metricas
covid
Buscar en
Revista Española de Cirugía Ortopédica y Traumatología (English Edition)
Toda la web
Inicio Revista Española de Cirugía Ortopédica y Traumatología (English Edition) Influence of instrumentation on the surgical time to implant a total knee prosth...
Journal Information

Statistics

Follow this link to access the full text of the article

Original Article
Influence of instrumentation on the surgical time to implant a total knee prosthesis
Influencia de la instrumentación sobre el tiempo quirúrgico para implantar una prótesis total de rodilla
V.J. León-Muñoza,
Corresponding author
vleonmd@gmail.com

Corresponding author.
, A.J. Lisón-Almagrob, M. López-Lópezc
a Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
b Servicio de Cirugía Ortopédica y Traumatología, Hospital de la Vega Lorenzo Guirao, Cieza, Murcia, Spain
c Subdirección General de Tecnologías de la Información, Servicio Murciano de Salud, Murcia, Spain
Read
1538
Times
was read the article
246
Total PDF
1292
Total HTML
Share statistics
 array:23 [
  "pii" => "S1988885619300513"
  "issn" => "19888856"
  "doi" => "10.1016/j.recote.2019.04.006"
  "estado" => "S300"
  "fechaPublicacion" => "2019-09-01"
  "aid" => "810"
  "copyright" => "SECOT"
  "copyrightAnyo" => "2019"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "fla"
  "cita" => "Rev Esp Cir Ortop Traumatol. 2019;63:321-6"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:1 [
    "total" => 0
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S1888441519300694"
      "issn" => "18884415"
      "doi" => "10.1016/j.recot.2019.04.006"
      "estado" => "S300"
      "fechaPublicacion" => "2019-09-01"
      "aid" => "810"
      "copyright" => "SECOT"
      "documento" => "article"
      "crossmark" => 1
      "subdocumento" => "fla"
      "cita" => "Rev Esp Cir Ortop Traumatol. 2019;63:321-6"
      "abierto" => array:3 [
        "ES" => false
        "ES2" => false
        "LATM" => false
      ]
      "gratuito" => false
      "lecturas" => array:2 [
        "total" => 483
        "formatos" => array:2 [
          "HTML" => 434
          "PDF" => 49
        ]
      ]
      "es" => array:12 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">ORIGINAL</span>"
        "titulo" => "Influencia de la instrumentaci&#243;n sobre el tiempo quir&#250;rgico para implantar una pr&#243;tesis total de rodilla"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "321"
            "paginaFinal" => "326"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Influence of instrumentation on the surgical time to implant a total knee prosthesis"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "V&#46;J&#46; Le&#243;n-Mu&#241;oz, A&#46;J&#46; Lis&#243;n-Almagro, M&#46; L&#243;pez-L&#243;pez"
            "autores" => array:3 [
              0 => array:2 [
                "nombre" => "V&#46;J&#46;"
                "apellidos" => "Le&#243;n-Mu&#241;oz"
              ]
              1 => array:2 [
                "nombre" => "A&#46;J&#46;"
                "apellidos" => "Lis&#243;n-Almagro"
              ]
              2 => array:2 [
                "nombre" => "M&#46;"
                "apellidos" => "L&#243;pez-L&#243;pez"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S1988885619300513"
          "doi" => "10.1016/j.recote.2019.04.006"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1988885619300513?idApp=UINPBA00004N"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1888441519300694?idApp=UINPBA00004N"
      "url" => "/18884415/0000006300000005/v2_201910021010/S1888441519300694/v2_201910021010/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S198888561930046X"
    "issn" => "19888856"
    "doi" => "10.1016/j.recote.2019.06.003"
    "estado" => "S300"
    "fechaPublicacion" => "2019-09-01"
    "aid" => "809"
    "copyright" => "SECOT"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Rev Esp Cir Ortop Traumatol. 2019;63:327-35"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Anthropometrical study of the human glenoid in a normal Spanish population"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "327"
          "paginaFinal" => "335"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Estudio antropom&#233;trico de la glena humana en una poblaci&#243;n espa&#241;ola normal"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 986
              "Ancho" => 600
              "Tamanyo" => 32429
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Three dimensional reconstruction of the CT image&#44; sagittal view&#59; note the circumferential edge in the exterior of the glenoid cavity&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "L&#46; Rosales-Rosales, A&#46;P&#46; Rosales-Varo, M&#46;A&#46; Garc&#237;a-Espona, O&#46; Roda-Murillo, I&#46; Montesinos, P&#46; Hernandez-Cort&#233;s"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "L&#46;"
              "apellidos" => "Rosales-Rosales"
            ]
            1 => array:2 [
              "nombre" => "A&#46;P&#46;"
              "apellidos" => "Rosales-Varo"
            ]
            2 => array:2 [
              "nombre" => "M&#46;A&#46;"
              "apellidos" => "Garc&#237;a-Espona"
            ]
            3 => array:2 [
              "nombre" => "O&#46;"
              "apellidos" => "Roda-Murillo"
            ]
            4 => array:2 [
              "nombre" => "I&#46;"
              "apellidos" => "Montesinos"
            ]
            5 => array:2 [
              "nombre" => "P&#46;"
              "apellidos" => "Hernandez-Cort&#233;s"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S1888441519300682"
        "doi" => "10.1016/j.recot.2019.04.005"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1888441519300682?idApp=UINPBA00004N"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S198888561930046X?idApp=UINPBA00004N"
    "url" => "/19888856/0000006300000005/v1_201909060709/S198888561930046X/v1_201909060709/en/main.assets"
  ]
  "en" => array:19 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
    "titulo" => "Influence of instrumentation on the surgical time to implant a total knee prosthesis"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "321"
        "paginaFinal" => "326"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "V&#46;J&#46; Le&#243;n-Mu&#241;oz, A&#46;J&#46; Lis&#243;n-Almagro, M&#46; L&#243;pez-L&#243;pez"
        "autores" => array:3 [
          0 => array:4 [
            "nombre" => "V&#46;J&#46;"
            "apellidos" => "Le&#243;n-Mu&#241;oz"
            "email" => array:1 [
              0 => "vleonmd@gmail.com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "A&#46;J&#46;"
            "apellidos" => "Lis&#243;n-Almagro"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "M&#46;"
            "apellidos" => "L&#243;pez-L&#243;pez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:3 [
          0 => array:3 [
            "entidad" => "Servicio de Cirug&#237;a Ortop&#233;dica y Traumatolog&#237;a&#44; Hospital Cl&#237;nico Universitario Virgen de la Arrixaca&#44; Murcia&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Servicio de Cirug&#237;a Ortop&#233;dica y Traumatolog&#237;a&#44; Hospital de la Vega Lorenzo Guirao&#44; Cieza&#44; Murcia&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Subdirecci&#243;n General de Tecnolog&#237;as de la Informaci&#243;n&#44; Servicio Murciano de Salud&#44; Murcia&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Influencia de la instrumentaci&#243;n sobre el tiempo quir&#250;rgico para implantar una pr&#243;tesis total de rodilla"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">There are different types of instrumentation systems for implanting a knee prosthesis&#44; a total knee replacement &#40;TKR&#41;&#46; The conventional systems&#44; the most widely used&#44; are based on intramedullary mechanical guide devices at the femoral level and intra- or extramedullary devices at the tibial level&#44; over which cutting blocks are anchored for the relevant osteotomies&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Computer assisted surgery &#40;CAS&#41; works with anatomical references that a computer system analyses to guide the cutting block placement&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;4</span></a> Another alternative is designing the surgery over virtual 3-dimensional &#40;3D&#41; models obtained from a computed tomography or magnetic resonance study &#40;that is&#44; a preoperative guide&#41; and the use of personalised cutting blocks or placers as instruments &#40;patient-specific instruments &#40;PSI&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a> Each of these technologies involve a sequence of different surgical steps and actions&#44; so an intervention can last more or less time&#46; Knowing the length of interventions can help to optimise the performance of each surgical session&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a> There are various studies<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;10</span></a> that suggest that replacing conventional instruments with patient-specific instruments reduces the time that the intervention lasts and consequently has a positive effect on the cost-efficiency and cost-effectiveness analyses&#46; The objective of this study was to demonstrate if there was a significant difference in the time knee prosthetic surgery lasts depending on the instrumentation system used&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and method</span><p id="par0010" class="elsevierStylePara elsevierViewall">We carried out a retrospective analysis of the information registered in the database of the web form specifically designed for TKR surgery&#46; The durations of 243 interventions performed by the same senior surgeon &#40;XXX&#41; between 2008 and 2012 were analysed&#46; The study included cases affected by bi- or tricompartmental knee osteoarthritis&#44; with no prior interventions on the affected knee&#44; in which the same prosthetic model was implanted&#46; Patients not operated by XXX&#44; patients that received posterior prosthesis implants or those stabilised medially&#44; cases without patellar replacement&#44; cases with cementing in two stages&#44; osteotomy modifications&#44; use of stems and&#47;or supplements&#44; patients with one-stage bilateral interventions and osteotomies with anterior tibial tuberosity for the approach &#40;that is&#44; the cases in which non-standard actions during the intervention might cause a variation in the intervention time&#41; were all excluded from the study&#46; The first 15 cases undergoing an intervention with each system were also excluded&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">To implant the prosthesis&#44; conventional mechanical instruments &#40;CI&#41; were used in 72 cases &#40;29&#46;63&#37;&#41;&#44; computer assisted surgery &#40;CAS&#41; was used in 68 cases &#40;27&#46;98&#37;&#41; and patient-specific instruments &#40;PSI&#41; were used in 103 cases &#40;42&#46;39&#37;&#41;&#46; The surgeries with CI were performed simultaneously with those carried out with CAS and PSI&#46; The ones performed with PSI and CAS were consecutive&#44; given that either 1 system or the other was used&#46; The cases were not selected on the basis of radiographic&#44; clinical or anthropometric characteristics&#46; The demographic and anthropometric characteristics of the series are presented in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; There were no statistically significant differences with respect to the variables of age&#44; sex distribution&#44; height and body mass index among the 3 groups&#46; There was a difference in weight &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;0&#46;019&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Surgical intervention</span><p id="par0020" class="elsevierStylePara elsevierViewall">Independently of the instrumentation system used&#44; the prosthesis implanted was always the cemented Global Medacta Knee &#40;GMK<span class="elsevierStyleSup">&#174;</span>&#44; Medacta International SA&#44; Castel San Pietro&#44; Switzerland&#41;&#44; with an ultra-congruent insert&#46; The kneecap was implanted in all cases&#46; The postoperative alignment objective in all cases&#44; regardless of the instruments used&#44; was to obtain a mechanical femorotibial angle &#40;mFTa&#41; of 180&#176;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Ischemia was performed using a sterile exsanguinations tourniquet &#40;S-MART<span class="elsevierStyleSup">&#174;</span> or HemaClear<span class="elsevierStyleSup">&#174;</span>&#44; OHK Medical Devices&#44; Haifa&#44; Israel&#41;&#46; This was applied just before the incision and removed after bandaging the limb&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In the cases undergoing an intervention using conventional mechanical instruments&#44; intramedullary femoral and tibial alignment and the ligament balancing system were used to establish femoral external rotation&#46; Computer assisted surgery was performed with the iMNS system &#8212; Medacta Navigation System &#40;Medacta International S&#46;A&#46;&#44; Castel San Pietro&#44; Switzerland&#41;&#46; Cutting blocks were used following intervention planning on virtual 3D models obtained after computed tomography study&#44; with the MyKnee<span class="elsevierStyleSup">&#174;</span> system &#40;Medacta International S&#46;A&#46;&#44; Castel San Pietro&#44; Switzerland&#41;&#46; Using computer-aided design &#40;CAD&#41; programs&#44; the patient-specific instruments were designed and then produced using selective laser sintering of a precision polyamide powder&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Variables</span><p id="par0035" class="elsevierStylePara elsevierViewall">Skin-to-skin time &#40;time from the beginning of the approach until the surgical wound is closed&#41; and ischemia time &#40;sterile ischemia just before the incision and removal after limb bandaging&#41; were determined&#46; The time the intervention lasted was obtained by exploitation of the database of the web form specifically designed for the capture of activity related to TKR surgery&#46; This information was crossed with that registered in the web form for operating theatre management&#44; used by the nursing staff&#46; In addition&#44; we analysed limb deformity by means of the preoperative standing mFTa angle determined via telemetry&#44; the degree of osteoarthritis according to the Kellgren and Lawrence classification<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;12</span></a> and the preoperative joint movement &#40;existence of the inability to extend the knee and maximum active flexion movement&#41;&#44; as can be seen in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; There were no statistically significant differences between the groups&#46; We determined the postoperative coronal plane alignment in the 3 groups&#46; Because the variables to analyse became anonymous upon their downloading from the databases&#44; it was not necessary to obtain express informed consent from the patients for the publication of these data&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Statistical analysis</span><p id="par0040" class="elsevierStylePara elsevierViewall">The predictive analytical software Minitab<span class="elsevierStyleSup">&#174;</span> Statistical Software v&#46;18 and IBM SPSS v&#46;25 for Windows were used for the analytical treatment&#46; The absence of normal distribution of values&#44; as demonstrated by the Kolmogorov&#8211;Smirnov test&#44; made it necessary to use the Kruskal&#8211;Wallis test for more than 2 independent samples&#44; the Pearson chi-square test for qualitative variables and the Pearson correlation coefficient&#46; Intervals of confidence were set to 95&#37; and the value of significance to <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;0&#46;05&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0045" class="elsevierStylePara elsevierViewall">We obtained a statistically significant difference &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;0&#46;000&#41; in favour of the cutting blocks compared with the other 2 instrumentation systems&#44; as is shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#44; with a 9-minute reduction with respect to CI and a 44-minute reduction with respect to CAS&#46; There was also a statistically-significant difference in favour of the cases in which CI were used&#44; as opposed to using computer assisted surgery&#44; of 35&#8239;min &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;0&#46;000&#41;&#46; In no case of the patients operated using PSI was it necessary to interrupt the technique and change to CI&#46; We established a weak positive correlation between mFTa and the time the intervention lasted&#46; The greater the valgus of the limb&#44; the greater the skin-to-skin time &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;0&#46;049&#41; and the greater the ischemia time &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;0&#46;038&#41;&#46; There was no correlation between preoperative joint movement and operative time&#46; The percentage of cases with postoperative alignment &#40;mFTa&#41; in the range of 180&#176;&#8239;&#177;&#8239;3&#176; was as follows&#58; 73&#46;4&#37; with CI&#44; 90&#46;2&#37; with CAS and 88&#46;6&#37; with PSI &#40;with a mean standard deviation outside of the range of 1&#46;98&#176;&#8239;&#177;&#8239;1&#46;73&#176; for the PSI cases&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discussion</span><p id="par0050" class="elsevierStylePara elsevierViewall">The most relevant observation in our study is the statistically significant reduction in operative time required for TKR implantation when patient-specific instruments &#40;PSI&#41; are used instead of conventional mechanical instruments or direct computer assisted surgery&#46; Our records are comparable with those published by other authors&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#8211;19</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">It has been estimated that using PSI to implant a TKR reduces the surgical procedure by up to 21 steps&#44; with the consequent reduction in time&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> In a systematic review and metaanalysis performed by Gong et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> 9 studies that published operative time were evaluated&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;22&#8211;29</span></a> According to their result&#44; surgery with PSI significantly reduced operative time an average of 7&#8239;min&#44; compared with the use of CI &#40;confidence interval &#91;CI&#93; of 95&#37; from &#8722;10&#46;95 to &#8722;3&#46;75 with <span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;0&#46;0001 and ratio of total variation attributable to study heterogeneity &#91;I<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span>&#93;</a> of 78&#37;&#41;&#46; The currently-available literature not analysed in the study by Gong et al&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> is not consistent about the reduction of operative time with the use of patient-specific instruments&#46; Several studies<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#8211;16&#44;24&#44;30</span></a> indicate that there is a significant reduction in time when the intervention is carried out using PSI&#46; Other authors<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;18</span></a> show a certain decrease in the length of surgery&#44; without a statistically-significant difference&#44; between the cases operated using CI and those using PSI&#46; To the contrary&#44; Hamilton et al&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> have published a prospective randomized study in which the surgeries are filmed for later detailed analysis of 15 sequential steps in prosthesis implantation&#46; In their study&#44; implanting the prosthesis by means of PSI takes a few minutes more when conventional instruments are used &#40;61&#46;47&#8239;&#177;&#8239;5&#46;48&#8239;min against 57&#46;27&#8239;&#177;&#8239;4&#46;58&#8239;min with <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;0&#46;006&#41;&#46; Interpreting the results&#44; Hamilton postulates that they stem from having experience with more than 1500 interventions using conventional instruments and with only 20 cases using guide blocks before the study&#46; In a series of 86 cases&#44; Chinnappa et al&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> establish a significant reduction in operative time after the learning curve&#44; with 85&#8239;&#177;&#8239;11&#46;1&#8239;min in the first 30 cases compared with 78&#8239;&#177;&#8239;8&#46;7&#8239;min in the next 56 &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;0&#46;001&#41;&#46; Steimle et al&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a> also publish a non-significant greater time consumption when patient-personalised instruments are used &#40;102&#46;2&#8239;&#177;&#8239;13&#46;4&#8239;min compared with 99&#8239;&#177;&#8239;21&#46;3&#8239;min with conventional instruments and <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;0&#46;721&#41;&#46; Focusing on the economic aspect&#44; Watters et al&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a> publish a comparison of costs and efficiencies between CI&#44; PSI and CAS&#44; from the supplier&#8217;s perspective&#46; These authors state that the cost per case is higher with PSI than with conventional instruments&#44; but less than with CAS&#46; This is in spite of estimating&#44; with respect to the conventional technique&#44; a 13-min reduction of operative time when patient-specific instrumentation is used and a 39-min increase when CAS is used&#46; In contrast&#44; Tibesku et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> apply activity-based costing and determine that prosthetic knee surgery using patient-specific instruments is economically effective&#44; as long as the time savings &#40;they estimate 10&#8239;min in the surgery and 20&#8239;min in the operating theatre preparation&#41; is used effectively to perform additional procedures&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">In our study&#44; we have observed a mean decrease of 9&#8239;min when comparing PSI with CI&#44; and of 44&#8239;min when comparing PSI with CAS&#46; Computer assisted surgery involves the capture of various anatomical references for computer processing and offers real-time information&#44; allowing corrections in the osteotomies&#44; with an obvious time consumption&#46; It is true that 9&#8239;min&#44; in spite of the statistical significance&#44; might appear irrelevant&#46; However&#44; if we consider one of the objectives of the surgery&#44; such as obtaining a postoperative mFTa of 180&#176;&#8239;&#177;&#8239;3&#176;&#44; we can state that we achieve the objective &#40;73&#46;4&#37; using CI&#44; 90&#46;2&#37; using CAS and 88&#46;6&#37; using PSI&#41; with shorter operative time&#46; Our coronal alignment with PSI is comparable to that of other authors&#44; using the same system &#40;Koch et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a> 87&#46;6&#37;&#44; and Anderl et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a> 90&#46;4&#37;&#44; or Helmy et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a> 81&#46;4&#37;&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">There are a few limitations to our study&#46; The main ones are the retrospective nature of the study and the lack of randomization in the cases undergoing an intervention with each instrumentation&#46; All the surgeries have been performed at a single institution by the same surgeon&#46; It is true that this factor avoids bias in differences in surgical technique among different surgeons&#44; but it is no less true that it makes it impossible for the conclusions to be easily generalised&#46; The study has been carried out in a hospital that currently handles a population of approximately 54&#44;500 inhabitants&#46; The surgeon has performed an annual mean of 49&#8239;&#177;&#8239;10 primary knee replacement surgeries in the last 10 years&#46; We cannot extrapolate the result to institutions in which the surgeons perform a very different number of annual surgeries &#40;institutions with a very limited or a very high volume of primary knee implants&#41;&#46; In addition&#44; only one type of patient-specific instrumentation has been used &#40;the MyKnee<span class="elsevierStyleSup">&#174;</span> cutting block system from Medacta International SA&#44; Castel San Pietro&#44; Switzerland&#41;&#44; so the results should not be extrapolated to the different devices of other manufacturers&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">We can conclude that&#44; in the conditions in which our study has been carried out&#44; the length of time for implanting a TKR has been less when we have used PSI than when we have used other instrumentation systems&#46; Quantitatively and with respect to the CI system&#44; the time consumption does not seem to be an advantage of patient-specific instruments&#46; Further studies will be necessary to be able to correlate the reduction in operative time with advantageous operating theatre utilisation and with the positive effect on cost-effectiveness and cost-efficiency&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Level of evidence</span><p id="par0075" class="elsevierStylePara elsevierViewall">Level of evidence III&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflict of interests</span><p id="par0080" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:11 [
        0 => array:3 [
          "identificador" => "xres1239351"
          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Objective"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Material and methods"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Results"
            ]
            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Conclusions"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1150219"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres1239352"
          "titulo" => "Resumen"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Objetivo"
            ]
            1 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "Material y m&#233;todo"
            ]
            2 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Resultados"
            ]
            3 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Conclusiones"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec1150218"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Materials and method"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Surgical intervention"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Variables"
            ]
            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Statistical analysis"
            ]
          ]
        ]
        6 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Results"
        ]
        7 => array:2 [
          "identificador" => "sec0035"
          "titulo" => "Discussion"
        ]
        8 => array:2 [
          "identificador" => "sec0040"
          "titulo" => "Level of evidence"
        ]
        9 => array:2 [
          "identificador" => "sec0045"
          "titulo" => "Conflict of interests"
        ]
        10 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2019-02-04"
    "fechaAceptado" => "2019-04-07"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1150219"
          "palabras" => array:4 [
            0 => "Arthroplasty"
            1 => "Knee"
            2 => "Time"
            3 => "Instruments"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1150218"
          "palabras" => array:4 [
            0 => "Artroplastia"
            1 => "Rodilla"
            2 => "Tiempo"
            3 => "Instrumentaci&#243;n"
          ]
        ]
      ]
    ]
    "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="spar0065" class="elsevierStyleSimplePara elsevierViewall">To demonstrate whether there is a difference in the time that total knee arthroplasty &#40;TKA&#41; takes according to the instrumentation system used&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Retrospective analysis of the duration of 243 interventions &#40;skin-to-skin time and ischaemia time&#41; performed by the same surgeon&#46; 72 cases operated with conventional instruments &#40;CI&#41;&#44; 68 operated with computer assisted surgery &#40;CAS&#41; and 103 with personalized instrumentation system &#40;PSI&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">CI skin-to-skin 87&#46;85&#8239;min &#40;SD 11&#46;86&#41;&#46; CI ischaemia 94&#46;44&#8239;min &#40;SD 11&#46;49&#41;&#46; CAS skin-to-skin 123&#46;46&#8239;min &#40;SD 11&#46;27&#41;&#46; CAS ischaemia 129&#46;63&#8239;min &#40;SD 11&#46;37&#41;&#46; PSI skin-to-skin 78&#46;69&#8239;min &#40;SD 13&#46;06&#41;&#46; PSI ischaemia 84&#46;63 &#40;DE 12&#46;06&#41;&#46; There is a significant difference between PSI and the other instrumentation systems &#40;p 0&#46;000&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">In our study&#44; the time taken for TKA was significantly lower when we used customized cutting blocks rather than other systems&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objective"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Material and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          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="spar0085" class="elsevierStyleSimplePara elsevierViewall">Demostrar si existe diferencia en el tiempo que se prolonga la cirug&#237;a para implantar una pr&#243;tesis de rodilla &#40;PTR&#41; atendiendo al sistema de instrumentaci&#243;n empleado&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todo</span><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">An&#225;lisis retrospectivo de la duraci&#243;n de 243 intervenciones &#40;tiempo piel-piel y tiempo de isquemia&#41; realizadas por el mismo cirujano&#46; 72 casos intervenidos con instrumental convencional &#40;IC&#41;&#44; 68 asistidos por navegador &#40;CAS&#44; de <span class="elsevierStyleItalic">computer assisted surgery</span>&#41; y 103 con bloques de corte personalizados &#40;PSI&#44; de <span class="elsevierStyleItalic">personalized instrumentation system</span>&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">IC piel-piel 87&#44;85&#8239;min &#40;DE 11&#44;86&#41;&#46; IC isquemia 94&#44;44&#8239;min &#40;DE 11&#44;49&#41;&#46; CAS piel-piel 123&#44;46&#8239;min &#40;DE 11&#44;27&#41;&#46; CAS isquemia 129&#44;63&#8239;min &#40;DE 11&#44;37&#41;&#46; PSI piel-piel 78&#44;69&#8239;min &#40;DE 13&#44;06&#41;&#46; PSI isquemia 84&#44;63 &#40;DE 12&#44;06&#41;&#46; Existe una diferencia significativa favorable a PSI respecto a los otros sistemas de instrumentaci&#243;n &#40;p 0&#44;000&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">En nuestro estudio&#44; el consumo de tiempo para la implantaci&#243;n de una PTR ha sido significativamente inferior cuando hemos empleado bloques de corte personalizados&#44; que cuando hemos empleado otros sistemas&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Material y m&#233;todo"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Le&#243;n-Mu&#241;oz VJ&#44; Lis&#243;n-Almagro AJ&#44; L&#243;pez-L&#243;pez M&#46; Influencia de la instrumentaci&#243;n sobre el tiempo quir&#250;rgico para implantar una pr&#243;tesis total de rodilla&#46; Rev Esp Cir Ortop Traumatol&#46; 2019&#59;63&#58;321&#8211;326&#46;</p>"
      ]
    ]
    "multimedia" => array:3 [
      0 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0005"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Values expressed in mean and standard deviation or number and percentage&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">BMI&#58; body mass index&#59; CAS&#58; computer assisted surgery&#59; CI&#58; conventional instruments&#59; PSI&#58; patient-specific instruments&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Level of significance <span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;0&#46;05&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">CI &#40;n 72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">CAS &#40;n 68&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">PSI &#40;n 103&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Age &#40;in years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71&#46;04&#8239;&#177;&#8239;7&#46;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71&#46;96&#8239;&#177;&#8239;7&#46;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71&#46;28&#8239;&#177;&#8239;7&#46;69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;510&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Height &#40;in cm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">159&#46;75&#8239;&#177;&#8239;9&#46;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">157&#8239;&#177;&#8239;8&#46;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">159&#46;28&#8239;&#177;&#8239;9&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;202&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Weight &#40;in kg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">79&#46;22&#8239;&#177;&#8239;8&#46;67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74&#46;81&#8239;&#177;&#8239;11&#46;43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78&#46;61&#8239;&#177;&#8239;10&#46;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BMI &#40;in kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#46;22&#8239;&#177;&#8239;4&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#46;37&#8239;&#177;&#8239;4&#46;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#46;09&#8239;&#177;&#8239;4&#46;62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;517&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sex&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Females 47 &#40;65&#46;28&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Females 46 &#40;67&#46;65&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Females 74 &#40;71&#46;84&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;637&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Males 25 &#40;34&#46;72&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Males 22 &#40;32&#46;35&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Males 29 &#40;28&#46;16&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2117763.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Anthropometric and demographic characteristics of the series&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0010"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Values expressed in mean and standard deviation or number and percentage&#46;</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">CAS&#58; computer assisted surgery&#59; CI&#58; conventional instruments&#59; KL III &#38; KL IV&#58; the degree of osteoarthritis according to the Kellgren and Lawrence classification<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;12</span></a>&#59; mFTa&#58; mechanical femorotibial angle&#59; PSI&#58; patient-specific instruments&#46;</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Level of significance <span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;0&#46;05&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">CI &#40;n 72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">CAS &#40;n 68&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">PSI &#40;n 103&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">mFTa &#40;in &#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">171&#46;67&#8239;&#177;&#8239;6&#46;29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">172&#46;45&#8239;&#177;&#8239;7&#46;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">171&#46;48&#8239;&#177;&#8239;6&#46;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;907&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">KL III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30 &#40;41&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40 &#40;58&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53 &#40;51&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;124&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">KL IV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42 &#40;58&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28 &#40;41&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50 &#40;48&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Extension &#40;in &#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;03&#8239;&#177;&#8239;5&#46;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;79&#8239;&#177;&#8239;4&#46;76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;64&#8239;&#177;&#8239;5&#46;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;376&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Flexion &#40;in &#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">104&#46;51&#8239;&#177;&#8239;12&#46;76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">104&#46;04&#8239;&#177;&#8239;11&#46;85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">103&#46;30&#8239;&#177;&#8239;12&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;653&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2117765.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Radiographic characteristics and joint movement&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0015"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Values expressed in mean and standard deviation or number and percentage&#46;</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">CAS&#58; computer assisted surgery&#59; CI&#58; conventional instruments&#59; PSI&#58; patient-specific instruments&#46;</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Level of significance <span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;0&#46;05&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">CI &#40;n 72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">CAS &#40;n 68&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">PSI &#40;n 103&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Skin-to-skin time &#40;in min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">87&#46;85&#8239;&#177;&#8239;11&#46;86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">123&#46;46&#8239;&#177;&#8239;11&#46;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78&#46;69&#8239;&#177;&#8239;13&#46;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ischemia time &#40;in min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">94&#46;44&#8239;&#177;&#8239;11&#46;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">129&#46;63&#8239;&#177;&#8239;11&#46;37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&#46;63&#8239;&#177;&#8239;12&#46;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2117764.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Results&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:36 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cirug&#237;a e instrumentaci&#243;n en la artroplastia total de rodilla"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;N&#46; Insall"
                            1 => "M&#46;E&#46; Easley"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:6 [
                        "editores" => "J&#46;N&#46;Insall, W&#46;N&#46;Scott"
                        "titulo" => "Rodilla &#40;Edici&#243;n en espa&#241;ol de Surgery of the knee"
                        "paginaInicial" => "1553"
                        "paginaFinal" => "1620"
                        "edicion" => "3 ed&#46;"
                        "serieFecha" => "2004"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Applications of computer-assisted surgery &#40;CAS&#41; in total knee arthroplasty &#40;TKA&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46; Mugnai"
                            1 => "D&#46; Vitantonio"
                            2 => "F&#46; Catani"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:5 [
                        "editores" => "S&#46;Affatato"
                        "titulo" => "Surgical Techniques in Total Knee Arthroplasty and Alternative Procedures"
                        "paginaInicial" => "183"
                        "paginaFinal" => "205"
                        "serieFecha" => "2014"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Surgical navigation for total knee arthroplasty&#58; a perspective"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "R&#46;A&#46; Siston"
                            1 => "N&#46;J&#46; Giori"
                            2 => "S&#46;B&#46; Goodman"
                            3 => "S&#46;L&#46; Delp"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jbiomech.2007.01.006"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Biomech"
                        "fecha" => "2007"
                        "volumen" => "40"
                        "numero" => "4"
                        "paginaInicial" => "728"
                        "paginaFinal" => "735"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17317419"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Computer assisted navigation in total knee and hip arthroplasty"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "K&#46; Deep"
                            1 => "S&#46; Shankar"
                            2 => "A&#46; Mahendra"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1051/sicotj/2017034"
                      "Revista" => array:5 [
                        "tituloSerie" => "SICOT J"
                        "fecha" => "2017"
                        "volumen" => "3"
                        "paginaInicial" => "50"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28752819"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Initial experience with custom-fit total knee replacement&#58; intra-operative events and long-leg coronal alignment"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "B&#46;A&#46; Spencer"
                            1 => "M&#46;A&#46; Mont"
                            2 => "M&#46;S&#46; McGrath"
                            3 => "B&#46; Boyd"
                            4 => "M&#46;F&#46; Mitrick"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00264-008-0693-x"
                      "Revista" => array:7 [
                        "tituloSerie" => "Int Orthop"
                        "fecha" => "2009"
                        "volumen" => "33"
                        "numero" => "December &#40;6&#41;"
                        "paginaInicial" => "1571"
                        "paginaFinal" => "1575"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19099305"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Accuracy of MRI vs CT imaging with particular reference to patient specific templates for total knee replacement surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46; White"
                            1 => "K&#46;L&#46; Chelule"
                            2 => "B&#46;B&#46; Seedhom"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/rcs.201"
                      "Revista" => array:7 [
                        "tituloSerie" => "Int J Med Robot"
                        "fecha" => "2008"
                        "volumen" => "4"
                        "numero" => "September&#40;3&#41;"
                        "paginaInicial" => "224"
                        "paginaFinal" => "231"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18680138"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Contribuci&#243;n de un programa de calidad asistencial al desarrollo de un Instituto de Gesti&#243;n Cl&#237;nica del Aparato Locomotor"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46; Santi&#241;&#225;"
                            1 => "A&#46; Combal&#237;a"
                            2 => "A&#46; Prata"
                            3 => "S&#46; Suso"
                            4 => "M&#46; Ba&#241;os"
                            5 => "A&#46; Trilla"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Esp Cir Ortop Traumatol"
                        "fecha" => "2008"
                        "volumen" => "52"
                        "numero" => "July&#40;4&#41;"
                        "paginaInicial" => "199"
                        "paginaFinal" => "270"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "&#191;Realizamos bien la programaci&#243;n quir&#250;rgica&#63; &#191;C&#243;mo podemos mejorarla&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Albareda"
                            1 => "D&#46; Clavel"
                            2 => "C&#46; Mahulea"
                            3 => "N&#46; Blanco"
                            4 => "L&#46; Ezquerra"
                            5 => "J&#46; G&#243;mez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.recot.2017.07.006"
                      "Revista" => array:7 [
                        "tituloSerie" => "Rev Esp Cir Ortop Traumatol"
                        "fecha" => "2017"
                        "volumen" => "61"
                        "numero" => "November&#8211;December &#40;6&#41;"
                        "paginaInicial" => "375"
                        "paginaFinal" => "382"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28890119"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Benefits of using customized instrumentation in total knee arthroplasty&#58; results from an activity-based costing model"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46;O&#46; Tibesku"
                            1 => "P&#46; Hofer"
                            2 => "W&#46; Portegies"
                            3 => "C&#46;J&#46; Ruys"
                            4 => "P&#46; Fennema"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00402-012-1667-4"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Orthop Trauma Surg"
                        "fecha" => "2013"
                        "volumen" => "133"
                        "numero" => "March &#40;3&#41;"
                        "paginaInicial" => "405"
                        "paginaFinal" => "411"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Patient-specific instrumentation in total knee arthroplasty&#58; simpler&#44; faster and more accurate than standard instrumentation - a randomized controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46; Vide"
                            1 => "T&#46;P&#46; Freitas"
                            2 => "A&#46; Ramos"
                            3 => "H&#46; Cruz"
                            4 => "J&#46;P&#46; Sousa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00167-015-3869-0"
                      "Revista" => array:7 [
                        "tituloSerie" => "Knee Surg Sports Traumatol Arthrosc"
                        "fecha" => "2017"
                        "volumen" => "25"
                        "numero" => "August &#40;8&#41;"
                        "paginaInicial" => "2616"
                        "paginaFinal" => "2621"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26585908"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Radiological assessment of osteo-arthrosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;H&#46; Kellgren"
                            1 => "J&#46;S&#46; Lawrence"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/ard.16.4.494"
                      "Revista" => array:8 [
                        "tituloSerie" => "Ann Rheum Dis"
                        "fecha" => "1957"
                        "volumen" => "16"
                        "numero" => "December &#40;4&#41;"
                        "paginaInicial" => "494"
                        "paginaFinal" => "502"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/13498604"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0264410X15005009"
                          "estado" => "S300"
                          "issn" => "0264410X"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Classifications in brief&#58; Kellgren-Lawrence Classification of Osteoarthritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46;D&#46; Kohn"
                            1 => "A&#46;A&#46; Sassoon"
                            2 => "N&#46;D&#46; Fernando"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s11999-016-4732-4"
                      "Revista" => array:7 [
                        "tituloSerie" => "Clin Orthop Relat Res"
                        "fecha" => "2016"
                        "volumen" => "474"
                        "numero" => "August &#40;8&#41;"
                        "paginaInicial" => "1886"
                        "paginaFinal" => "1893"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26872913"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A comparison of alignment using patient specific guides&#44; computer navigation and conventional instrumentation in total knee arthroplasty"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "S&#46;J&#46; MacDessi"
                            1 => "B&#46; Jang"
                            2 => "I&#46;A&#46; Harris"
                            3 => "E&#46; Wheatley"
                            4 => "C&#46; Bryant"
                            5 => "D&#46;B&#46; Chen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.knee.2013.11.004"
                      "Revista" => array:6 [
                        "tituloSerie" => "Knee"
                        "fecha" => "2014"
                        "volumen" => "1"
                        "numero" => "March &#40;2&#41;"
                        "paginaInicial" => "406"
                        "paginaFinal" => "409"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Custom-fit total knee arthroplasty&#58; our initial experience in 32 knees"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "K&#46; Bali"
                            1 => "P&#46; Walker"
                            2 => "W&#46; Bruce"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.arth.2011.12.006"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Arthroplasty"
                        "fecha" => "2012"
                        "volumen" => "27"
                        "numero" => "June &#40;6&#41;"
                        "paginaInicial" => "1149"
                        "paginaFinal" => "1154"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22285230"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Patient-specific versus conventional instrumentation for total knee arthroplasty&#58; peri-operative and cost differences"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46;M&#46; DeHaan"
                            1 => "J&#46;R&#46; Adams"
                            2 => "M&#46;L&#46; DeHart"
                            3 => "T&#46;W&#46; Huff"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.arth.2014.06.019"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Arthroplasty"
                        "fecha" => "2014"
                        "volumen" => "29"
                        "numero" => "November &#40;11&#41;"
                        "paginaInicial" => "2065"
                        "paginaFinal" => "2069"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25065735"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Improved alignment and operating room efficiency with patient-specific instrumentation for TKA"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "L&#46; Renson"
                            1 => "P&#46; Poilvache"
                            2 => "H&#46; Van den Wyngaert"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.knee.2014.09.008"
                      "Revista" => array:7 [
                        "tituloSerie" => "Knee"
                        "fecha" => "2014"
                        "volumen" => "21"
                        "numero" => "December &#40;6&#41;"
                        "paginaInicial" => "1216"
                        "paginaFinal" => "1220"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25450010"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A comparison of patient-specific and conventional instrumentation for total knee arthroplasty&#58; a multicentre randomised controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "L&#46; Abane"
                            1 => "P&#46; Anract"
                            2 => "S&#46; Boisgard"
                            3 => "S&#46; Descamps"
                            4 => "J&#46;P&#46; Courpied"
                            5 => "M&#46; Hamadouche"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1302/0301-620X.97B1.34440"
                      "Revista" => array:6 [
                        "tituloSerie" => "Bone Joint J"
                        "fecha" => "2015"
                        "volumen" => "97-B"
                        "numero" => "January &#40;1&#41;"
                        "paginaInicial" => "56"
                        "paginaFinal" => "63"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Are patient-specific cutting blocks cost-effective for total knee arthroplasty&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46;M&#46; Nunley"
                            1 => "B&#46;S&#46; Ellison"
                            2 => "E&#46;L&#46; Ruh"
                            3 => "B&#46;M&#46; Williams"
                            4 => "K&#46; Foreman"
                            5 => "A&#46;D&#46; Ford"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s11999-011-2221-3"
                      "Revista" => array:7 [
                        "tituloSerie" => "Clin Orthop Relat Res"
                        "fecha" => "2012"
                        "volumen" => "470"
                        "numero" => "March &#40;3&#41;"
                        "paginaInicial" => "889"
                        "paginaFinal" => "894"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22183476"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Total knee arthroplasty using patient-specific guides&#58; Is there a learning curve&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46; Chinnappa"
                            1 => "D&#46;B&#46; Chen"
                            2 => "I&#46;A&#46; Harris"
                            3 => "S&#46;J&#46; MacDessi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.knee.2015.03.002"
                      "Revista" => array:7 [
                        "tituloSerie" => "Knee"
                        "fecha" => "2015"
                        "volumen" => "22"
                        "numero" => "December &#40;6&#41;"
                        "paginaInicial" => "613"
                        "paginaFinal" => "617"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26120064"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Patient-specific instrumentation for total knee arthroplasty&#58; a review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46;P&#46; Ast"
                            1 => "D&#46; Nam"
                            2 => "S&#46;B&#46; Haas"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ocl.2012.07.004"
                      "Revista" => array:7 [
                        "tituloSerie" => "Orthop Clin North Am"
                        "fecha" => "2012"
                        "volumen" => "43"
                        "numero" => "November &#40;5&#41;"
                        "paginaInicial" => "e17"
                        "paginaFinal" => "e22"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23102417"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Patient-specific instrumentation improved axial alignment of the femoral component&#44; operative time and perioperative blood loss after total knee arthroplasty"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Gong"
                            1 => "W&#46; Xu"
                            2 => "R&#46; Wang"
                            3 => "Z&#46; Wang"
                            4 => "B&#46; Wang"
                            5 => "L&#46; Han"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00167-018-5256-0"
                      "Revista" => array:4 [
                        "tituloSerie" => "Knee Surg Sports Traumatol Arthrosc"
                        "fecha" => "2018"
                        "numero" => "October"
                        "itemHostRev" => array:3 [
                          "pii" => "S0264410X13012462"
                          "estado" => "S300"
                          "issn" => "0264410X"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Intra-operative results and radiological outcome of conventional and patient-specific surgery in total knee arthroplasty&#58; a multicentre&#44; randomised controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "B&#46; Boonen"
                            1 => "M&#46;G&#46; Schotanus"
                            2 => "B&#46; Kerens"
                            3 => "W&#46; Van der Weegen"
                            4 => "R&#46;A&#46; van Drumpt"
                            5 => "N&#46;P&#46; Kort"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00167-013-2620-y"
                      "Revista" => array:7 [
                        "tituloSerie" => "Knee Surg Sports Traumatol Arthrosc"
                        "fecha" => "2013"
                        "volumen" => "21"
                        "numero" => "October &#40;10&#41;"
                        "paginaInicial" => "2206"
                        "paginaFinal" => "2212"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23928929"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A prospective randomized controlled study of patient-specific cutting guides compared with conventional instrumentation in total knee replacement"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "K&#46; Chareancholvanich"
                            1 => "R&#46; Narkbunnam"
                            2 => "C&#46; Pornrattanamaneewong"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1302/0301-620X.95B3.29903"
                      "Revista" => array:6 [
                        "tituloSerie" => "Bone Joint J"
                        "fecha" => "2013"
                        "volumen" => "95-B"
                        "numero" => "March &#40;3&#41;"
                        "paginaInicial" => "354"
                        "paginaFinal" => "359"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Accuracy and efficacy of osteotomy in total knee arthroplasty with patient-specific navigational template"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "Y&#46; Gan"
                            1 => "J&#46; Ding"
                            2 => "Y&#46; Xu"
                            3 => "C&#46; Hou"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Clin Exp Med"
                        "fecha" => "2015"
                        "volumen" => "8"
                        "numero" => "August &#40;8&#41;"
                        "paginaInicial" => "12192"
                        "paginaFinal" => "12201"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Component alignment and clinical outcome following total knee arthroplasty&#58; a randomised controlled trial comparing an intramedullary alignment system with patient-specific instrumentation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "H&#46;J&#46; Huijbregts"
                            1 => "R&#46;J&#46; Khan"
                            2 => "D&#46;P&#46; Fick"
                            3 => "M&#46;J&#46; Hall"
                            4 => "S&#46;A&#46; Punwar"
                            5 => "E&#46; Sorensen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1302/0301-620X.98B8.37240"
                      "Revista" => array:7 [
                        "tituloSerie" => "B Bone Joint J"
                        "fecha" => "2016"
                        "volumen" => "98-B"
                        "numero" => "August &#40;8&#41;"
                        "paginaInicial" => "1043"
                        "paginaFinal" => "1049"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27482015"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "No improvement in reducing outliers in coronal axis alignment with patient-specific instrumentation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "U&#46; Maus"
                            1 => "C&#46;J&#46; Marques"
                            2 => "D&#46; Scheunemann"
                            3 => "F&#46; Lampe"
                            4 => "D&#46; Lazovic"
                            5 => "H&#46; Hommel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00167-017-4741-1"
                      "Revista" => array:8 [
                        "tituloSerie" => "Knee Surg Sports Traumatol Arthrosc"
                        "fecha" => "2018"
                        "volumen" => "26"
                        "numero" => "September &#40;9&#41;"
                        "paginaInicial" => "2788"
                        "paginaFinal" => "2796"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29071356"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0264410X16308428"
                          "estado" => "S300"
                          "issn" => "0264410X"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Custom-fit minimally invasive total knee arthroplasty&#58; effect on blood loss and early clinical outcomes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Pietsch"
                            1 => "O&#46; Djahani"
                            2 => "Ch&#46; Zweiger"
                            3 => "F&#46; Plattner"
                            4 => "R&#46; Radl"
                            5 => "Ch&#46; Tschauner"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00167-012-2284-z"
                      "Revista" => array:7 [
                        "tituloSerie" => "Knee Surg Sports Traumatol Arthrosc"
                        "fecha" => "2013"
                        "volumen" => "21"
                        "numero" => "October &#40;10&#41;"
                        "paginaInicial" => "2234"
                        "paginaFinal" => "2240"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23114870"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Component alignment during total knee arthroplasty with use of standard or custom instrumentation&#58; a randomized clinical trial using computed tomography for postoperative alignment measurement"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "S&#46;T&#46; Woolson"
                            1 => "A&#46;H&#46; Harris"
                            2 => "D&#46;W&#46; Wagner"
                            3 => "N&#46;J&#46; Giori"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2106/JBJS.L.01722"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Bone Joint Surg Am"
                        "fecha" => "2014"
                        "volumen" => "96"
                        "numero" => "March &#40;5&#41;"
                        "paginaInicial" => "366"
                        "paginaFinal" => "372"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24599197"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparison between patient-specific instruments and conventional instruments and computer navigation in total knee arthroplasty&#58; a randomized controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46;H&#46; Yan"
                            1 => "K&#46;Y&#46; Chiu"
                            2 => "F&#46;Y&#46; Ng"
                            3 => "P&#46;K&#46; Chan"
                            4 => "C&#46;X&#46; Fang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00167-014-3264-2"
                      "Revista" => array:7 [
                        "tituloSerie" => "Knee Surg Sports Traumatol Arthrosc"
                        "fecha" => "2015"
                        "volumen" => "23"
                        "numero" => "December &#40;12&#41;"
                        "paginaInicial" => "3637"
                        "paginaFinal" => "3645"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25217311"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The value of patient-matched instrumentation in total knee arthroplasty"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;W&#46; Noble Jr"
                            1 => "C&#46;A&#46; Moore"
                            2 => "N&#46; Liu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.arth.2011.07.006"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Arthroplasty"
                        "fecha" => "2012"
                        "volumen" => "27"
                        "numero" => "January &#40;1&#41;"
                        "paginaInicial" => "153"
                        "paginaFinal" => "155"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21908169"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Patient-specific instrumentation does not shorten surgical time&#58; a prospective&#44; randomized trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "W&#46;G&#46; Hamilton"
                            1 => "N&#46;L&#46; Parks"
                            2 => "A&#46; Saxena"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.arth.2013.04.049"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Arthroplasty"
                        "fecha" => "2013"
                        "volumen" => "28"
                        "numero" => "September &#40;8 Suppl&#41;"
                        "paginaInicial" => "96"
                        "paginaFinal" => "100"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23910821"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acute perioperative comparison of patient-specific instrumentation versus conventional instrumentation utilization during bilateral total knee arthroplasty"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;A&#46; Steimle"
                            1 => "M&#46;T&#46; Groover"
                            2 => "B&#46;A&#46; Webb"
                            3 => "B&#46;J&#46; Ceccarelli"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1155/2018/9326459"
                      "Revista" => array:4 [
                        "tituloSerie" => "Surg Res Pract"
                        "fecha" => "2018"
                        "volumen" => "2018"
                        "numero" => "February"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Analysis of procedure-related costs and proposed benefits of using patient-specific approach in total knee arthroplasty"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "T&#46;S&#46; Watters"
                            1 => "R&#46;C&#46; Mather 3rd"
                            2 => "J&#46;A&#46; Browne"
                            3 => "K&#46;R&#46; Berend"
                            4 => "A&#46;V&#46; Lombardi Jr&#46;"
                            5 => "M&#46;P&#46; Bolognesi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "J Surg Orthop Adv"
                        "fecha" => "2011"
                        "volumen" => "20"
                        "numero" => "Summer &#40;2&#41;"
                        "paginaInicial" => "112"
                        "paginaFinal" => "116"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21838072"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Radiographic accuracy in TKA with a CT-based patient-specific cutting block technique"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "P&#46;P&#46; Koch"
                            1 => "D&#46; M&#252;ller"
                            2 => "M&#46; Pisan"
                            3 => "S&#46;F&#46; Fucentese"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00167-013-2625-6"
                      "Revista" => array:7 [
                        "tituloSerie" => "Knee Surg Sports Traumatol Arthrosc"
                        "fecha" => "2013"
                        "volumen" => "21"
                        "numero" => "October &#40;10&#41;"
                        "paginaInicial" => "2200"
                        "paginaFinal" => "2205"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23942882"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Patient-specific instrumentation improved mechanical alignment&#44; while early clinical outcome was comparable to conventional instrumentation in TKA"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "W&#46; Anderl"
                            1 => "L&#46; Pauzenberger"
                            2 => "R&#46; K&#246;lblinger"
                            3 => "G&#46; Kiesselbach"
                            4 => "G&#46; Brandl"
                            5 => "B&#46; Laky"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00167-014-3345-2"
                      "Revista" => array:7 [
                        "tituloSerie" => "Knee Surg Sports Traumatol Arthrosc"
                        "fecha" => "2016"
                        "volumen" => "24"
                        "numero" => "January &#40;1&#41;"
                        "paginaInicial" => "102"
                        "paginaFinal" => "111"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25326759"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Accuracy of patient specific cutting blocks in total knee arthroplasty"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "N&#46; Helmy"
                            1 => "M&#46;L&#46; Dao Trong"
                            2 => "S&#46;P&#46; K&#252;hnel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1155/2014/562919"
                      "Revista" => array:4 [
                        "tituloSerie" => "Biomed Res Int"
                        "fecha" => "2014"
                        "volumen" => "2014"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25580438"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/19888856/0000006300000005/v1_201909060709/S1988885619300513/v1_201909060709/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "7577"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Original articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/19888856/0000006300000005/v1_201909060709/S1988885619300513/v1_201909060709/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1988885619300513?idApp=UINPBA00004N"
]
Article information
ISSN: 19888856
Original language: English
The statistics are updated each day
Year/Month Html Pdf Total
2024 November 3 0 3
2024 October 23 0 23
2024 September 13 2 15
2024 August 25 2 27
2024 July 59 3 62
2024 June 31 1 32
2024 May 38 2 40
2024 April 34 3 37
2024 March 34 3 37
2024 February 39 8 47
2024 January 25 2 27
2023 December 23 11 34
2023 November 22 4 26
2023 October 25 4 29
2023 September 15 4 19
2023 August 15 3 18
2023 July 18 5 23
2023 June 26 9 35
2023 May 45 5 50
2023 April 57 1 58
2023 March 37 4 41
2023 February 25 3 28
2023 January 11 3 14
2022 December 11 6 17
2022 November 28 3 31
2022 October 24 8 32
2022 September 15 5 20
2022 August 23 5 28
2022 July 21 6 27
2022 June 23 3 26
2022 May 22 7 29
2022 April 39 8 47
2022 March 35 13 48
2022 February 41 2 43
2022 January 12 7 19
2021 December 14 10 24
2021 November 38 9 47
2021 October 47 7 54
2021 September 45 13 58
2021 August 58 0 58
2021 July 17 7 24
2021 June 24 4 28
2021 May 25 3 28
2021 April 48 16 64
2021 March 13 10 23
2021 February 13 8 21
2021 January 12 3 15
2020 December 1 1 2
Show all

Follow this link to access the full text of the article

es en pt

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

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

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