62 points&#44; respectively&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">In summary&#44; there were 4 &#40;7&#37;&#41; hips &#40;2 cups and 2 stems&#41; in the octogenarian cohort and 7 &#40;6&#46;6&#37;&#41; hips &#40;2 cups and 5 stems&#41; in the control cohort with aseptic revision or need of it&#46; The survival rate of the prosthesis at 9 years&#44; with the final point being revision or need of it &#8211; not including the cases of septic revision or periprosthetic fracture &#8211; was 89&#46;2&#37; &#40;95&#37; CI&#58; 78&#8211;100&#41; in the octogenarian cohort and 86&#46;3&#37; &#40;95&#37; CI&#58; 69&#46;6&#8211;100&#41; in the control cohort &#40;log-rank&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;728&#41;&#46; For the acetabular component &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#44; the survival rate was 96&#46;4&#37; &#40;95&#37; CI&#58; 91&#8211;100&#41; in the octogenarians and 97&#46;4&#37; &#40;95&#37; CI&#58; 91&#46;3&#8211;100&#41; in the control cohort &#40;log-rank&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;599&#41;&#46; For the femoral component &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#44; the survival rate was 92&#46;6&#37; &#40;95&#37; CI&#58; 82&#8211;100&#41; in the octogenarians and 94&#46;0&#37; &#40;95&#37; CI&#58; 88&#8211;100&#41; in the control cohort &#40;log-rank&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;978&#41;&#46; Cox regression analysis revealed that prosthesis failure&#44; sex&#44; BMI&#44; Dorr category&#44; and prosthesis type were not significant independent predictors in either cohort &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Discussion</span><p id="par0160" class="elsevierStylePara elsevierViewall">We have not found comparative studies on the efficacy of the primary cementless prosthetic hip in patients older than 80 years&#46; Consequently&#44; our results could only be discussed with respect to other case series studies&#46; The main weakness in our study was its retrospective design&#46; Furthermore&#44; even though our patients were consecutive&#44; there could be an implicit selection process in the surgery indication&#44; given that patients showed relatively good preoperative medical condition overall&#58; 86&#37; fell under grades 1 and 2 of the ASA&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">Total hip replacement has shown to be greatly advantageous in elderly patients&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> which is why it has been advised that the selection of candidates for this surgery not be done solely based on age&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22&#44;23</span></a> In previous studies carried out in our institution&#44; we observed satisfactory results with cementless prostheses in young patients&#44; at both the acetabular<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> and femoral<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> component levels&#46; Nonetheless&#44; there is controversy<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> surrounding the type of fixation used in elderly patients&#46; The convenience of cemented fixation at an arbitrary age has been postulated because of poor bone quality&#44;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;26</span></a> as well as for economic reasons<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> based on less physical demand and lower life expectancy for the patient&#46; Our study indicated that the patient&#39;s age does not have to be a deciding factor in selecting the type of fixation for THA&#44; as the increase in functional results showed its efficacy and the complication rates were similar in patients whose ages were within the range of our normal surgical practice&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Economic arguments for restricting the use of cementless prostheses in elderly patients have been refuted by other studies&#46; Barrack et al&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> and Laupacis et al&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> determined the difference in costs between a cementless and cemented prosthesis to be irrelevant with the current cementation systems &#40;costs of cementing&#44; mixing device&#44; pressurization&#44; gun&#44; cement cap&#44; pulsating irrigation device&#41;&#46; They also posited that in many cases&#44; the current cost of a modern cemented prosthesis may be higher than a cementless one&#46; Furthermore&#44; cementless prostheses reduce intervention time and rates of hypotensive crisis&#44; embolism&#44; and&#44; in general&#44; adverse effects known as bone cement implantation syndrome&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The increase in costs derived from the potential failure rate and consequential surgical revision for the cementless prosthetic in octogenarians is not supported by the lack of significant difference between that cohort and these rates in younger patients&#44; as shown in our study and in those by other authors&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">In our study&#44; there were no differences between the 2 groups regarding the risk of requiring postoperative transfusion&#44; and the medical complications rate was similar&#44; as reported by other authors&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;9</span></a> No perioperative deaths were observed and the mortality rate in the octogenarians after a mean follow-up of 7 years was 12&#46;9&#37;&#44; which was not significantly different from that of the control group&#46; Using cementless prostheses in octogenarians&#44; Badhe et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> reported an 11&#37; mortality rate at 7 years in 60 patients&#44; and Keisu et al&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> reported no perioperative deaths and a mortality rate of 6&#37; at 2 years in 114 patients&#46; Using cemented prostheses in octogenarians&#44; Ekelund et al&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> reported a 2&#37; mortality rate in the first 3 months after the operation in a series of 162 patients&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">In our octogenarian cohort&#44; there were no cases of deep infection&#44; 2 dislocations&#44; 2 intraoperative fractures&#44; and no weakening of acetabulum or aseptic stem weakening&#44; all these figures being similar to those in the control cohort&#46; There was a 7&#37; rate of surgical revision or need of it&#46; All this was similar to other studies with cementless prostheses in octogenarians&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;8&#44;9</span></a> Other authors<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> reported that there might have been defects in fixation due to poor bone quality&#46; In our octogenarian group&#44; all of the acetabulum showed osseointegration and only 1 stem was unstable because of subsidence&#46; Badhe et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> reported 57 osseointegrated stems and 2 with subsidence&#44; although asymptomatic&#44; in their series of 59 octogenarians with a mean postoperative follow-up period of 7 years&#46; In this study&#44; all the cups were stable except for 2 asymptomatic fibrous ones&#46; Keisu et al&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> reported that all acetabular and femoral components showed osseointegration in their series of 114 octogenarians with a mean follow-up of 7 years&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">In our octogenarian group&#44; the survival rate at 7 years&#44; for aseptic reasons&#44; was 96&#37; for the acetabular component and 98&#37; for the stem&#46; Badhe et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> found a survival rate of 98&#37; and 100&#37;&#44; respectively&#44; at 7 years&#46; Keisu et al&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> found a survival rate of 100&#37; for both components at 5 years&#46; Using cementless prostheses in younger patients&#44; 65 years or older&#44; Engh et al&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> reported a survival rate of 98&#37; for the prosthesis at 8 years&#44; and McAuley et al&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> reported 92&#37; at 12 years&#46; Ogino et al&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> carried out a descriptive study of the Finnish registry of arthroplasties&#44; finding 6989 registered THA implants in patients older than 80 years between 1980 and 2004&#46; Of this sample&#44; there was some information regarding 195 &#40;2&#46;8&#37;&#41; that resulted in revision due to failure&#44; the principal causes being aseptic weakening &#40;1&#46;2&#37;&#41;&#44; recurrent dislocation &#40;0&#46;5&#37;&#41;&#44; periprosthetic fracture &#40;0&#46;3&#37;&#41;&#44; and deep infection &#40;0&#46;3&#37;&#41;&#46; However&#44; no data were provided as to the initial diagnosis or the type of fixation used in the primary prosthesis in which the failure occurred&#46; According to those data&#44; they found that the survival rate for the prosthesis at 5 years after using hybrid fixation was 98&#37;&#44; 97&#37; for cemented&#44; and 96&#37; for cementless&#59; although they reported no significant difference between the latter 2 types&#44; there was a significant difference between the hybrids and the cementless&#46; They therefore recommended using cemented stems for patients with advanced age&#46; However&#44; the study presented significant weaknesses in our opinion&#44; as the data available were limited and incomplete&#46; Furthermore&#44; 392 different prosthetic systems were used in the study&#44; and 30&#37; of the procedures were done with prostheses designed at least 20 years ago&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">In our study&#44; the mean score increase among the octogenarians&#44; between pre- and postoperative scores&#44; was 6 points on the Merle d&#8217;Aubign&#233; scale and 52 points on the Harris scale&#46; All of the octogenarians&#44; except for 2&#44; had excellent or good results&#44; which was similar to the control group&#46; In our study&#44; this demonstrated the efficacy of cementless prostheses in patients in this age range&#46; Other authors reported similar increases on the hip function scales for octogenarians with cementless prostheses&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;8&#44;9</span></a> Several authors<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">30&#44;31</span></a> found no differences in incidence of anterior thigh pain from using cementless stems or cemented ones in elderly patients&#44;&#46; With cemented THA in octogenarians&#44; a recent study<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a> reported a 48&#37; rate of satisfactory results after a mean follow-up of 2&#46;5 years&#44; finding that regular and poor function results were associated with concomitant affectation of other joints&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">In our study&#44; cementless total hip arthroplasty was shown to be safe and effective in octogenarian patients with coxarthrosis&#44; with a component survival rate similar to that in younger patients&#46; The notable increase found in functional results justifies the continued use of cementless prostheses in patients with advanced age&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Ethical responsibilities</span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Human and animal protection</span><p id="par0200" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were carried out on humans or animals for this study&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Data confidentiality</span><p id="par0205" class="elsevierStylePara elsevierViewall">The authors declare that they followed the protocols of their work center regarding publication of patient data&#44; and that all patients included in the study received sufficient information and gave their informed consent in writing to participate in the study&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Right to privacy and informed consent</span><p id="par0210" class="elsevierStylePara elsevierViewall">The authors declare that this article does not present any patient data&#46;</p></span></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Conflict of interest</span><p id="par0215" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:11 [
        0 => array:2 [
          "identificador" => "xres231469"
          "titulo" => array:6 [
            0 => "Abstract"
            1 => "Objective"
            2 => "Material and methods"
            3 => "Results"
            4 => "Discussion"
            5 => "Conclusions"
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec217974"
          "titulo" => "Keywords"
        ]
        2 => array:2 [
          "identificador" => "xres231470"
          "titulo" => array:6 [
            0 => "Resumen"
            1 => "Objetivo"
            2 => "Material y m&#233;todos"
            3 => "Resultados"
            4 => "Discusi&#243;n"
            5 => "Conclusiones"
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec217973"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Material and methods"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Surgical protocol"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Evaluations"
            ]
            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Statistical analysis"
            ]
          ]
        ]
        6 => array:3 [
          "identificador" => "sec0030"
          "titulo" => "Results"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Medical complications and postoperative mortality"
            ]
            1 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Hip function results"
            ]
            2 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Radiographic results"
            ]
            3 => array:2 [
              "identificador" => "sec0050"
              "titulo" => "Orthopedic complications and surgical reviews"
            ]
          ]
        ]
        7 => array:2 [
          "identificador" => "sec0055"
          "titulo" => "Discussion"
        ]
        8 => array:3 [
          "identificador" => "sec0060"
          "titulo" => "Ethical responsibilities"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0065"
              "titulo" => "Human and animal protection"
            ]
            1 => array:2 [
              "identificador" => "sec0070"
              "titulo" => "Data confidentiality"
            ]
            2 => array:2 [
              "identificador" => "sec0075"
              "titulo" => "Right to privacy and informed consent"
            ]
          ]
        ]
        9 => array:2 [
          "identificador" => "sec0080"
          "titulo" => "Conflict of interest"
        ]
        10 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2012-12-06"
    "fechaAceptado" => "2013-02-07"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec217974"
          "palabras" => array:3 [
            0 => "Octogenarian"
            1 => "Total hip arthroplasty"
            2 => "Osteoarthritis"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec217973"
          "palabras" => array:3 [
            0 => "Octogenarios"
            1 => "Artroplastia total de cadera"
            2 => "Artrosis"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To evaluate the results and efficacy of cementless total hip arthroplasty &#40;THA&#41; in octogenarians with osteoarthritis&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Matched case&#8211;control study with ratio 1&#58;2&#46; Consecutive selection of 54 octogenarians &#40;55 hips&#41;&#44; and 106 control patients &#40;110 hips&#41; with age ranging from 70 to 79 years&#46; Mean follow-up of 7 years &#40;range&#44; 5&#8211;12&#41;&#46; Before 5 postoperative years&#44; 1 and 4 patients&#44; respectively&#44; died and they were excluded&#46; Clinical assessment was performed using ASA grade&#44; comorbidities&#44; and Harris and Merle d&#8217;Aubign&#233; hip scores&#44; and radiographic&#44; complications&#44; and mortality evaluations were made&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">There were no perioperative deaths in either cohort&#46; The rates of postoperative medical complications &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;601&#41; and survival &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;360&#41; were similar&#46; The survival at 7 years was 89&#46;8&#37; in octogenarian and 95&#46;3&#37; in controls&#44; with no influence of the preoperative variables&#46; There were no differences in postoperative functional outcomes &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;761&#41;&#44; but improvement with respect to the preoperative was higher in octogenarian &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;002&#41;&#46; In octogenarians there were 2 intraoperative fractures&#44; 2 dislocations and 2 unstable stems&#44; and in control patients 1 deep infection&#44; 1 peri-prosthetic femoral fracture&#44; 2 unstable cups and 4 unstable stems&#46; The rates of aseptic complications&#44; the need for revision&#44; and arthroplasty survival &#40;94&#37; at 7 years&#41; were similar in both cohorts&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Discussion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Due to improvement in health status&#44; the octogenarian may have a life expectancy of at least 10 years&#46; The cost arguments and an arbitrary age should not influence the selection of candidates for cementless THA&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Cementless THA has been shown to be safe and effective in octogenarian patients with osteoarthritis&#46; The notable increase found in functional outcomes justifies the continued use in these patients&#46;</p>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0040">Objetivo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Valorar resultados y eficacia de la artroplastia total de cadera &#40;ATC&#41; no cementada en octogenarios con coxartrosis&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Material y m&#233;todos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Estudio de caso-control con emparejamiento 1&#58;2&#46; Selecci&#243;n consecutiva de 54 octogenarios &#40;55 caderas&#41; y 106 controles &#40;110 caderas&#41; con edad 70-79 a&#241;os&#46; Seguimiento medio de 7 a&#241;os &#40;rango&#44; 5-12&#41;&#46; Antes de 5 a&#241;os de seguimiento murieron 1 y 4 pacientes&#44; respectivamente&#44; siendo excluidos&#46; Se realiz&#243; valoraci&#243;n cl&#237;nica mediante ASA&#44; comorbilidades&#44; escalas de Harris y Merle D&#8217;Aubign&#233;&#44; y valoraci&#243;n radiogr&#225;fica&#44; de complicaciones y de mortalidad&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Resultados</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">En ambas cohortes no hubo muertes perioperatorias&#44; siendo similar la tasa de complicaciones m&#233;dicas &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;601&#41; y la supervivencia &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;360&#41; que a 7 a&#241;os fue 89&#44;8&#37; en octogenarios y 95&#44;3&#37; en controles&#44; no influyendo las variables preoperatorias&#46; No hubo diferencias en los resultados funcionales postoperatorios &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;761&#41; pero los octogenarios tuvieron mayor incremento &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41; respecto al preoperatorio&#46; En octogenarios hubo 2 fracturas intraoperatorias&#44; 2 luxaciones y 2 v&#225;stagos inestables&#46; En los controles&#44; 1 infecci&#243;n profunda&#44; 1 fractura periprot&#233;sica femoral&#44; e inestabilidad en 2 cotilos y 4 v&#225;stagos&#46; Las tasas de complicaciones as&#233;pticas&#44; de necesidad de revisi&#243;n y de supervivencia de la artroplastia &#40;94&#37; a 7 a&#241;os&#41; fueron similares en ambas cohortes&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0055">Discusi&#243;n</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">El incremento en el estado de salud hace que los octogenarios tengan una expectativa de vida de al menos 10 a&#241;os&#46; El argumento de costes y una edad arbitraria no debe influir en la selecci&#243;n de candidatos a ATC no cementada&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0060">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">La ATC no cementada se ha mostrado segura y efectiva en los octogenarios con coxartrosis&#46; El notable incremento encontrado en los resultados funcionales justifica el continuar utiliz&#225;ndola en estos pacientes&#46;</p>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Lizaur-Utrilla A&#44; Sanz-Reig J&#46; Artroplastia total de cadera primaria electiva no cementada en octogenarios&#46; Estudio de caso-control&#46; Rev Esp Cir Ortop Traumatol&#46; 2013&#59;<span class="elsevierStyleBold">57</span>&#58;186&#8211;93&#46;</p>"
      ]
    ]
    "multimedia" => array:5 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1379
            "Ancho" => 1533
            "Tamanyo" => 73761
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Cumulative survival rate &#40;Kaplan&#8211;Meier&#41; for mortality &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;360&#41;&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1378
            "Ancho" => 1526
            "Tamanyo" => 73034
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Cumulative survival rate &#40;Kaplan&#8211;Meier&#41; for the acetabular component &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;599&#41;&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1347
            "Ancho" => 1495
            "Tamanyo" => 72355
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Cumulative survival rate &#40;Kaplan&#8211;Meier&#41; for the femoral component &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;978&#41;&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">For continuous variables&#44; the data are presented as mean &#40;SD&#41;&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td 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" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Octogenarians&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Controls&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span> value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><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">Age&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">81&#46;7 &#40;1&#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
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74&#46;2 &#40;2&#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">&#46;001&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&#47;male&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&#47;19&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">68&#47;38&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;916&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BMI&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">29&#46;3 &#40;4&#46;0&#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">29&#46;1 &#40;3&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;866&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ASA &#40;1&#47;2&#47;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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#47;44&#47;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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#47;95&#47;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;038&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&#46; of comorbidities&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">0&#46;9 &#40;0&#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">0&#46;6 &#40;0&#46;5&#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;001&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hemoglobin&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">13&#46;3 &#40;1&#46;0&#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">13&#46;9 &#40;1&#46;2&#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;014&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hematocrit&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">39&#46;7 &#40;3&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&#46;0 &#40;3&#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;061&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dorr &#40;A&#47;B&#47;C&#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">13&#47;32&#47;10&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">23&#47;73&#47;14&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;850&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Charnley &#40;A&#47;B&#47;C&#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">34&#47;15&#47;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">71&#47;24&#47;15&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;698&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Harris&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;8 &#40;8&#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">40&#46;2 &#40;6&#46;1&#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;001&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Merle d&#8217;Aubign&#233;&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">4&#46;3 &#40;1&#46;2&#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">4&#46;8 &#40;1&#46;1&#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;028&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab347196.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Preoperative and demographic data&#46;</p>"
        ]
      ]
      4 => array:7 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Survival rate &#40;95&#37; CI&#41;&#59; SD&#58; standard deviation&#59; N&#47;C&#58; cannot be calculated&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td 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" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Octogenarians&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Controls&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span> value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><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">No&#46; of transfusions&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">12&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">18&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;399&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&#46; of medical complications&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">2&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">2&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;601&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mortality at 9 years&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">21&#46;6&#37; &#40;38&#8211;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">14&#46;5&#37; &#40;67&#8211;2&#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">&#46;360&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Merle d&#8217;Aubign&#233;&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">10&#46;2 &#40;SD&#58; 1&#46;0&#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">10&#46;4 &#40;SD&#58; 1&#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
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;525&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Harris&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">87&#46;5 &#40;SD&#58; 4&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">87&#46;3 &#40;SD&#58; 14&#46;0&#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">&#46;899&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Deep infection&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">0&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">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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#47;C&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Intraoperative fracture&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">2&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">0&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">N&#47;C&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dislocation&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">2&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">0&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">N&#47;C&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Unstable cup&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">0&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">2&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">N&#47;C&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Unstable stem&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">2&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&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;560&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&#46; of revisions&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">2&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&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;560&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cup survival at 9 years&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">96&#46;3&#37; &#40;91&#8211;100&#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">97&#46;4 &#40;91&#8211;100&#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">&#46;599&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Stem survival at 9 years&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">92&#46;6&#37; &#40;82&#8211;100&#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">94&#46;0&#37; &#40;88&#8211;100&#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">&#46;978&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab347197.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Postoperative results and complications&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:32 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The nine and ten year results of the low-friction arthroplasty of the hip"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46; Charnley"
                            1 => "Z&#46; Cupic"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Orthop Relat Res"
                        "fecha" => "1973"
                        "volumen" => "95"
                        "paginaInicial" => "9"
                        "paginaFinal" => "25"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4754221"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Primary cementless total hip arthroplasty in octogenarians&#58; two to eleven-year follow-up"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "K&#46;S&#46; Keisu"
                            1 => "F&#46; Orozco"
                            2 => "P&#46;F&#46; Sharkey"
                            3 => "W&#46;J&#46; Hozack"
                            4 => "R&#46;H&#46; Rothman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Bone Joint Surg Am"
                        "fecha" => "2001"
                        "volumen" => "83"
                        "paginaInicial" => "359"
                        "paginaFinal" => "363"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11263639"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bone cement implantation syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46;J&#46; Donaldson"
                            1 => "H&#46;E&#46; Thomson"
                            2 => "N&#46;J&#46; Harper"
                            3 => "N&#46;W&#46; Kenny"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/bja/aen328"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Anaesth"
                        "fecha" => "2009"
                        "volumen" => "102"
                        "paginaInicial" => "12"
                        "paginaFinal" => "22"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19059919"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cost of implanting a cemented versus cementless femoral stem"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46;L&#46; Barrack"
                            1 => "F&#46; Castro"
                            2 => "S&#46; Guinn"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Arthroplasty"
                        "fecha" => "1996"
                        "volumen" => "11"
                        "paginaInicial" => "373"
                        "paginaFinal" => "376"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8792242"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Total joint arthroplasty in the extremely elderly&#58; hip and knee arthroplasty after entering the 89th year of life"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46;E&#46; Berend"
                            1 => "A&#46;E&#46; Thong"
                            2 => "G&#46;W&#46; Faris"
                            3 => "G&#46; Newbern"
                            4 => "J&#46;L&#46; Pierson"
                            5 => "M&#46;A&#46; Ritter"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Arthroplasty"
                        "fecha" => "2003"
                        "volumen" => "18"
                        "paginaInicial" => "817"
                        "paginaFinal" => "821"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14566733"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The outcome of primary total hip and knee arthroplasty in patients aged 80 years or more"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "N&#46;D&#46; Clement"
                            1 => "D&#46; MacDonald"
                            2 => "C&#46;R&#46; Howie"
                            3 => "L&#46;C&#46; Biant"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1302/0301-620X.93B9.25962"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Bone Joint Surg Br"
                        "fecha" => "2011"
                        "volumen" => "93"
                        "paginaInicial" => "1265"
                        "paginaFinal" => "1270"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21911540"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Total hip replacement in patients eighty years of age and older"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46; Ogino"
                            1 => "H&#46; Kawaji"
                            2 => "L&#46; Konttinen"
                            3 => "M&#46; Lehto"
                            4 => "P&#46; Rantanen"
                            5 => "A&#46; Malmivaara"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2106/JBJS.G.00147"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Bone Joint Surg Am"
                        "fecha" => "2008"
                        "volumen" => "90"
                        "paginaInicial" => "1884"
                        "paginaFinal" => "1890"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18762648"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cementless total hip arthroplasty in patients older than 80 years of age"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "H&#46; Pieringer"
                            1 => "G&#46; Labek"
                            2 => "V&#46; Auersperg"
                            3 => "N&#46; B&#246;hler"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Bone Joint Surg Br"
                        "fecha" => "2003"
                        "volumen" => "85"
                        "paginaInicial" => "641"
                        "paginaFinal" => "645"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12892182"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The uncemented Bicontact total hip arthroplasty in octogenarians"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "N&#46;P&#46; Badhe"
                            1 => "R&#46;C&#46; Quinnell"
                            2 => "P&#46;W&#46; Howard"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Eur J Orthop Surg Traumatol"
                        "fecha" => "2002"
                        "volumen" => "12"
                        "paginaInicial" => "192"
                        "paginaFinal" => "197"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Relative value guide"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "American Society of Anesthesiologists"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:1 [
                        "fecha" => "2008"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Functional results in total hip replacement in patients 65 years and older"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "L&#46;D&#46; Dorr"
                            1 => "Z&#46; Wan"
                            2 => "T&#46; Gruen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Orthop Relat Res"
                        "fecha" => "1997"
                        "volumen" => "336"
                        "paginaInicial" => "143"
                        "paginaFinal" => "151"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9060498"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Outcomes after surgery for fractures of the hip in patients aged over 95 years"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "G&#46; Holt"
                            1 => "D&#46; Macdonald"
                            2 => "M&#46; Fraser"
                            3 => "A&#46;T&#46; Reece"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1302/0301-620X.88B8.17398"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Bone Joint Surg Br"
                        "fecha" => "2006"
                        "volumen" => "88"
                        "paginaInicial" => "1060"
                        "paginaFinal" => "1064"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16877606"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The direct lateral approach to the hip"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "K&#46; Hardinge"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Bone Joint Surg Br"
                        "fecha" => "1982"
                        "volumen" => "64B"
                        "paginaInicial" => "17"
                        "paginaFinal" => "19"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Traumatic arthritis of the hip after dislocation and acetabular fractures&#58; treatment by mold arthroplasty&#46; An end-result study using a new method of result evaluation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "W&#46;H&#46; Harris"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Bone Joint Surg Am"
                        "fecha" => "1969"
                        "volumen" => "51"
                        "paginaInicial" => "737"
                        "paginaFinal" => "755"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/5783851"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Functional results of hip arthroplasty with acrylic prosthesis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "R&#46; Merle d&#8217;Aubign&#233;"
                            1 => "M&#46; Postel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Bone Joint Surg Am"
                        "fecha" => "1954"
                        "volumen" => "36"
                        "paginaInicial" => "451"
                        "paginaFinal" => "475"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/13163078"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Radiologic demarcation of cemented sockets in total hip replacement"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;S&#46; DeLee"
                            1 => "J&#46; Charnley"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Orthop Relat Res"
                        "fecha" => "1976"
                        "volumen" => "121"
                        "paginaInicial" => "20"
                        "paginaFinal" => "32"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/991504"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "&#8220;Modes of failures&#8221; of cemented stem-type femoral component&#58; a radiographic analysis of loosening"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "T&#46;A&#46; Gruen"
                            1 => "G&#46;M&#46; McNiece"
                            2 => "H&#46;C&#46; Amstutz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Orthop Relat Res"
                        "fecha" => "1979"
                        "volumen" => "141"
                        "paginaInicial" => "17"
                        "paginaFinal" => "27"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/477100"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evaluation of cementless acetabular component migration&#58; an experimental study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "P&#46; Massin"
                            1 => "L&#46; Schmidt"
                            2 => "C&#46;A&#46; Engh"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Arthroplasty"
                        "fecha" => "1989"
                        "volumen" => "4"
                        "paginaInicial" => "245"
                        "paginaFinal" => "251"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2795031"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical and radiographic results associated with a modern&#44; cementless modular cup design in total hip arthroplasty"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46; Gonz&#225;lez Della Valle"
                            1 => "A&#46; Zoppi"
                            2 => "M&#46;G&#46;E&#46; Peterson"
                            3 => "E&#46;A&#46; Salvati"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Bone Joint Surg Am"
                        "fecha" => "2004"
                        "volumen" => "86"
                        "paginaInicial" => "1998"
                        "paginaFinal" => "2003"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15342763"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Porous-coated hip replacement&#58; the factors governing bone ingrowth&#44; stress shielding&#44; and clinical results"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46;A&#46; Engh"
                            1 => "J&#46;D&#46; Bobyn"
                            2 => "A&#46;H&#46; Glassman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Bone Joint Surg Br"
                        "fecha" => "1987"
                        "volumen" => "69"
                        "paginaInicial" => "45"
                        "paginaFinal" => "55"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3818732"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ectopic ossification following total hip replacement"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46;F&#46; Brooker"
                            1 => "J&#46;W&#46; Bowerman"
                            2 => "R&#46;A&#46; Robinson"
                            3 => "L&#46;H&#46; Riley"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Bone Joint Surg Am"
                        "fecha" => "1973"
                        "volumen" => "551"
                        "paginaInicial" => "629"
                        "paginaFinal" => "632"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The effect of age on pain&#44; function&#44; and quality of life after total hip and knee arthroplasty"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "C&#46;A&#46; Jones"
                            1 => "D&#46;C&#46; Voaklander"
                            2 => "D&#46;W&#46; Johnston"
                            3 => "M&#46;E&#46; Suarez-Almazor"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Intern Med"
                        "fecha" => "2001"
                        "volumen" => "161"
                        "paginaInicial" => "454"
                        "paginaFinal" => "460"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11176772"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Patient characteristics affecting the prognosis of total hip and knee joint arthroplasty&#58; a systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46;L&#46; Santaguida"
                            1 => "G&#46;A&#46; Hawker"
                            2 => "P&#46;L&#46; Hudak"
                            3 => "R&#46; Glazier"
                            4 => "N&#46;N&#46; Mahomed"
                            5 => "H&#46;J&#46; Kreder"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Can J Surg"
                        "fecha" => "2008"
                        "volumen" => "51"
                        "paginaInicial" => "428"
                        "paginaFinal" => "436"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19057730"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Supervivencia del componente acetabular no cementado con par polietileno-metal en pacientes j&#243;venes&#58; estudio prospectivo con seguimiento de 8 a 13 a&#241;os"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46; Sanz Reig"
                            1 => "A&#46; Lizaur Utrilla"
                            2 => "J&#46; Plazola Guti&#233;rrez"
                            3 => "R&#46; Cebri&#225;n G&#243;mez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Esp Cir Ortop Traumatol"
                        "fecha" => "2009"
                        "volumen" => "53"
                        "paginaInicial" => "83"
                        "paginaFinal" => "89"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Resultados del v&#225;stago femoral no cementado Meridian&#58; estudio prospectivo de 109 casos"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46; Sanz Reig"
                            1 => "A&#46; Lizaur Utrilla"
                            2 => "I&#46; Llamas Merino"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Esp Cir Ortop Traumatol"
                        "fecha" => "2011"
                        "volumen" => "55"
                        "paginaInicial" => "346"
                        "paginaFinal" => "351"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparison of a hybrid with an uncemented total hip replacement&#58; a retrospective matched-pair study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "W&#46;J&#46; Maloney"
                            1 => "W&#46;H&#46; Harris"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Bone Joint Surg Am"
                        "fecha" => "1990"
                        "volumen" => "72"
                        "paginaInicial" => "1349"
                        "paginaFinal" => "1352"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2229111"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Costs of elective total hip arthroplasty during first year&#58; cemented versus non-cemented"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Laupacis"
                            1 => "R&#46; Bourne"
                            2 => "C&#46; Rorabeck"
                            3 => "D&#46; Feeny"
                            4 => "C&#46; Wong"
                            5 => "P&#46; Tugwell"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Arthroplasty"
                        "fecha" => "1994"
                        "volumen" => "9"
                        "paginaInicial" => "481"
                        "paginaFinal" => "487"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7807104"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Total hip arthroplasty in patients 80 years of age and older"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46; Ekelund"
                            1 => "N&#46; Rydell"
                            2 => "O&#46;S&#46; Nilsson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Orthop Relat Res"
                        "fecha" => "1992"
                        "volumen" => "281"
                        "paginaInicial" => "101"
                        "paginaFinal" => "106"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1499193"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Total hip arthroplasty with porous-coated prosthesis fixed without cement in-patients who are sixty five years of age or older"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;P&#46; McAuley"
                            1 => "D&#46;K&#46; Moore"
                            2 => "W&#46;J&#46; Culpepper"
                            3 => "A&#46; Engh"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Bone Joint Surg Am"
                        "fecha" => "1998"
                        "volumen" => "80"
                        "paginaInicial" => "1648"
                        "paginaFinal" => "1655"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9840634"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Total hip arthroplasty with uncemented femoral stem"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;R&#46; McLaughlin"
                            1 => "K&#46;R&#46; Lee"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Bone Joint Surg Br"
                        "fecha" => "1997"
                        "volumen" => "79"
                        "paginaInicial" => "900"
                        "paginaFinal" => "907"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9393901"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Long-term results of Charnley total hip replacement&#58; review of 92 patients at 15 to 20 years"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "L&#46; Neumann"
                            1 => "K&#46;G&#46; Freund"
                            2 => "K&#46;H&#46; Sorenson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Bone Joint Surg Br"
                        "fecha" => "1994"
                        "volumen" => "76"
                        "paginaInicial" => "245"
                        "paginaFinal" => "251"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8113285"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Total hip arthroplasty for osteoarthritis in patients aged 80 years or older&#58; influence of co-morbidities on final outcome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "E&#46; De Thomasson"
                            1 => "I&#46; Caux"
                            2 => "O&#46; Guingand"
                            3 => "R&#46; Terracher"
                            4 => "C&#46; Mazel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.otsr.2009.03.011"
                      "Revista" => array:6 [
                        "tituloSerie" => "Orthop Traumatol Surg Res"
                        "fecha" => "2009"
                        "volumen" => "95"
                        "paginaInicial" => "249"
                        "paginaFinal" => "253"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19443286"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/19888856/0000005700000003/v1_201307260034/S1988885613000321/v1_201307260034/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "7577"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Original articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/19888856/0000005700000003/v1_201307260034/S1988885613000321/v1_201307260034/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1988885613000321?idApp=UINPBA00004N"
]

Article information

ISSN: 19888856
Original language: English

DOI:10.1016/j.recote.2013.06.002

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	7	1	8
2024 October	18	2	20
2024 September	26	3	29
2024 August	17	2	19
2024 July	14	1	15
2024 June	15	2	17
2024 May	9	4	13
2024 April	17	5	22
2024 March	6	3	9
2024 February	12	3	15
2024 January	12	3	15
2023 December	14	8	22
2023 November	7	1	8
2023 October	20	7	27
2023 September	13	0	13
2023 August	13	1	14
2023 July	11	2	13
2023 June	19	2	21
2023 May	38	1	39
2023 April	44	3	47
2023 March	46	3	49
2023 February	8	3	11
2023 January	6	3	9
2022 December	4	4	8
2022 November	7	4	11
2022 October	11	5	16
2022 September	10	7	17
2022 August	13	8	21
2022 July	11	6	17
2022 June	10	8	18
2022 May	12	4	16
2022 April	26	5	31
2022 March	20	7	27
2022 February	20	4	24
2022 January	34	4	38
2021 December	42	12	54
2021 November	24	9	33
2021 October	22	11	33
2021 September	15	10	25
2021 August	12	5	17
2021 July	14	6	20
2021 June	16	6	22
2021 May	12	6	18
2021 April	27	23	50
2021 March	6	4	10
2021 February	11	9	20
2021 January	6	5	11
2020 December	2	1	3
2018 February	5	3	8
2018 January	6	1	7
2017 December	5	0	5
2017 November	7	1	8
2017 October	14	15	29
2017 September	15	2	17
2017 August	11	1	12
2017 July	11	3	14
2017 June	18	18	36
2017 May	7	1	8
2017 April	21	4	25
2017 March	23	14	37
2017 February	7	1	8
2017 January	9	0	9
2016 December	17	4	21
2016 November	9	1	10
2016 October	23	7	30
2016 September	13	4	17
2016 August	6	1	7
2016 July	6	0	6
2016 June	9	3	12
2016 May	10	3	13
2016 April	10	4	14
2016 March	7	3	10
2016 February	10	7	17
2016 January	8	2	10
2015 December	8	1	9
2015 November	8	3	11
2015 October	18	6	24
2015 September	15	2	17
2015 August	9	4	13
2015 July	8	6	14
2015 June	3	1	4
2015 May	12	2	14
2015 April	0	1	1
2015 March	1	0	1
2015 January	1	0	1
2014 July	4	0	4
2014 May	2	1	3
2014 April	1	0	1

Show all

Indexed in:

Follow us:

Statistics

Indexed in:

Follow us:

Statistics

Subscribe to our newsletter