Modular prosthesis reconstruction after tumour resection, evaluation of failures and survival | Revista Española de Cirugía Ortopédica y Traumatología (English Edition)

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Cabas-Geat, M.G. Bruchmann, J.I. Albergo, M.A. Ayerza, G. Farfalli, L.A. Aponte-Tinao, L.D. Muscolo" "autores" => array:7 [ 0 => array:4 [ "nombre" => "A.E." "apellidos" => "Cabas-Geat" "email" => array:1 [ 0 => "angelescabasgeat@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "M.G." "apellidos" => "Bruchmann" ] 2 => array:2 [ "nombre" => "J.I." "apellidos" => "Albergo" ] 3 => array:2 [ "nombre" => "M.A." "apellidos" => "Ayerza" ] 4 => array:2 [ "nombre" => "G." "apellidos" => "Farfalli" ] 5 => array:2 [ "nombre" => "L.A." "apellidos" => "Aponte-Tinao" ] 6 => array:2 [ "nombre" => "L.D." "apellidos" => "Muscolo" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Ortopedia Oncológica y Trasplantes Óseos, Hospital Italiano, Buenos Aires, Argentina" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Reconstrucción con prótesis modulares posterior a una resección oncológica. Evaluación de los fracasos y análisis de la supervivencia" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 832 "Ancho" => 2104 "Tamanyo" => 70401 ] ] "descripcion" => array:1 [ "en" => "(a) Primary bone tumour survival at 2 years was 70% (95% CI: 54–84), and 56% at 5 years (95% CI: 71–70). (b) Overall primary implant survival: 80% at 2 and at 5 years (95% CI: 65–94.4)." ] ] ] "textoCompleto" => """ IntroductionThe treatment of musculoskeletal tumours has undergone momentous change in recent decades. At the beginning of the nineteen seventies the mainstay of treatment for these types of tumours was amputation, with survival rates of less than 30%.<a class="elsevierStyleCrossRefs" href="#bib0160">1,2</a> With the advent of neoadjuvant chemotherapy and the advances in radiation therapy, survival rates improved significantly, rising to 60%–70% at 5 years.<a class="elsevierStyleCrossRefs" href="#bib0170">3,4</a> Limb salvage surgery is currently the treatment of choice for most of these patients. Many studies in the literature show that there are no differences in terms of survival between patients treated with limb salvage surgery and amputated patients.<a class="elsevierStyleCrossRefs" href="#bib0180">5–7</a> A great many reconstructive options for the treatment of bone defects after oncological resections have been described. These include biological or prosthetic reconstructions or a combination of both, such as alloprostheses.<a class="elsevierStyleCrossRefs" href="#bib0195">8–11</a>Reconstruction with structural allograft after tumour resection in the limbs makes it possible to preserve more bone stock and biomechanically restore the flexor-extensor and ligament system, with the limitations that weight-bearing of the limb must be restricted for a prolonged period of time, it requires an extensive rehabilitation period, and there is a risk of transplant failure given the need for adjuvant radiation treatment. By contrast, endoprostheses show greater benefits for people with tumours of poor prognosis or the elderly, and enables early ambulation and cessation of pain. Associated advantages and disadvantages have been described for both procedures, but there is controversy with regard to the best reconstructive option.<a class="elsevierStyleCrossRefs" href="#bib0215">12–14</a> Historically, our institution was renowned for its use of bone transplants as a reconstructive technique.<a class="elsevierStyleCrossRefs" href="#bib0230">15–17</a> However, since the beginning of 2000 there has been a major increase in the indication for endoprostheses in limb salvage surgery.<a class="elsevierStyleCrossRef" href="#bib0245">18</a> The use of endoprostheses has evolved in recent decades, principally due to the improvements to these implants. Their advantages are availability, their flexibility in dealing with varying bone defects, they enable early weight bearing and mobilisation, and patients are able to rapidly resume their daily living activities. On the other hand, complications such as loosening, dislocation, decoupling of the implant's modules, and infection remain a concern for surgeons.<a class="elsevierStyleCrossRefs" href="#bib0250">19,20</a>The aim of our paper was to study a series of oncological patients treated with modular endoprostheses and assess:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">•Implant survival</li><li class="elsevierStyleListItem" id="lsti0010">•Causes of failure according to the classification by Henderson et al.<a class="elsevierStyleCrossRef" href="#bib0260">21</a></li><li class="elsevierStyleListItem" id="lsti0015">•Re-intervention rate due to complications</li><li class="elsevierStyleListItem" id="lsti0020">•Survival of the limb</li><li class="elsevierStyleListItem" id="lsti0025">•Functional outcomes: Musculoskeletal Tumour Society (MSTS)<a class="elsevierStyleCrossRef" href="#bib0265">22</a> and time to full weight bearing.</li></ul>Material and methodsA retrospective search on our longitudinal oncological database was performed between March 2001 and August 2015 of all patients who underwent reconstruction with modular endoprostheses. Skeletally mature patients were included in the study, with primary or secondary bone tumour disease, and with a minimum follow-up of 24 months for the patients who were alive at the time of the study. All patients operated for purely reconstructive purposes or treated in a different institution were excluded. The indications for the use of modular endoprostheses in oncological patients in our institution were: patients with a poor response to chemotherapy, with metastases (with expected survival of more than 6 months), undergoing adjuvant radiotherapy treatment, elderly patients, the anatomical region of the proximal femur, and with reconstructive surgery secondary to the failure of massive bone transplants. Modular prostheses with rotating hinges and cemented stems were used, manufactured by Zimmer Biomet Spain S.L.U. (Barcelona, Spain). The study population was divided into 3 groups: group 1, comprising patients with primary malignant or benign locally aggressive tumours; group 2, patients with bone metastases and group 3, patients reconstructed with a modular endoprosthesis due to failure of massive bone transplants.The following variables were analysed:<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0030">•Survival of the implant according to the Kaplan–Meier method.</li><li class="elsevierStyleListItem" id="lsti0035">•Causes of limb salvage surgery failure according to the classification by Henderson et al. (2014). There are 5 types. From 1 to 3 are mechanical failures. Types 4 and 5 are non-mechanical failures. Type 1: soft tissue failure (1A: functional failure; 1B: coverage failure). Type 2: aseptic loosening (2A: \n <at 2="" years;="" 2b:="">\n at 2 years). Type 3: structural failure (3A: implant rupture or wear; 3B: periprosthetic fracture). Type 4: infection that requires a change of prosthesis (4A: \n <at 2="" years;="" 4b:="">\n at 2 years). Type 5: recurrence or progression of the tumour in contact with the prosthesis (5A: soft tissues; 5B: bone).\n </at>\n </at></li><li class="elsevierStyleListItem" id="lsti0040">•Rate of reinvention due to complications.</li><li class="elsevierStyleListItem" id="lsti0045">•Limb salvage rate.</li><li class="elsevierStyleListItem" id="lsti0050">•Functional outcomes were assessed according to the MSTS score that gives a maximum score 30 points and a minimum of 0. Time to weight bearing was analysed from the first postoperative day to the time that the patient was able to walk bearing 100% of their weight.</li><li class="elsevierStyleListItem" id="lsti0055">•Survival was analysed using the Kaplan–Meier method. The student's t-test was used for the demographic analysis of the groups. The differences in the groups were compared using the log-rank test. STAVIEW software was used for the statistical analysis. A p<.05 was considered statistically significant.</li></ul>ResultsA total of 106 patients with bone tumours treated with modular endoprostheses were included in the study. The mean age of the series was 48.5 (95% CI range: 14–89), and the average patient follow-up was 68 months (95% CI range: 24–288). The overall survival of the implant in our series was 86.4% at 2 years (95% CI: 79–94), and 73% at 5 years (95% CU: 60–80) (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1–3</a>). According to the anatomical site, survival of the reconstruction in the hip was 97% at 5 years (95% CI: 91–102), in the humerus it was 90% at 5 years (95% CI: 77–103), and 60% at 5 years in the knee (IC 95%: 40–78) (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia>The size of the resection was not a prognostic factor for the prosthetic reconstruction failures (p: .2). Primary surgery vs revision surgery was not associated with a higher rate of implant failure (p: .21).The limb salvage rate in the entire series was 96% at 5 years (95% CI: 91–99). The mean time until the patients were able to fully weight bear was 2.3 weeks (range 2–5).Group 1 primary bone tumours: 36 patients were included. The mean age of the series was 43 (range 14–81), and the average follow-up was 62.5 months (range 24–180 months). The demographic characteristics of the series are summarised in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. The most common anatomical site was the proximal femur (33%), followed by the proximal humerus (19%), then the distal femur (8%), and the proximal tibia (8%) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia>The patients’ overall survival at 2 years was 70% (95% CI: 54 –84), and 56% at 5 years (95% CI: 71–70). The survival at 2 and 5 years of the implant was 80% (95%CI: 65–94.4) (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>). Adjuvant chemotherapy was a risk factor for failure of the reconstruction (p<.01); not the size of the resection (p: .2) or the presence of a pathological fracture (p: .67).<elsevierMultimedia ident="fig0025"></elsevierMultimedia>Three failures were classified as mechanical (2 type 1A, one type 3A), and 3 as non-mechanical (2 type 4A, one type 5A). The mean time until failure was 16 months (range: 1–24). Seventeen of the 36 patients (47.2%) had to be treated with at least one further surgical procedure due to a complication (total 22 procedures). The causes were: local recurrence (9), infection (5), and dislocations (5). The limb salvage rate was 94.4% (95%CI: 91–99). The functional assessment according to the MSTS was 26 points (range: 20–29).Group 2 bone metastases: 44 patients were included in this group. The average age was 63 (range 34–89). The mean follow-up was 67 months (range 24–170). The demographic characteristics are summarised in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. The most common anatomical site was the proximal femur (21/44 patients; 48%), then the proximal humerus (16/44 patients; 36%), followed by the distal femur (3/44 patients; 9%) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).The patients’ overall survival was 57% at one year (95% CI: 42 and 51), 39% at 2 years (95% CI: 24 and 73), and 17% at 5 years (95% CI: 24–30). The survival of the implant in this group was 100% at 12 months, and 95% at 24 months (95% CI: 87–100) (<a class="elsevierStyleCrossRef" href="#fig0030">Fig. 6</a>). The only patient who failed was due to an acute infection (Henderson 4A). Six of the 44 patients (14%) had to be treated by at least one further procedure due to a complication (total of 7 procedures). The causes were: dislocation (n=4) and infection (n=3). The limb salvage rate in this group was 100%. The functional assessment according to the MSTS score was 24/30 (range: 19–29).<elsevierMultimedia ident="fig0030"></elsevierMultimedia>Group 3 revision of massive bone transplants. Twenty-six patients were included in this group, with an average age of 32.5 years (range: 14–76), and a mean follow-up of 70 months (range: 12–180). The primary reconstructions were 7 intercalary transplantations, and 19 osteoarticular transplants.The survival of the implant was 86% at 2 years (95% CI: 79–94), and 73% at 5 years (95% CI: 60–83). Twelve reconstructions failed; mechanical cause was the most prevalent (n=7) and, of these, aseptic loosening (Henderson type 2A) was the most frequent (n=3). The other failures are detailed in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>. Fourteen of the 26 patients (58%) had to be treated with at least one further surgical procedure, due to a complication, with a total of 27 procedures. The causes were: infection (n=8), implant rupture (n=3), tumour recurrence (n=4), loosening (n=3), and dislocation (n=3).<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>According to the MSTS assessment, the mean functional outcome was 24 points (range: 17–28).DiscussionLimb salvage surgery is the treatment of choice for patients with malignant and locally aggressive bone tumours. Although many reconstructive techniques have been described, there is no evidence in the literature that one technique is superior to the others. Albergo et al. compared 133 patients with proximal tibia reconstructions with massive bone transplants and endoprostheses, and found no differences in the failure rates at 5 and at 10 years.<a class="elsevierStyleCrossRef" href="#bib0270">23</a> In recent decades, the use of endoprostheses to reconstruct large segmentary bone defects has gained acceptance among orthopaedic surgeons. This is due to advances in adjuvant therapies for the treatment of oncological patients, to the improved prosthetic designs and their availability, to advances in surgical techniques, and increased surgeon experience. Myers et al. studied the long-term follow-up of distal femoral endoprostheses, where the risk of revision surgery due to aseptic loosening of the hinged prostheses was 35%, was 24% with constrained prostheses with hydroxyapatite, and 0% for those with hydroxyapatite collar.<a class="elsevierStyleCrossRef" href="#bib0275">24</a>The survival rates of endoprostheses vary according to their location, from 54% in the proximal tibia to 90% in the proximal femur.<a class="elsevierStyleCrossRefs" href="#bib0280">25,26</a> Zeegen et al. studied 141 patients with endoprostheses, and reported an overall survival rate of the implant of 88% at 3 years, and 76% at 5 years, with a survival rate at 3 years in the hip and shoulder of 100%, 87% in the knee, and 53% for total femur implants.<a class="elsevierStyleCrossRef" href="#bib0290">27</a> The overall survival of the implant in our series was 86% at 2 years, and 73% at 5 years. According to anatomical site, in the hip it was 97% at 5 years, in the humerus it was 90%, and 60% in the knee. We believe that these findings are in line with the corresponding survival rates in the studies published in the literature. In terms of the survival of the implant in each particular group, we found that the patients with metastases had better rates compared to the other 2 groups (100% at one year and 95% at 2 years). However we must stress that this finding relates to the low overall survival of these patients, which was 17% at 5 years.<a class="elsevierStyleCrossRef" href="#bib0295">28</a> According to the classification by Henderson et al., 19 implant failures were described in our series, and the most prevalent were mechanical. The most frequent sites of failure were the distal femur, and the proximal tibia. Of the mechanical failures, those of soft tissues, type 1 in the classification, presented in the hip and shoulder principally, which reflects the intrinsic instability of these joints.<a class="elsevierStyleCrossRef" href="#bib0250">19</a> Unwin et al. described the results of 1001 endoprostheses with aseptic weakening as the final outcome, and reported that the prosthesis failed most frequently in the distal femur, with a 9.9% revision rate.<a class="elsevierStyleCrossRef" href="#bib0300">29</a>Forty seven percent of the patients with primary tumours, 58% of patients who had undergone revision surgery due to failed massive bone transplants, and 13% of the patients with metastases had to be reoperated due to a complication. Infection was the main reason for reintervention in all of the 3 groups. However, in our series less than 8% of the endoprosthesis failures were caused by infection. Jeys et al. reported a periprosthetic infection rate of 11% in a series of 1264 oncological patients treated with endoprostheses over a period of 37 years.<a class="elsevierStyleCrossRef" href="#bib0305">30</a>Although it was expected that revision surgery secondary to a failed massive bone transplant would have a higher rate of complications than primary surgery, the implant failure rate between these 2 groups was not statistically significant (p: .21), which was also reported by Zeegen et al.<a class="elsevierStyleCrossRef" href="#bib0290">27</a>Grimer et al., in their paper on very long term follow-up of endoprosthetic replacement for malignant bone tumours, reported an average of 2.7 reinterventions per patients. However, the risk of amputation at 30 years was 16%, and most of the patients preserved their limb.<a class="elsevierStyleCrossRef" href="#bib0310">31</a> In our series, the rates of limb preservation were 96% at 5 years.Our paper has some limitations: its short-term follow-up, retrospective design and the heterogeneity of the sample.ConclusionLimb salvage surgery is the treatment of choice for patients with bone tumours and reconstruction with endoprostheis is a valid alternative, with similar failure rates to other forms of reconstruction.Level of evidenceLevel of evidence III.Conflict of interestsThe authors have no conflict of interest to declare. """ "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres1182948" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Materials and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Result" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1103549" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1182947" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Materiales y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1103548" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Material and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Level of evidence" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflict of interests" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-08-23" "fechaAceptado" => "2019-01-07" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1103549" "palabras" => array:3 [ 0 => "Bone tumour" 1 => "Endoprosthesis reconstruction" 2 => "Limb preservation" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1103548" "palabras" => array:3 [ 0 => "Tumores óseos" 1 => "Prótesis modulares" 2 => "Conservación de miembro" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectiveTo analyse a series of patients with bone tumours reconstructed with modular prostheses and to evaluate: (1) Survival of the implant. (2) Causes of failure. (3) Complication rates. (4) Limb salvage overall survival. (5) Functional results and full weight bearing. Materials and methodsA retrospective study from longitudinally maintained oncology databases was undertaken. All patients with bone tumours reconstructed with endoprosthesis were analysed. A total of 106 patients matched the inclusion criteria. They were divided into groups: group 1, primary bone tumours; group 2, bone metastasis; group 3, osteoarticular allograft reconstruction revisions. The type of failures were classified according to Henderson et al. (2014) and functional results assessed by the Musculoskeletal Tumor Society (MSTS). Demographic analysis, survival and the differences between groups were recorded. ResultThe mean follow-up of the patients was 68 months. Mean age was 43 years. Overall implant survival was 86.4% at 2 years (95% CI: 79–94) and 73% at 5 years (95% CI: 60–80). Nineteen patients (18%) developed a prosthetic failure. The limb salvage overall survival was 96% at 5 years (95% CI: 91–99). The mean functional results according to the MSTS was 24 and mean time to full weight bearing was 2.3 weeks. ConclusionsLimb conservation surgery and endosprosthetic reconstruction is a valid option for patients with bone tumours with failure rates similar to other reconstruction methods." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Materials and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Result" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "ObjetivoAnalizar una serie de pacientes oncológicos tratados con prótesis modulares y evaluar: 1) Supervivencia del implante. 2) Causas de fracaso. 3) Tasa de reintervención. 4) Supervivencia del miembro. 5) Resultados funcionales y tiempo hasta la carga completa. Materiales y métodosSe realizó una búsqueda retrospectiva en una base de datos oncológica entre marzo de 2001 y agosto de 2015 de pacientes con tumores óseos y pacientes con cirugía de revisión de trasplantes óseos reconstruidos con endoprótesis. Se incluyó a 106 pacientes con seguimiento mínimo de 2 años. Se dividió la población en 3 grupos: grupo 1, tumores óseos primarios; grupo 2, metástasis ósea; grupo 3, revisiones de trasplantes óseos masivos. Las causas de fracasos fueron clasificadas según Henderson et al. (2014) y la funcionalidad se evaluó según el la escala de la Musculoskeletal Tumor Society (MSTS). Se realizó análisis demográfico, estimación de la supervivencia y se compararon las diferencias entre grupos. ResultadosEl seguimiento medio de los pacientes fue de 68 meses. La edad promedio fue de 43 años. La supervivencia global del implante fue del 86% a 2 años (IC 95%: 79-94) y del 73% a 5 años (IC 95%: 60-80). Diecinueve pacientes (18%) presentaron fracaso protésico, con revisión. La conservación del miembro en nuestra serie fue del 96% a 5 años (IC 95%: 91-99). Los resultados funcionales promedio según la escala de la MSTS fueron de 24 y el tiempo medio para carga completa de 2, 3 semanas. ConclusiónLa cirugía de conservación de miembro representa el tratamiento de elección en pacientes con tumores óseos y la reconstrucción con endoprótesis resulta una alternativa válida, con índices de fracaso similares a otras reconstrucciones." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Materiales y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Cabas-Geat AE, Bruchmann MG, Albergo JI, Ayerza MA, Farfalli G, Aponte-Tinao LA, et al. Reconstrucción con prótesis modulares posterior a una resección oncológica. Evaluación de los fracasos y análisis de la supervivencia. Rev Esp Cir Ortop Traumatol. 2019;63:173–l80." ] ] "multimedia" => array:9 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 988 "Ancho" => 2503 "Tamanyo" => 105219 ] ] "descripcion" => array:1 [ "en" => "(a) Overall survival of the implant was 86.4% at 2 years (95% CI: 79–94), and 73% at 5 years (95% CI: 60–80). (b) Overall survival of the implant per group: primary: 80% at 2 and at 5 years (95% CI: 65–94.4); metastasis: 95% at 2 years; revisions: 73% at 5 years (95% CI: 60–80)." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1556 "Ancho" => 1671 "Tamanyo" => 133923 ] ] "descripcion" => array:1 [ "en" => "Overall survival at 2 and 5 years for each group. Overall implant survival at 2 and 5 years for each group." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1457 "Ancho" => 1583 "Tamanyo" => 61052 ] ] "descripcion" => array:1 [ "en" => "Survival of the implant according to anatomical region. (1) Hip: 97%; (2) humerus: 90%; (3) knee: 60%; (4) total arthroplasties: 45%." ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 832 "Ancho" => 2104 "Tamanyo" => 70401 ] ] "descripcion" => array:1 [ "en" => "(a) Primary bone tumour survival at 2 years was 70% (95% CI: 54–84), and 56% at 5 years (95% CI: 71–70). (b) Overall primary implant survival: 80% at 2 and at 5 years (95% CI: 65–94.4)." ] ] 4 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 806 "Ancho" => 2094 "Tamanyo" => 73285 ] ] "descripcion" => array:1 [ "en" => "(a) The overall survival rate of the patients with metastatic bone tumours was 57% at year one, 39% at 2 years and 17% at 5 years. (b) Implant survival in this group was 100% at 12 months and 95% at 24 months." ] ] 5 => array:7 [ "identificador" => "fig0030" "etiqueta" => "Figure 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 891 "Ancho" => 1252 "Tamanyo" => 42703 ] ] "descripcion" => array:1 [ "en" => "Overall implant survival after revisions: 86% at 2 years (95% CI: 79–94), and 73% at 5 years (95% CI: 60–80)." ] ] 6 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "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"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Primary tumours \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Metastasis \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Revisions \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">32 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Sex</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Tumour</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Osteosarcoma 11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Kidney 14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Osteoarticular 19 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Chondrosarcoma 9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Breast 12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Intercalary 7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ewing 5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Lung 7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Myeloma 4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Melanoma 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Malignant fibrohistiocytoma 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bladder 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Other<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> 4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Other<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Chemotherapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">36% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">100% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Size of resection</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">0–25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">25–50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">50–57 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">75–100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Follow-up in months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">62.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">67 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">70 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2016214.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Leiomyosarcoma (1), rhabdomyosarcoma (1), giant cell tumour (1), fibrous dysplasia (1)." ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "Lymphoma (2), colon (2), rhabdomyosarcoma (1), uterus (1), parotid glands (1)." ] ] ] "descripcion" => array:1 [ "en" => "Demographic outcomes." ] ] 7 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "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"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Site \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Primary tumour \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Metastasis \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Revisions \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Proximal femur \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Distal femur \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total femur \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Proximal tibia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Proximal humerus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Distal humerus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total humerus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2016212.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Tumour site." ] ] 8 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Source: Henderson et al. (2014).<a class="elsevierStyleCrossRef" href="#bib0260">21</a>" "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"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Failures \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Primary tumour \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Metastasis \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Revisions \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total failures n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 (16.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (2.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12 (46.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total mechanical failures n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 (8.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 (27) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Henderson 1 (soft tissue failure) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">A B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 – \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– – \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 – \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Henderson 2 (aseptic weakening or non-union) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">A B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– – \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– – \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– 3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Henderson 3 (Structural failure) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">A B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 – \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– – \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total of non-mechanical failures n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 (8.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (2.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 (19) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Henderson 4 (infections) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">A B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 – \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 – \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Henderson 5 (tumour progression) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">A B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 – \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– – \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 – \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2016213.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Type of prosthetic failure according to Henderson et al." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:31 [ 0 => array:3 [ "identificador" => "bib0160" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Limb-sparing surgery preserves more function than amputation: a Scandinavian sarcoma group study of 118 patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L.H. Aksnes" 1 => "H.C. Bauer" 2 => "N.L. Jebsen" 3 => "G. Follerås" 4 => "C. Allert" 5 => "G.S. Haugen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Bone Joint Surg [Br]" "fecha" => "2008" "volumen" => "90B" "paginaInicial" => "786" "paginaFinal" => "794" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0165" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The UCLA experience in limb salvage surgery for malignant tumors" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.J. Eckardt" 1 => "F.R. Eilber" 2 => "F.J. Dorey" 3 => "J.M. Mirra" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Orthopedics" "fecha" => "1985" "volumen" => "8" "paginaInicial" => "612" "paginaFinal" => "621" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3912743" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0170" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Adjuvant chemotherapy for osteosarcoma: a randomized prospective trial" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "F. Eilber" 1 => "A. Giuliano" 2 => "J. Eckardt" 3 => "K. Patterson" 4 => "S. Moseley" 5 => "J. Goodnight" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1200/JCO.1987.5.1.21" "Revista" => array:6 [ "tituloSerie" => "J Clin Oncol" "fecha" => "1987" "volumen" => "5" "paginaInicial" => "21" "paginaFinal" => "26" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3543236" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0175" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neoadjuvant chemotherapy for high grade osteosarcoma of the extremities: long-term results for patients treated according to the Rizzoli IOR/OS-3b protocol" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Bacci" 1 => "S. Ferrari" 2 => "A. Longhi" 3 => "C. Forni" 4 => "F. Bertoni" 5 => "N. Fabbri" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1179/joc.2001.13.1.93" "Revista" => array:6 [ "tituloSerie" => "J Chemother" "fecha" => "2001" "volumen" => "13" "paginaInicial" => "93" "paginaFinal" => "99" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11233808" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0180" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Limb-salvage treatment versus amputation for osteosarcoma of the distal end of the femur" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M.A. Simon" 1 => "M.A. Aschliman" 2 => "N. Thomas" 3 => "H.J. Mankin" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "JBJS Am" "fecha" => "1986" "volumen" => "68" "paginaInicial" => "1331" "paginaFinal" => "1337" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3465732" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0185" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Limb salvage compared with amputation for osteosarcoma of the distal end of the femur: a long-term oncological, functional and quality of life study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "B.T. Rougraff" 1 => "M.A. Simon" 2 => "J.S. Kneisl" 3 => "D.B. Greenberg" 4 => "H.J. Mankin" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "JBJS Am" "fecha" => "1994" "volumen" => "76" "paginaInicial" => "649" "paginaFinal" => "656" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8175811" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0190" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Advances in bone tumour treatment in 30 years with respect to survival and limb salvage. A single institution experience" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Kotz" 1 => "M. Dominkus" 2 => "T. Zettl" 3 => "P. Ritschl" 4 => "R. Windhager" 5 => "H. Gadner" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00264-002-0365-1" "Revista" => array:6 [ "tituloSerie" => "Int Orthop" "fecha" => "2002" "volumen" => "26" "paginaInicial" => "197" "paginaFinal" => "202" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12185518" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0195" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Endoprosthetic replacement of the proximal tibia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.J. Grimer" 1 => "S.R. Carter" 2 => "R.M. Tillman" 3 => "R.S. Sneath" 4 => "P.S. Walker" 5 => "P.S. Unwin" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Bone Joint Surg Br" "fecha" => "1999" "volumen" => "81" "paginaInicial" => "488" "paginaFinal" => "494" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10872373" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0200" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Survivorship and clinical outcome of modular endoprosthetic reconstruction for neoplastic disease of the lower limb" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "E.R. Ahlmann" 1 => "L.R. Menendez" 2 => "C. Kermani" 3 => "H. Gotha" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1302/0301-620X.88B6.17519" "Revista" => array:6 [ "tituloSerie" => "JBJS Br" "fecha" => "2006" "volumen" => "88" "paginaInicial" => "790" "paginaFinal" => "795" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16720775" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0205" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Biological reconstruction after resection of bone tumors around the knee: long-term follow-up" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "Y.Y. Abed" 1 => "G. Beltrami" 2 => "D.A. Campanacci" 3 => "M. Innocenti" 4 => "G. Scoccianti" 5 => "R. Capanna" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1302/0301-620X.91B10.22212" "Revista" => array:6 [ "tituloSerie" => "J Bone Joint Surg Br" "fecha" => "2009" "volumen" => "91" "paginaInicial" => "1366" "paginaFinal" => "1372" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19794174" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0210" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Frequent complications and severe bone loss associated with the repiphysis expandable distal femoral prosthesis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C.A. Cipriano" 1 => "I.S. Gruzinova" 2 => "R.M. Frank" 3 => "S. Gitelis" 4 => "W.W. Virkus" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11999-014-3564-3" "Revista" => array:6 [ "tituloSerie" => "Clin Orthop Relat Res" "fecha" => "2015" "volumen" => "473" "paginaInicial" => "831" "paginaFinal" => "838" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24664193" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0215" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Uncemented tumor endoprostheses at the knee: root causes of failure" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A.M. Griffin" 1 => "J.A. Parsons" 2 => "A.M. Davis" 3 => "R.S. Bell" 4 => "J.S. Wunder" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.blo.0000180050.27961.8a" "Revista" => array:6 [ "tituloSerie" => "Clin Orthop Relat Res" "fecha" => "2005" "volumen" => "438" "paginaInicial" => "71" "paginaFinal" => "79" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16131872" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0220" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Etiology and results of tumor endoprosthesis revision surgery in 64 patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "P.Z. Wirganowicz" 1 => "J.J. Eckardt" 2 => "F.J. Dorey" 3 => "F.R. Eilber" 4 => "J.M. Kabo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/00003086-199901000-00009" "Revista" => array:5 [ "tituloSerie" => "Clin Orthop Relat Res" "fecha" => "1999" "volumen" => "358" "paginaInicial" => "64" "paginaFinal" => "74" ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0225" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "What are the functional outcomes of endoprosthestic reconstructions after tumor resection?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "N.M. Bernthal" 1 => "M. Greenberg" 2 => "K. Heberer" 3 => "J.J. Eckardt" 4 => "E.G. Fowler" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11999-014-3655-1" "Revista" => array:6 [ "tituloSerie" => "Clin Orthop Relat Res" "fecha" => "2015" "volumen" => "473" "paginaInicial" => "812" "paginaFinal" => "819" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24777730" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0230" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Use of distal femoral osteoarticular allografts in limb salvage surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D.L. Muscolo" 1 => "M.A. Ayerza" 2 => "L.A. Aponte-Tinao" 3 => "M. Ranalletta" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2106/JBJS.D.02170" "Revista" => array:6 [ "tituloSerie" => "J Bone Joint Surg Am" "fecha" => "2005" "volumen" => "87" "paginaInicial" => "2449" "paginaFinal" => "2455" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16264120" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0235" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Proximal tibia osteoarticular allografts in tumor limb salvage surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D.L. Muscolo" 1 => "M.A. Ayerza" 2 => "G. Farfalli" 3 => "L.A. Aponte-Tinao" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11999-009-1186-y" "Revista" => array:6 [ "tituloSerie" => "Clin Orthop Relat Res" "fecha" => "2010" "volumen" => "468" "paginaInicial" => "1396" "paginaFinal" => "1404" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20020336" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0240" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The principles and applications of fresh frozen allografts to bone and joint reconstruction" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "L.A. Aponte-Tinao" 1 => "L.E. Ritacco" 2 => "J.I. Albergo" 3 => "M.A. Ayerza" 4 => "D.L. Muscolo" 5 => "G.L. Farfalli" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ocl.2013.12.008" "Revista" => array:6 [ "tituloSerie" => "Orthop Clin North Am" "fecha" => "2014" "volumen" => "45" "paginaInicial" => "257" "paginaFinal" => "269" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24684919" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0245" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Endoprosthetic replacement for bony metastases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D. Chan" 1 => "S.R. Carter" 2 => "R.J. Grimer" 3 => "R.S. Sneath" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann R Coll Surg Engl" "fecha" => "1992" "volumen" => "74" "paginaInicial" => "13" "paginaFinal" => "18" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1371043" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0250" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Failure mode classification for tumor endoprostheses: retrospective review of five institutions and a literature review" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E.R. Henderson" 1 => "J.S. Groundland" 2 => "E. Pala" 3 => "J.A. Dennis" 4 => "R. Wooten" 5 => "D. Cheong" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2106/JBJS.J.00834" "Revista" => array:6 [ "tituloSerie" => "J Bone Joint Surg Am" "fecha" => "2011" "volumen" => "93" "paginaInicial" => "418" "paginaFinal" => "429" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21368074" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0255" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Survival of modern knee tumor megaprostheses: failures, functional results, and a comparative statistical analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "E. Pala" 1 => "G. Trovarelli" 2 => "T. Calabro" 3 => "A. Angelini" 4 => "C.N. Abati" 5 => "P. Ruggieri" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11999-014-3699-2" "Revista" => array:6 [ "tituloSerie" => "Clin Orthop Relat Res" "fecha" => "2015" "volumen" => "473" "paginaInicial" => "891" "paginaFinal" => "899" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24874116" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0260" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Classification of failure of limb salvage after reconstructive surgery for bone tumors: a modified system including biological and expandable reconstructions" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E.R. Henderson" 1 => "M.I. O’Connor" 2 => "P. Ruggieri" 3 => "R. Windhager" 4 => "P.T. Funo- vics" 5 => "C.L. Gibbons" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1302/0301-620X.96B11.34747" "Revista" => array:6 [ "tituloSerie" => "Bone Joint J" "fecha" => "2014" "volumen" => "96" "paginaInicial" => "1436" "paginaFinal" => "1440" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25371453" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0265" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A system for the functional evaluation of reconstructive procedures after surgical treatment of the musculoskeletal system" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "W.F. Enneking" 1 => "W. Dunham" 2 => "M.C. Gebhardt" 3 => "M. Malawar" 4 => "D.J. Pritchard" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Clin Orthop Relat Res" "fecha" => "1993" "volumen" => "286" "paginaInicial" => "241" "paginaFinal" => "324" ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0270" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Proximal tibia reconstruction after bone tumor resection: are survivorship and outcomes of endoprosthetic replacement and osteoarticular allograft similar?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.I. Albergo" 1 => "C.L. Gaston" 2 => "L.A. Aponte-Tinao" 3 => "M.A. Ayerza" 4 => "D.L. Muscolo" 5 => "G.L. Farfalli" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Clin Ortho Relat Res" "fecha" => "2017" "volumen" => "475" "paginaInicial" => "676" "paginaFinal" => "682" ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0275" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Endoprosthetic replacement of the distal femur for bone tumors: long-term results" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "G.J. Myers" 1 => "A.T. Abudu" 2 => "S.R. Carter" 3 => "R.M. Tillman" 4 => "R.J. Grimer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1302/0301-620X.89B4.18631" "Revista" => array:6 [ "tituloSerie" => "J Bone Joint Surg Br" "fecha" => "2007" "volumen" => "89" "paginaInicial" => "521" "paginaFinal" => "526" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17463123" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0280" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prosthetic and extremity survivorship after limb salvage for sarcoma: how long do the reconstructions last?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S.M. Horowitz" 1 => "D.B. Glasser" 2 => "J.M. Lane" 3 => "J.H. Healey" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Clin Orthop" "fecha" => "1993" "volumen" => "293" "paginaInicial" => "280" "paginaFinal" => "286" ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0285" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prosthetic replacement of the distal femur for primary bone tumors" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "P. Roberts" 1 => "D. Chan" 2 => "R.J. Grimer" 3 => "R.S. Sneath" 4 => "J.T. Scales" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Bone Joint Surg" "fecha" => "1991" "volumen" => "73B" "paginaInicial" => "762" "paginaFinal" => "769" ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0290" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Survivorship analysis of 141 modular metallic endoprostheses at early followup" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "E.N. Zeegen" 1 => "L.A. Aponte-Tinao" 2 => "F.J. Hornicek" 3 => "M.C. Gebhardt" 4 => "H.J. Mankin" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Clin Orthop Relat Res" "fecha" => "2004" "volumen" => "420" "paginaInicial" => "239" "paginaFinal" => "250" ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0295" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Functional and oncologic outcome of cemented endoprosthesis for malignant proximal femoral tumors" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.T. Houdek" 1 => "C.D. Watts" 2 => "C.C. Wyles" 3 => "P.S. Rose" 4 => "M.J. Taunton" 5 => "F.H. Sim" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/jso.24339" "Revista" => array:6 [ "tituloSerie" => "J Surg Oncol" "fecha" => "2016" "volumen" => "114" "paginaInicial" => "501" "paginaFinal" => "506" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27353406" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0300" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Aseptic loosening in cemented custom-made prosthetic replacements for bone tumours of the lower limb" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "P.S. Unwin" 1 => "S.R. Cannon" 2 => "R.J. Grimer" 3 => "H.B. Kemp" 4 => "R.S. Sneath" 5 => "P.S. Walker" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Bone Joint Surg [Br]" "fecha" => "1996" "volumen" => "78-B" "paginaInicial" => "5" "paginaFinal" => "13" ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0305" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Periprosthetic infection in patients treated for an orthopaedic oncological condition" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "L.M. Jeys" 1 => "R.J. Grimer" 2 => "S.R. Carter" 3 => "R.M. Tillman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Bone Joint Surg [Am]" "fecha" => "2005" "volumen" => "87-A" "paginaInicial" => "842" "paginaFinal" => "849" "itemHostRev" => array:3 [ "pii" => "S0923181113000121" "estado" => "S300" "issn" => "09231811" ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0310" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Very long-term outcomes after endoprosthetic replacement for malignant tumours of bone" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.J. Grimer" 1 => "B.K. Aydin" 2 => "H. Wafa" 3 => "S.R. Carter" 4 => "L. Jeys" 5 => "A. 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Original Article

Modular prosthesis reconstruction after tumour resection, evaluation of failures and survival

Reconstrucción con prótesis modulares posterior a una resección oncológica. Evaluación de los fracasos y análisis de la supervivencia

A.E. Cabas-Geat

Corresponding author

angelescabasgeat@gmail.com

Corresponding author.

, M.G. Bruchmann, J.I. Albergo, M.A. Ayerza, G. Farfalli, L.A. Aponte-Tinao, L.D. Muscolo

Servicio de Ortopedia Oncológica y Trasplantes Óseos, Hospital Italiano, Buenos Aires, Argentina

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      <span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The treatment of musculoskeletal tumours has undergone momentous change in recent decades&#46; At the beginning of the nineteen seventies the mainstay of treatment for these types of tumours was amputation&#44; with survival rates of less than 30&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">1&#44;2</span></a> With the advent of neoadjuvant chemotherapy and the advances in radiation therapy&#44; survival rates improved significantly&#44; rising to 60&#37;&#8211;70&#37; at 5 years&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">3&#44;4</span></a> Limb salvage surgery is currently the treatment of choice for most of these patients&#46; Many studies in the literature show that there are no differences in terms of survival between patients treated with limb salvage surgery and amputated patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">5&#8211;7</span></a> A great many reconstructive options for the treatment of bone defects after oncological resections have been described&#46; These include biological or prosthetic reconstructions or a combination of both&#44; such as alloprostheses&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">8&#8211;11</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Reconstruction with structural allograft after tumour resection in the limbs makes it possible to preserve more bone stock and biomechanically restore the flexor-extensor and ligament system&#44; with the limitations that weight-bearing of the limb must be restricted for a prolonged period of time&#44; it requires an extensive rehabilitation period&#44; and there is a risk of transplant failure given the need for adjuvant radiation treatment&#46; By contrast&#44; endoprostheses show greater benefits for people with tumours of poor prognosis or the elderly&#44; and enables early ambulation and cessation of pain&#46; Associated advantages and disadvantages have been described for both procedures&#44; but there is controversy with regard to the best reconstructive option&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">12&#8211;14</span></a> Historically&#44; our institution was renowned for its use of bone transplants as a reconstructive technique&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">15&#8211;17</span></a> However&#44; since the beginning of 2000 there has been a major increase in the indication for endoprostheses in limb salvage surgery&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">18</span></a> The use of endoprostheses has evolved in recent decades&#44; principally due to the improvements to these implants&#46; Their advantages are availability&#44; their flexibility in dealing with varying bone defects&#44; they enable early weight bearing and mobilisation&#44; and patients are able to rapidly resume their daily living activities&#46; On the other hand&#44; complications such as loosening&#44; dislocation&#44; decoupling of the implant&#39;s modules&#44; and infection remain a concern for surgeons&#46;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">19&#44;20</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The aim of our paper was to study a series of oncological patients treated with modular endoprostheses and assess&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0020" class="elsevierStylePara elsevierViewall">Implant survival</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0025" class="elsevierStylePara elsevierViewall">Causes of failure according to the classification by Henderson et al&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">21</span></a></p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0030" class="elsevierStylePara elsevierViewall">Re-intervention rate due to complications</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8226;</span><p id="par0035" class="elsevierStylePara elsevierViewall">Survival of the limb</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#8226;</span><p id="par0040" class="elsevierStylePara elsevierViewall">Functional outcomes&#58; Musculoskeletal Tumour Society &#40;MSTS&#41;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">22</span></a> and time to full weight bearing&#46;</p></li></ul></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0045" class="elsevierStylePara elsevierViewall">A retrospective search on our longitudinal oncological database was performed between March 2001 and August 2015 of all patients who underwent reconstruction with modular endoprostheses&#46; Skeletally mature patients were included in the study&#44; with primary or secondary bone tumour disease&#44; and with a minimum follow-up of 24 months for the patients who were alive at the time of the study&#46; All patients operated for purely reconstructive purposes or treated in a different institution were excluded&#46; The indications for the use of modular endoprostheses in oncological patients in our institution were&#58; patients with a poor response to chemotherapy&#44; with metastases &#40;with expected survival of more than 6 months&#41;&#44; undergoing adjuvant radiotherapy treatment&#44; elderly patients&#44; the anatomical region of the proximal femur&#44; and with reconstructive surgery secondary to the failure of massive bone transplants&#46; Modular prostheses with rotating hinges and cemented stems were used&#44; manufactured by Zimmer Biomet Spain S&#46;L&#46;U&#46; &#40;Barcelona&#44; Spain&#41;&#46; The study population was divided into 3 groups&#58; group 1&#44; comprising patients with primary malignant or benign locally aggressive tumours&#59; group 2&#44; patients with bone metastases and group 3&#44; patients reconstructed with a modular endoprosthesis due to failure of massive bone transplants&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The following variables were analysed&#58;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#8226;</span><p id="par0055" class="elsevierStylePara elsevierViewall">Survival of the implant according to the Kaplan&#8211;Meier method&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">&#8226;</span><p id="par0060" class="elsevierStylePara elsevierViewall">Causes of limb salvage surgery failure according to the classification by Henderson et al&#46; &#40;2014&#41;&#46; There are 5 types&#46; From 1 to 3 are mechanical failures&#46; Types 4 and 5 are non-mechanical failures&#46; Type 1&#58; soft tissue failure &#40;1A&#58; functional failure&#59; 1B&#58; coverage failure&#41;&#46; Type 2&#58; aseptic loosening &#40;2A&#58; \n
      &lt;at 2="" years;="" 2b:=""&gt;\n
       at 2 years&#41;&#46; Type 3&#58; structural failure &#40;3A&#58; implant rupture or wear&#59; 3B&#58; periprosthetic fracture&#41;&#46; Type 4&#58; infection that requires a change of prosthesis &#40;4A&#58; \n
       &lt;at 2="" years;="" 4b:=""&gt;\n
         at 2 years&#41;&#46; Type 5&#58; recurrence or progression of the tumour in contact with the prosthesis &#40;5A&#58; soft tissues&#59; 5B&#58; bone&#41;&#46;\n
       &lt;/at&gt;\n
      &lt;/at&gt;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">&#8226;</span><p id="par0065" class="elsevierStylePara elsevierViewall">Rate of reinvention due to complications&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">&#8226;</span><p id="par0070" class="elsevierStylePara elsevierViewall">Limb salvage rate&#46;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">&#8226;</span><p id="par0075" class="elsevierStylePara elsevierViewall">Functional outcomes were assessed according to the MSTS score that gives a maximum score 30 points and a minimum of 0&#46; Time to weight bearing was analysed from the first postoperative day to the time that the patient was able to walk bearing 100&#37; of their weight&#46;</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">&#8226;</span><p id="par0080" class="elsevierStylePara elsevierViewall">Survival was analysed using the Kaplan&#8211;Meier method&#46; The student&#39;s <span class="elsevierStyleItalic">t</span>-test was used for the demographic analysis of the groups&#46; The differences in the groups were compared using the log-rank test&#46; STAVIEW software was used for the statistical analysis&#46; A <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05 was considered statistically significant&#46;</p></li></ul></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0085" class="elsevierStylePara elsevierViewall">A total of 106 patients with bone tumours treated with modular endoprostheses were included in the study&#46; The mean age of the series was 48&#46;5 &#40;95&#37; CI range&#58; 14&#8211;89&#41;&#44; and the average patient follow-up was 68 months &#40;95&#37; CI range&#58; 24&#8211;288&#41;&#46; The overall survival of the implant in our series was 86&#46;4&#37; at 2 years &#40;95&#37; CI&#58; 79&#8211;94&#41;&#44; and 73&#37; at 5 years &#40;95&#37; CU&#58; 60&#8211;80&#41; &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1&#8211;3</a>&#41;&#46; According to the anatomical site&#44; survival of the reconstruction in the hip was 97&#37; at 5 years &#40;95&#37; CI&#58; 91&#8211;102&#41;&#44; in the humerus it was 90&#37; at 5 years &#40;95&#37; CI&#58; 77&#8211;103&#41;&#44; and 60&#37; at 5 years in the knee &#40;IC 95&#37;&#58; 40&#8211;78&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">The size of the resection was not a prognostic factor for the prosthetic reconstruction failures &#40;<span class="elsevierStyleItalic">p</span>&#58; &#46;2&#41;&#46; Primary surgery vs revision surgery was not associated with a higher rate of implant failure &#40;<span class="elsevierStyleItalic">p</span>&#58; &#46;21&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">The limb salvage rate in the entire series was 96&#37; at 5 years &#40;95&#37; CI&#58; 91&#8211;99&#41;&#46; The mean time until the patients were able to fully weight bear was 2&#46;3 weeks &#40;range 2&#8211;5&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Group 1 primary bone tumours&#58; 36 patients were included&#46; The mean age of the series was 43 &#40;range 14&#8211;81&#41;&#44; and the average follow-up was 62&#46;5 months &#40;range 24&#8211;180 months&#41;&#46; The demographic characteristics of the series are summarised in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; The most common anatomical site was the proximal femur &#40;33&#37;&#41;&#44; followed by the proximal humerus &#40;19&#37;&#41;&#44; then the distal femur &#40;8&#37;&#41;&#44; and the proximal tibia &#40;8&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">The patients&#8217; overall survival at 2 years was 70&#37; &#40;95&#37; CI&#58; 54 &#8211;84&#41;&#44; and 56&#37; at 5 years &#40;95&#37; CI&#58; 71&#8211;70&#41;&#46; The survival at 2 and 5 years of the implant was 80&#37; &#40;95&#37;CI&#58; 65&#8211;94&#46;4&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#41;&#46; Adjuvant chemotherapy was a risk factor for failure of the reconstruction &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41;&#59; not the size of the resection &#40;<span class="elsevierStyleItalic">p</span>&#58; &#46;2&#41; or the presence of a pathological fracture &#40;<span class="elsevierStyleItalic">p</span>&#58; &#46;67&#41;&#46;</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">Three failures were classified as mechanical &#40;2 type 1A&#44; one type 3A&#41;&#44; and 3 as non-mechanical &#40;2 type 4A&#44; one type 5A&#41;&#46; The mean time until failure was 16 months &#40;range&#58; 1&#8211;24&#41;&#46; Seventeen of the 36 patients &#40;47&#46;2&#37;&#41; had to be treated with at least one further surgical procedure due to a complication &#40;total 22 procedures&#41;&#46; The causes were&#58; local recurrence &#40;9&#41;&#44; infection &#40;5&#41;&#44; and dislocations &#40;5&#41;&#46; The limb salvage rate was 94&#46;4&#37; &#40;95&#37;CI&#58; 91&#8211;99&#41;&#46; The functional assessment according to the MSTS was 26 points &#40;range&#58; 20&#8211;29&#41;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Group 2 bone metastases&#58; 44 patients were included in this group&#46; The average age was 63 &#40;range 34&#8211;89&#41;&#46; The mean follow-up was 67 months &#40;range 24&#8211;170&#41;&#46; The demographic characteristics are summarised in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; The most common anatomical site was the proximal femur &#40;21&#47;44 patients&#59; 48&#37;&#41;&#44; then the proximal humerus &#40;16&#47;44 patients&#59; 36&#37;&#41;&#44; followed by the distal femur &#40;3&#47;44 patients&#59; 9&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">The patients&#8217; overall survival was 57&#37; at one year &#40;95&#37; CI&#58; 42 and 51&#41;&#44; 39&#37; at 2 years &#40;95&#37; CI&#58; 24 and 73&#41;&#44; and 17&#37; at 5 years &#40;95&#37; CI&#58; 24&#8211;30&#41;&#46; The survival of the implant in this group was 100&#37; at 12 months&#44; and 95&#37; at 24 months &#40;95&#37; CI&#58; 87&#8211;100&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0030">Fig&#46; 6</a>&#41;&#46; The only patient who failed was due to an acute infection &#40;Henderson 4A&#41;&#46; Six of the 44 patients &#40;14&#37;&#41; had to be treated by at least one further procedure due to a complication &#40;total of 7 procedures&#41;&#46; The causes were&#58; dislocation &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#41; and infection &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41;&#46; The limb salvage rate in this group was 100&#37;&#46; The functional assessment according to the MSTS score was 24&#47;30 &#40;range&#58; 19&#8211;29&#41;&#46;</p><elsevierMultimedia ident="fig0030"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">Group 3 revision of massive bone transplants&#46; Twenty-six patients were included in this group&#44; with an average age of 32&#46;5 years &#40;range&#58; 14&#8211;76&#41;&#44; and a mean follow-up of 70 months &#40;range&#58; 12&#8211;180&#41;&#46; The primary reconstructions were 7 intercalary transplantations&#44; and 19 osteoarticular transplants&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">The survival of the implant was 86&#37; at 2 years &#40;95&#37; CI&#58; 79&#8211;94&#41;&#44; and 73&#37; at 5 years &#40;95&#37; CI&#58; 60&#8211;83&#41;&#46; Twelve reconstructions failed&#59; mechanical cause was the most prevalent &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>7&#41; and&#44; of these&#44; aseptic loosening &#40;Henderson type 2A&#41; was the most frequent &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41;&#46; The other failures are detailed in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46; Fourteen of the 26 patients &#40;58&#37;&#41; had to be treated with at least one further surgical procedure&#44; due to a complication&#44; with a total of 27 procedures&#46; The causes were&#58; infection &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#41;&#44; implant rupture &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41;&#44; tumour recurrence &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#41;&#44; loosening &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41;&#44; and dislocation &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">According to the MSTS assessment&#44; the mean functional outcome was 24 points &#40;range&#58; 17&#8211;28&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0140" class="elsevierStylePara elsevierViewall">Limb salvage surgery is the treatment of choice for patients with malignant and locally aggressive bone tumours&#46; Although many reconstructive techniques have been described&#44; there is no evidence in the literature that one technique is superior to the others&#46; Albergo et al&#46; compared 133 patients with proximal tibia reconstructions with massive bone transplants and endoprostheses&#44; and found no differences in the failure rates at 5 and at 10 years&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">23</span></a> In recent decades&#44; the use of endoprostheses to reconstruct large segmentary bone defects has gained acceptance among orthopaedic surgeons&#46; This is due to advances in adjuvant therapies for the treatment of oncological patients&#44; to the improved prosthetic designs and their availability&#44; to advances in surgical techniques&#44; and increased surgeon experience&#46; Myers et al&#46; studied the long-term follow-up of distal femoral endoprostheses&#44; where the risk of revision surgery due to aseptic loosening of the hinged prostheses was 35&#37;&#44; was 24&#37; with constrained prostheses with hydroxyapatite&#44; and 0&#37; for those with hydroxyapatite collar&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">24</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">The survival rates of endoprostheses vary according to their location&#44; from 54&#37; in the proximal tibia to 90&#37; in the proximal femur&#46;<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">25&#44;26</span></a> Zeegen et al&#46; studied 141 patients with endoprostheses&#44; and reported an overall survival rate of the implant of 88&#37; at 3 years&#44; and 76&#37; at 5 years&#44; with a survival rate at 3 years in the hip and shoulder of 100&#37;&#44; 87&#37; in the knee&#44; and 53&#37; for total femur implants&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">27</span></a> The overall survival of the implant in our series was 86&#37; at 2 years&#44; and 73&#37; at 5 years&#46; According to anatomical site&#44; in the hip it was 97&#37; at 5 years&#44; in the humerus it was 90&#37;&#44; and 60&#37; in the knee&#46; We believe that these findings are in line with the corresponding survival rates in the studies published in the literature&#46; In terms of the survival of the implant in each particular group&#44; we found that the patients with metastases had better rates compared to the other 2 groups &#40;100&#37; at one year and 95&#37; at 2 years&#41;&#46; However we must stress that this finding relates to the low overall survival of these patients&#44; which was 17&#37; at 5 years&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">28</span></a> According to the classification by Henderson et al&#46;&#44; 19 implant failures were described in our series&#44; and the most prevalent were mechanical&#46; The most frequent sites of failure were the distal femur&#44; and the proximal tibia&#46; Of the mechanical failures&#44; those of soft tissues&#44; type 1 in the classification&#44; presented in the hip and shoulder principally&#44; which reflects the intrinsic instability of these joints&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">19</span></a> Unwin et al&#46; described the results of 1001 endoprostheses with aseptic weakening as the final outcome&#44; and reported that the prosthesis failed most frequently in the distal femur&#44; with a 9&#46;9&#37; revision rate&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">29</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">Forty seven percent of the patients with primary tumours&#44; 58&#37; of patients who had undergone revision surgery due to failed massive bone transplants&#44; and 13&#37; of the patients with metastases had to be reoperated due to a complication&#46; Infection was the main reason for reintervention in all of the 3 groups&#46; However&#44; in our series less than 8&#37; of the endoprosthesis failures were caused by infection&#46; Jeys et al&#46; reported a periprosthetic infection rate of 11&#37; in a series of 1264 oncological patients treated with endoprostheses over a period of 37 years&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">30</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">Although it was expected that revision surgery secondary to a failed massive bone transplant would have a higher rate of complications than primary surgery&#44; the implant failure rate between these 2 groups was not statistically significant &#40;<span class="elsevierStyleItalic">p</span>&#58; &#46;21&#41;&#44; which was also reported by Zeegen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">27</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">Grimer et al&#46;&#44; in their paper on very long term follow-up of endoprosthetic replacement for malignant bone tumours&#44; reported an average of 2&#46;7 reinterventions per patients&#46; However&#44; the risk of amputation at 30 years was 16&#37;&#44; and most of the patients preserved their limb&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">31</span></a> In our series&#44; the rates of limb preservation were 96&#37; at 5 years&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Our paper has some limitations&#58; its short-term follow-up&#44; retrospective design and the heterogeneity of the sample&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusion</span><p id="par0170" class="elsevierStylePara elsevierViewall">Limb salvage surgery is the treatment of choice for patients with bone tumours and reconstruction with endoprostheis is a valid alternative&#44; with similar failure rates to other forms of reconstruction&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Level of evidence</span><p id="par0175" class="elsevierStylePara elsevierViewall">Level of evidence <span class="elsevierStyleSmallCaps">III</span>&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflict of interests</span><p id="par0180" class="elsevierStylePara elsevierViewall">The authors have no conflict of interest to declare&#46;</p></span></span>
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1103549"
          "palabras" => array:3 [
            0 => "Bone tumour"
            1 => "Endoprosthesis reconstruction"
            2 => "Limb preservation"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1103548"
          "palabras" => array:3 [
            0 => "Tumores &#243;seos"
            1 => "Pr&#243;tesis modulares"
            2 => "Conservaci&#243;n de miembro"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To analyse a series of patients with bone tumours reconstructed with modular prostheses and to evaluate&#58; &#40;1&#41; Survival of the implant&#46; &#40;2&#41; Causes of failure&#46; &#40;3&#41; Complication rates&#46; &#40;4&#41; Limb salvage overall survival&#46; &#40;5&#41; Functional results and full weight bearing&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Materials and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A retrospective study from longitudinally maintained oncology databases was undertaken&#46; All patients with bone tumours reconstructed with endoprosthesis were analysed&#46; A total of 106 patients matched the inclusion criteria&#46; They were divided into groups&#58; group 1&#44; primary bone tumours&#59; group 2&#44; bone metastasis&#59; group 3&#44; osteoarticular allograft reconstruction revisions&#46; The type of failures were classified according to Henderson et al&#46; &#40;2014&#41; and functional results assessed by the Musculoskeletal Tumor Society &#40;MSTS&#41;&#46; Demographic analysis&#44; survival and the differences between groups were recorded&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Result</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The mean follow-up of the patients was 68 months&#46; Mean age was 43 years&#46; Overall implant survival was 86&#46;4&#37; at 2 years &#40;95&#37; CI&#58; 79&#8211;94&#41; and 73&#37; at 5 years &#40;95&#37; CI&#58; 60&#8211;80&#41;&#46; Nineteen patients &#40;18&#37;&#41; developed a prosthetic failure&#46; The limb salvage overall survival was 96&#37; at 5 years &#40;95&#37; CI&#58; 91&#8211;99&#41;&#46; The mean functional results according to the MSTS was 24 and mean time to full weight bearing was 2&#46;3 weeks&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Limb conservation surgery and endosprosthetic reconstruction is a valid option for patients with bone tumours with failure rates similar to other reconstruction methods&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objective"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Materials and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Result"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Analizar una serie de pacientes oncol&#243;gicos tratados con pr&#243;tesis modulares y evaluar&#58; 1&#41; Supervivencia del implante&#46; 2&#41; Causas de fracaso&#46; 3&#41; Tasa de reintervenci&#243;n&#46; 4&#41; Supervivencia del miembro&#46; 5&#41; Resultados funcionales y tiempo hasta la carga completa&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Materiales y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; una b&#250;squeda retrospectiva en una base de datos oncol&#243;gica entre marzo de 2001 y agosto de 2015 de pacientes con tumores &#243;seos y pacientes con cirug&#237;a de revisi&#243;n de trasplantes &#243;seos reconstruidos con endopr&#243;tesis&#46; Se incluy&#243; a 106 pacientes con seguimiento m&#237;nimo de 2 a&#241;os&#46; Se dividi&#243; la poblaci&#243;n en 3 grupos&#58; grupo 1&#44; tumores &#243;seos primarios&#59; grupo 2&#44; met&#225;stasis &#243;sea&#59; grupo 3&#44; revisiones de trasplantes &#243;seos masivos&#46; Las causas de fracasos fueron clasificadas seg&#250;n Henderson et al&#46; &#40;2014&#41; y la funcionalidad se evalu&#243; seg&#250;n el la escala de la Musculoskeletal Tumor Society &#40;MSTS&#41;&#46; Se realiz&#243; an&#225;lisis demogr&#225;fico&#44; estimaci&#243;n de la supervivencia y se compararon las diferencias entre grupos&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">El seguimiento medio de los pacientes fue de 68 meses&#46; La edad promedio fue de 43 a&#241;os&#46; La supervivencia global del implante fue del 86&#37; a 2 a&#241;os &#40;IC 95&#37;&#58; 79-94&#41; y del 73&#37; a 5 a&#241;os &#40;IC 95&#37;&#58; 60-80&#41;&#46; Diecinueve pacientes &#40;18&#37;&#41; presentaron fracaso prot&#233;sico&#44; con revisi&#243;n&#46; La conservaci&#243;n del miembro en nuestra serie fue del 96&#37; a 5 a&#241;os &#40;IC 95&#37;&#58; 91-99&#41;&#46; Los resultados funcionales promedio seg&#250;n la escala de la MSTS fueron de 24 y el tiempo medio para carga completa de 2&#44; 3 semanas&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La cirug&#237;a de conservaci&#243;n de miembro representa el tratamiento de elecci&#243;n en pacientes con tumores &#243;seos y la reconstrucci&#243;n con endopr&#243;tesis resulta una alternativa v&#225;lida&#44; con &#237;ndices de fracaso similares a otras reconstrucciones&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Materiales y m&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusi&#243;n"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Please cite this article as&#58; Cabas-Geat AE&#44; Bruchmann MG&#44; Albergo JI&#44; Ayerza MA&#44; Farfalli G&#44; Aponte-Tinao LA&#44; et al&#46; Reconstrucci&#243;n con pr&#243;tesis modulares posterior a una resecci&#243;n oncol&#243;gica&#46; Evaluaci&#243;n de los fracasos y an&#225;lisis de la supervivencia&#46; Rev Esp Cir Ortop Traumatol&#46; 2019&#59;63&#58;173&#8211;l80&#46;</p>"
      ]
    ]
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      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 988
            "Ancho" => 2503
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          ]
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        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">&#40;a&#41; Overall survival of the implant was 86&#46;4&#37; at 2 years &#40;95&#37; CI&#58; 79&#8211;94&#41;&#44; and 73&#37; at 5 years &#40;95&#37; CI&#58; 60&#8211;80&#41;&#46; &#40;b&#41; Overall survival of the implant per group&#58; primary&#58; 80&#37; at 2 and at 5 years &#40;95&#37; CI&#58; 65&#8211;94&#46;4&#41;&#59; metastasis&#58; 95&#37; at 2 years&#59; revisions&#58; 73&#37; at 5 years &#40;95&#37; CI&#58; 60&#8211;80&#41;&#46;</p>"
        ]
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        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1556
            "Ancho" => 1671
            "Tamanyo" => 133923
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Overall survival at 2 and 5 years for each group&#46; Overall implant survival at 2 and 5 years for each group&#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" => 1457
            "Ancho" => 1583
            "Tamanyo" => 61052
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Survival of the implant according to anatomical region&#46; &#40;1&#41; Hip&#58; 97&#37;&#59; &#40;2&#41; humerus&#58; 90&#37;&#59; &#40;3&#41; knee&#58; 60&#37;&#59; &#40;4&#41; total arthroplasties&#58; 45&#37;&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "fig0020"
        "etiqueta" => "Figure 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr4.jpeg"
            "Alto" => 832
            "Ancho" => 2104
            "Tamanyo" => 70401
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">&#40;a&#41; Primary bone tumour survival at 2 years was 70&#37; &#40;95&#37; CI&#58; 54&#8211;84&#41;&#44; and 56&#37; at 5 years &#40;95&#37; CI&#58; 71&#8211;70&#41;&#46; &#40;b&#41; Overall primary implant survival&#58; 80&#37; at 2 and at 5 years &#40;95&#37; CI&#58; 65&#8211;94&#46;4&#41;&#46;</p>"
        ]
      ]
      4 => array:7 [
        "identificador" => "fig0025"
        "etiqueta" => "Figure 5"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr5.jpeg"
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            "Tamanyo" => 73285
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">&#40;a&#41; The overall survival rate of the patients with metastatic bone tumours was 57&#37; at year one&#44; 39&#37; at 2 years and 17&#37; at 5 years&#46; &#40;b&#41; Implant survival in this group was 100&#37; at 12 months and 95&#37; at 24 months&#46;</p>"
        ]
      ]
      5 => array:7 [
        "identificador" => "fig0030"
        "etiqueta" => "Figure 6"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr6.jpeg"
            "Alto" => 891
            "Ancho" => 1252
            "Tamanyo" => 42703
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Overall implant survival after revisions&#58; 86&#37; at 2 years &#40;95&#37; CI&#58; 79&#8211;94&#41;&#44; and 73&#37; at 5 years &#40;95&#37; CI&#58; 60&#8211;80&#41;&#46;</p>"
        ]
      ]
      6 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "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"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Primary tumours&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Metastasis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Revisions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Age</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Sex</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Tumour</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Osteosarcoma 11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Kidney 14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Osteoarticular 19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Chondrosarcoma 9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Breast 12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Intercalary 7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ewing 5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Lung 7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Myeloma 4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Melanoma 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Malignant fibrohistiocytoma 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bladder 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Other<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> 4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Other<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Chemotherapy</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Size of resection</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>0&#8211;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>25&#8211;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>50&#8211;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>75&#8211;100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Follow-up in months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">62&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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            ]
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Primary tumour&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Metastasis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Revisions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Proximal femur&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Distal femur&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total femur&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Proximal tibia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Proximal humerus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Distal humerus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total humerus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Source&#58; Henderson et al&#46; &#40;2014&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">21</span></a></p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Failures&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Primary tumour&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Metastasis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Revisions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total failures <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;16&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;2&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 &#40;46&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total mechanical failures <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;8&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;27&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Henderson 1 &#40;soft tissue failure&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">A<br>B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2<br>&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;<br>&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1<br>&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Henderson 2 &#40;aseptic weakening or non-union&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">A<br>B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;<br>&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;<br>&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;<br>3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Henderson 3<br>&#40;Structural failure&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">A<br>B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1<br>&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;<br>&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1<br>2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total of non-mechanical failures n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;8&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;2&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Henderson 4 &#40;infections&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">A<br>B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2<br>&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1<br>&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1<br>1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Henderson 5 &#40;tumour progression&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">A<br>B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1<br>&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;<br>&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3<br>&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Type of prosthetic failure according to Henderson et al&#46;</p>"
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    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:31 [
            0 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Limb-sparing surgery preserves more function than amputation&#58; a Scandinavian sarcoma group study of 118 patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46;H&#46; Aksnes"
                            1 => "H&#46;C&#46; Bauer"
                            2 => "N&#46;L&#46; Jebsen"
                            3 => "G&#46; Foller&#229;s"
                            4 => "C&#46; Allert"
                            5 => "G&#46;S&#46; Haugen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Bone Joint Surg &#91;Br&#93;"
                        "fecha" => "2008"
                        "volumen" => "90B"
                        "paginaInicial" => "786"
                        "paginaFinal" => "794"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The UCLA experience in limb salvage surgery for malignant tumors"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;J&#46; Eckardt"
                            1 => "F&#46;R&#46; Eilber"
                            2 => "F&#46;J&#46; Dorey"
                            3 => "J&#46;M&#46; Mirra"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Orthopedics"
                        "fecha" => "1985"
                        "volumen" => "8"
                        "paginaInicial" => "612"
                        "paginaFinal" => "621"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3912743"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Adjuvant chemotherapy for osteosarcoma&#58; a randomized prospective trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "F&#46; Eilber"
                            1 => "A&#46; Giuliano"
                            2 => "J&#46; Eckardt"
                            3 => "K&#46; Patterson"
                            4 => "S&#46; Moseley"
                            5 => "J&#46; Goodnight"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1200/JCO.1987.5.1.21"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Oncol"
                        "fecha" => "1987"
                        "volumen" => "5"
                        "paginaInicial" => "21"
                        "paginaFinal" => "26"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3543236"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Neoadjuvant chemotherapy for high grade osteosarcoma of the extremities&#58; long-term results for patients treated according to the Rizzoli IOR&#47;OS-3b protocol"
                      "autores" => array:1 [
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                          "autores" => array:6 [
                            0 => "G&#46; Bacci"
                            1 => "S&#46; Ferrari"
                            2 => "A&#46; Longhi"
                            3 => "C&#46; Forni"
                            4 => "F&#46; Bertoni"
                            5 => "N&#46; Fabbri"
                          ]
                        ]
                      ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1179/joc.2001.13.1.93"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Chemother"
                        "fecha" => "2001"
                        "volumen" => "13"
                        "paginaInicial" => "93"
                        "paginaFinal" => "99"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11233808"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
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                ]
              ]
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            4 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Limb-salvage treatment versus amputation for osteosarcoma of the distal end of the femur"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46;A&#46; Simon"
                            1 => "M&#46;A&#46; Aschliman"
                            2 => "N&#46; Thomas"
                            3 => "H&#46;J&#46; Mankin"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "JBJS Am"
                        "fecha" => "1986"
                        "volumen" => "68"
                        "paginaInicial" => "1331"
                        "paginaFinal" => "1337"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3465732"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Limb salvage compared with amputation for osteosarcoma of the distal end of the femur&#58; a long-term oncological&#44; functional and quality of life study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "B&#46;T&#46; Rougraff"
                            1 => "M&#46;A&#46; Simon"
                            2 => "J&#46;S&#46; Kneisl"
                            3 => "D&#46;B&#46; Greenberg"
                            4 => "H&#46;J&#46; Mankin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "JBJS Am"
                        "fecha" => "1994"
                        "volumen" => "76"
                        "paginaInicial" => "649"
                        "paginaFinal" => "656"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8175811"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Advances in bone tumour treatment in 30 years with respect to survival and limb salvage&#46; A single institution experience"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; Kotz"
                            1 => "M&#46; Dominkus"
                            2 => "T&#46; Zettl"
                            3 => "P&#46; Ritschl"
                            4 => "R&#46; Windhager"
                            5 => "H&#46; Gadner"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00264-002-0365-1"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int Orthop"
                        "fecha" => "2002"
                        "volumen" => "26"
                        "paginaInicial" => "197"
                        "paginaFinal" => "202"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12185518"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Endoprosthetic replacement of the proximal tibia"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46;J&#46; Grimer"
                            1 => "S&#46;R&#46; Carter"
                            2 => "R&#46;M&#46; Tillman"
                            3 => "R&#46;S&#46; Sneath"
                            4 => "P&#46;S&#46; Walker"
                            5 => "P&#46;S&#46; Unwin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Bone Joint Surg Br"
                        "fecha" => "1999"
                        "volumen" => "81"
                        "paginaInicial" => "488"
                        "paginaFinal" => "494"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10872373"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Survivorship and clinical outcome of modular endoprosthetic reconstruction for neoplastic disease of the lower limb"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "E&#46;R&#46; Ahlmann"
                            1 => "L&#46;R&#46; Menendez"
                            2 => "C&#46; Kermani"
                            3 => "H&#46; Gotha"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1302/0301-620X.88B6.17519"
                      "Revista" => array:6 [
                        "tituloSerie" => "JBJS Br"
                        "fecha" => "2006"
                        "volumen" => "88"
                        "paginaInicial" => "790"
                        "paginaFinal" => "795"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16720775"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Biological reconstruction after resection of bone tumors around the knee&#58; long-term follow-up"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "Y&#46;Y&#46; Abed"
                            1 => "G&#46; Beltrami"
                            2 => "D&#46;A&#46; Campanacci"
                            3 => "M&#46; Innocenti"
                            4 => "G&#46; Scoccianti"
                            5 => "R&#46; Capanna"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1302/0301-620X.91B10.22212"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Bone Joint Surg Br"
                        "fecha" => "2009"
                        "volumen" => "91"
                        "paginaInicial" => "1366"
                        "paginaFinal" => "1372"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19794174"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0210"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Frequent complications and severe bone loss associated with the repiphysis expandable distal femoral prosthesis"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46;A&#46; Cipriano"
                            1 => "I&#46;S&#46; Gruzinova"
                            2 => "R&#46;M&#46; Frank"
                            3 => "S&#46; Gitelis"
                            4 => "W&#46;W&#46; Virkus"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s11999-014-3564-3"
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                        "tituloSerie" => "Clin Orthop Relat Res"
                        "fecha" => "2015"
                        "volumen" => "473"
                        "paginaInicial" => "831"
                        "paginaFinal" => "838"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24664193"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0215"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Uncemented tumor endoprostheses at the knee&#58; root causes of failure"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46;M&#46; Griffin"
                            1 => "J&#46;A&#46; Parsons"
                            2 => "A&#46;M&#46; Davis"
                            3 => "R&#46;S&#46; Bell"
                            4 => "J&#46;S&#46; Wunder"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.blo.0000180050.27961.8a"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Orthop Relat Res"
                        "fecha" => "2005"
                        "volumen" => "438"
                        "paginaInicial" => "71"
                        "paginaFinal" => "79"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16131872"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Etiology and results of tumor endoprosthesis revision surgery in 64 patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "P&#46;Z&#46; Wirganowicz"
                            1 => "J&#46;J&#46; Eckardt"
                            2 => "F&#46;J&#46; Dorey"
                            3 => "F&#46;R&#46; Eilber"
                            4 => "J&#46;M&#46; Kabo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/00003086-199901000-00009"
                      "Revista" => array:5 [
                        "tituloSerie" => "Clin Orthop Relat Res"
                        "fecha" => "1999"
                        "volumen" => "358"
                        "paginaInicial" => "64"
                        "paginaFinal" => "74"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "What are the functional outcomes of endoprosthestic reconstructions after tumor resection&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "N&#46;M&#46; Bernthal"
                            1 => "M&#46; Greenberg"
                            2 => "K&#46; Heberer"
                            3 => "J&#46;J&#46; Eckardt"
                            4 => "E&#46;G&#46; Fowler"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s11999-014-3655-1"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Orthop Relat Res"
                        "fecha" => "2015"
                        "volumen" => "473"
                        "paginaInicial" => "812"
                        "paginaFinal" => "819"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24777730"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Use of distal femoral osteoarticular allografts in limb salvage surgery"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "D&#46;L&#46; Muscolo"
                            1 => "M&#46;A&#46; Ayerza"
                            2 => "L&#46;A&#46; Aponte-Tinao"
                            3 => "M&#46; Ranalletta"
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                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2106/JBJS.D.02170"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Bone Joint Surg Am"
                        "fecha" => "2005"
                        "volumen" => "87"
                        "paginaInicial" => "2449"
                        "paginaFinal" => "2455"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16264120"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Proximal tibia osteoarticular allografts in tumor limb salvage surgery"
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                          "etal" => false
                          "autores" => array:4 [
                            0 => "D&#46;L&#46; Muscolo"
                            1 => "M&#46;A&#46; Ayerza"
                            2 => "G&#46; Farfalli"
                            3 => "L&#46;A&#46; Aponte-Tinao"
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s11999-009-1186-y"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Orthop Relat Res"
                        "fecha" => "2010"
                        "volumen" => "468"
                        "paginaInicial" => "1396"
                        "paginaFinal" => "1404"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20020336"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The principles and applications of fresh frozen allografts to bone and joint reconstruction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "L&#46;A&#46; Aponte-Tinao"
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                            2 => "J&#46;I&#46; Albergo"
                            3 => "M&#46;A&#46; Ayerza"
                            4 => "D&#46;L&#46; Muscolo"
                            5 => "G&#46;L&#46; Farfalli"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ocl.2013.12.008"
                      "Revista" => array:6 [
                        "tituloSerie" => "Orthop Clin North Am"
                        "fecha" => "2014"
                        "volumen" => "45"
                        "paginaInicial" => "257"
                        "paginaFinal" => "269"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24684919"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Endoprosthetic replacement for bony metastases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "D&#46; Chan"
                            1 => "S&#46;R&#46; Carter"
                            2 => "R&#46;J&#46; Grimer"
                            3 => "R&#46;S&#46; Sneath"
                          ]
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann R Coll Surg Engl"
                        "fecha" => "1992"
                        "volumen" => "74"
                        "paginaInicial" => "13"
                        "paginaFinal" => "18"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1371043"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Failure mode classification for tumor endoprostheses&#58; retrospective review of five institutions and a literature review"
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                        0 => array:2 [
                          "etal" => true
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                            1 => "J&#46;S&#46; Groundland"
                            2 => "E&#46; Pala"
                            3 => "J&#46;A&#46; Dennis"
                            4 => "R&#46; Wooten"
                            5 => "D&#46; Cheong"
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2106/JBJS.J.00834"
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                        "tituloSerie" => "J Bone Joint Surg Am"
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                        "paginaInicial" => "418"
                        "paginaFinal" => "429"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21368074"
                            "web" => "Medline"
                          ]
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                    ]
                  ]
                ]
              ]
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            19 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "20"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Survival of modern knee tumor megaprostheses&#58; failures&#44; functional results&#44; and a comparative statistical analysis"
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                        0 => array:2 [
                          "etal" => false
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                            4 => "C&#46;N&#46; Abati"
                            5 => "P&#46; Ruggieri"
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
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                        "tituloSerie" => "Clin Orthop Relat Res"
                        "fecha" => "2015"
                        "volumen" => "473"
                        "paginaInicial" => "891"
                        "paginaFinal" => "899"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24874116"
                            "web" => "Medline"
                          ]
                        ]
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                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Classification of failure of limb salvage after reconstructive surgery for bone tumors&#58; a modified system including biological and expandable reconstructions"
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                        0 => array:2 [
                          "etal" => true
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                            5 => "C&#46;L&#46; Gibbons"
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1302/0301-620X.96B11.34747"
                      "Revista" => array:6 [
                        "tituloSerie" => "Bone Joint J"
                        "fecha" => "2014"
                        "volumen" => "96"
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                        "paginaFinal" => "1440"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25371453"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A system for the functional evaluation of reconstructive procedures after surgical treatment of the musculoskeletal system"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "W&#46;F&#46; Enneking"
                            1 => "W&#46; Dunham"
                            2 => "M&#46;C&#46; Gebhardt"
                            3 => "M&#46; Malawar"
                            4 => "D&#46;J&#46; Pritchard"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Clin Orthop Relat Res"
                        "fecha" => "1993"
                        "volumen" => "286"
                        "paginaInicial" => "241"
                        "paginaFinal" => "324"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Proximal tibia reconstruction after bone tumor resection&#58; are survivorship and outcomes of endoprosthetic replacement and osteoarticular allograft similar&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;I&#46; Albergo"
                            1 => "C&#46;L&#46; Gaston"
                            2 => "L&#46;A&#46; Aponte-Tinao"
                            3 => "M&#46;A&#46; Ayerza"
                            4 => "D&#46;L&#46; Muscolo"
                            5 => "G&#46;L&#46; Farfalli"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Clin Ortho Relat Res"
                        "fecha" => "2017"
                        "volumen" => "475"
                        "paginaInicial" => "676"
                        "paginaFinal" => "682"
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "etiqueta" => "24"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Endoprosthetic replacement of the distal femur for bone tumors&#58; long-term results"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "G&#46;J&#46; Myers"
                            1 => "A&#46;T&#46; Abudu"
                            2 => "S&#46;R&#46; Carter"
                            3 => "R&#46;M&#46; Tillman"
                            4 => "R&#46;J&#46; Grimer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1302/0301-620X.89B4.18631"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Bone Joint Surg Br"
                        "fecha" => "2007"
                        "volumen" => "89"
                        "paginaInicial" => "521"
                        "paginaFinal" => "526"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17463123"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0280"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Prosthetic and extremity survivorship after limb salvage for sarcoma&#58; how long do the reconstructions last&#63;"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "S&#46;M&#46; Horowitz"
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                            2 => "J&#46;M&#46; Lane"
                            3 => "J&#46;H&#46; Healey"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Clin Orthop"
                        "fecha" => "1993"
                        "volumen" => "293"
                        "paginaInicial" => "280"
                        "paginaFinal" => "286"
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "etiqueta" => "26"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prosthetic replacement of the distal femur for primary bone tumors"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "P&#46; Roberts"
                            1 => "D&#46; Chan"
                            2 => "R&#46;J&#46; Grimer"
                            3 => "R&#46;S&#46; Sneath"
                            4 => "J&#46;T&#46; Scales"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Bone Joint Surg"
                        "fecha" => "1991"
                        "volumen" => "73B"
                        "paginaInicial" => "762"
                        "paginaFinal" => "769"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0290"
              "etiqueta" => "27"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Survivorship analysis of 141 modular metallic endoprostheses at early followup"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "E&#46;N&#46; Zeegen"
                            1 => "L&#46;A&#46; Aponte-Tinao"
                            2 => "F&#46;J&#46; Hornicek"
                            3 => "M&#46;C&#46; Gebhardt"
                            4 => "H&#46;J&#46; Mankin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Clin Orthop Relat Res"
                        "fecha" => "2004"
                        "volumen" => "420"
                        "paginaInicial" => "239"
                        "paginaFinal" => "250"
                      ]
                    ]
                  ]
                ]
              ]
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                    0 => array:2 [
                      "titulo" => "Functional and oncologic outcome of cemented endoprosthesis for malignant proximal femoral tumors"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46;T&#46; Houdek"
                            1 => "C&#46;D&#46; Watts"
                            2 => "C&#46;C&#46; Wyles"
                            3 => "P&#46;S&#46; Rose"
                            4 => "M&#46;J&#46; Taunton"
                            5 => "F&#46;H&#46; Sim"
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                      ]
                    ]
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                        "tituloSerie" => "J Surg Oncol"
                        "fecha" => "2016"
                        "volumen" => "114"
                        "paginaInicial" => "501"
                        "paginaFinal" => "506"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27353406"
                            "web" => "Medline"
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                  ]
                ]
              ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Aseptic loosening in cemented custom-made prosthetic replacements for bone tumours of the lower limb"
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                          "etal" => false
                          "autores" => array:6 [
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                            2 => "R&#46;J&#46; Grimer"
                            3 => "H&#46;B&#46; Kemp"
                            4 => "R&#46;S&#46; Sneath"
                            5 => "P&#46;S&#46; Walker"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Bone Joint Surg &#91;Br&#93;"
                        "fecha" => "1996"
                        "volumen" => "78-B"
                        "paginaInicial" => "5"
                        "paginaFinal" => "13"
                      ]
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                      "titulo" => "Periprosthetic infection in patients treated for an orthopaedic oncological condition"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "L&#46;M&#46; Jeys"
                            1 => "R&#46;J&#46; Grimer"
                            2 => "S&#46;R&#46; Carter"
                            3 => "R&#46;M&#46; Tillman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Bone Joint Surg &#91;Am&#93;"
                        "fecha" => "2005"
                        "volumen" => "87-A"
                        "paginaInicial" => "842"
                        "paginaFinal" => "849"
                        "itemHostRev" => array:3 [
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                      "titulo" => "Very long-term outcomes after endoprosthetic replacement for malignant tumours of bone"
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                        "fecha" => "2016"
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                        "paginaFinal" => "864"
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Article information

ISSN: 19888856
Original language: English

DOI:10.1016/j.recote.2019.04.003

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2024 November	3	0	3
2024 October	30	10	40
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2024 July	16	6	22
2024 June	19	8	27
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2024 February	113	17	130
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2023 October	51	18	69
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2023 June	28	7	35
2023 May	24	6	30
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2022 December	25	8	33
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