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Artroplastia total de rodilla navegada versus convencional; estudio prospectivo a 3 años de seguimiento
Navigated versus conventional total knee arthroplasty: A prospective study at three years follow-up
C. Martín-Hernándeza,
Autor para correspondencia
cmartinh@salud.aragon.es

Autor para correspondencia.
, M. Sanz-Sainza, C. Revenga-Giertychb, D. Hernández-Vaqueroc, J.M. Fernández-Carreirac, J. Albareda-Albaredad, A. Castillo-Palaciosd, M. Ranera-Garciaa
a Hospital Universitario Miguel Servet, IIS Aragón, Zaragoza, España
b Hospital San Juan Grande, Jerez de la Frontera, Cádiz, España
c Hospital San Agustín, Avilés, Asturias, España
d Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
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permite al cirujano planificar los cortes &#243;seos antes de su ejecuci&#243;n&#44; comprobarlos una vez hechos y evaluar la alineaci&#243;n postoperatoria de los componentes&#46; El prop&#243;sito de la aplicaci&#243;n de la CAO en la ATR es obtener una t&#233;cnica estandarizada para conseguir un posicionamiento y alineaci&#243;n m&#225;s precisos de los implantes en comparaci&#243;n con la instrumentaci&#243;n convencional<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">1</span></a>&#46; La navegaci&#243;n ha mostrado resultados m&#225;s homog&#233;neos en la alineaci&#243;n en el plano sagital con un mayor n&#250;mero de componentes colocados entre 3&#176; de varo y 3&#176; de valgo en comparaci&#243;n con las ATR convencionales<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">2-4</span></a>&#46; Sin embargo&#44; su eficacia en la obtenci&#243;n de una mejor alineaci&#243;n sagital sigue siendo controvertida<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">3&#44;4</span></a>&#46; La CAO permite adem&#225;s&#44; mediante la t&#233;cnica de equilibrio de espacios y realizando liberaciones secuenciales de partes blandas&#44; obtener un equilibrio ligamentoso adecuado e igualar los espacios en flexi&#243;n y extensi&#243;n<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">5</span></a>&#46; Aunque te&#243;ricamente ello podr&#237;a redundar en una mayor duraci&#243;n del implante y en unos mejores resultados cl&#237;nicos&#44; la evidencia actualmente disponible no ha permitido corroborar esta hip&#243;tesis&#46; Una serie de metaan&#225;lisis sobre la alineaci&#243;n del implante<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">2-12</span></a> han concluido que la navegaci&#243;n permite obtener mejores resultados&#46; En cuanto a los resultados cl&#237;nicos&#44; sin embargo&#44; ha habido informes controvertidos en la literatura&#44; debido principalmente a la gran variedad y heterogeneidad de los cuestionarios y de las mediciones utilizadas en los estudios recogidos<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">7-10</span></a>&#46; Rebal et al&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">11</span></a> publicaron en 2014 el primer metaan&#225;lisis que inclu&#237;a 21 estudios con nivel de evidencia 1&#44; demostrando que el uso de la navegaci&#243;n en ATR lograba una mejor alineaci&#243;n del eje mec&#225;nico y una mejor&#237;a de los resultados funcionales a corto y medio plazo analizando exclusivamente el cuestionario <span class="elsevierStyleItalic">Knee Society Score</span> &#40;KSS&#41;&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">El objetivo de este estudio es comparar&#44; tras 3 a&#241;os de seguimiento&#44; los resultados cl&#237;nicos y radiol&#243;gicos de artroplastias de rodilla navegadas con aquellos obtenidos en pr&#243;tesis implantadas mediante t&#233;cnica convencional&#44; con la hip&#243;tesis de que la navegaci&#243;n ofrecer&#237;a mejores resultados&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material y m&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Descripci&#243;n de la muestra</span><p id="par0015" class="elsevierStylePara elsevierViewall">En un estudio multic&#233;ntrico prospectivo realizado en 3 hospitales&#44; 199 pacientes fueron intervenidos por 3 cirujanos&#44; uno en cada hospital&#44; para implantar una ATR&#46; Los criterios de inclusi&#243;n fueron en ambos grupos gonartrosis primaria o secundaria con fracaso del tratamiento conservador&#46; Un hospital realiz&#243; la cirug&#237;a con t&#233;cnica convencional y pr&#243;tesis con conservaci&#243;n del ligamento cruzado posterior &#40;CR&#41; en 80 pacientes&#44; otro emple&#243; navegaci&#243;n y pr&#243;tesis CR en 29 pacientes y navegaci&#243;n y pr&#243;tesis posteroestabilizadas &#40;PS&#41; en 41 pacientes&#44; y el tercero &#40;49 pacientes&#41; emple&#243; navegaci&#243;n y pr&#243;tesis PS&#46; Cada uno de los 3 cirujanos contaba con amplia experiencia en artroplastia de rodilla con m&#225;s de 150 pr&#243;tesis anuales&#46; Cada paciente incluido firm&#243; un formulario de consentimiento informado&#46; Uno de los pacientes&#44; del grupo de cirug&#237;a convencional&#44; tuvo una infecci&#243;n profunda que oblig&#243; a retirar la pr&#243;tesis y a un recambio en 2 tiempos&#44; por lo que 198 fueron finalmente aptos para el estudio&#46; La etiolog&#237;a fue artrosis primaria en 194 casos&#44; en 3 casos &#40;2 del grupo de cirug&#237;a navegada y uno de convencional&#41; fue artrosis secundaria postraum&#225;tica y en uno&#44; correspondiente al grupo de navegaci&#243;n&#44; fue artritis reumatoide&#46; En la distribuci&#243;n por sexos hubo predominio de mujeres &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>143&#44; 72&#44;3&#37;&#41; sobre hombres &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>55&#59; 27&#44;7&#37;&#41;&#46; La mayor&#237;a de los pacientes ten&#237;an edad avanzada&#44; con un rango entre 41 y 87 a&#241;os &#40;media&#58; 71&#44;4 a&#241;os&#59; desviaci&#243;n est&#225;ndar &#91;DE&#93;&#58; 7&#44;8 a&#241;os&#41; y el &#237;ndice de masa corporal &#40;IMC&#41; fue de 31&#44;8<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#46; El n&#250;mero de rodillas operadas izquierdas y derechas fue de 83 &#40;42&#37;&#41; y 115 &#40;58&#37;&#41;&#44; respectivamente&#46; Seg&#250;n el sistema de clasificaci&#243;n de Ahlb&#228;ck<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">13</span></a> hab&#237;a 71 casos grado<span class="elsevierStyleHsp" style=""></span>1&#44; 79 casos grado<span class="elsevierStyleHsp" style=""></span>2&#44; 24 casos grado<span class="elsevierStyleHsp" style=""></span>3&#44; 17 casos grado<span class="elsevierStyleHsp" style=""></span>4&#44; y 7 casos grado<span class="elsevierStyleHsp" style=""></span>5&#59; 156 rodillas presentaban una deformidad en varo&#44; 18 en valgo y 24 presentaban un normoeje&#44; considerando este como un &#225;ngulo mec&#225;nico femorotibial de 180&#176;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Intervenci&#243;n</span><p id="par0020" class="elsevierStylePara elsevierViewall">En todos ellos se implant&#243; una artroplastia total de rodilla Apex<span class="elsevierStyleSup">&#174;</span> &#40;OMNI lifeScience&#44; East Taunton&#44; Massachusetts&#44; EE&#46;<span class="elsevierStyleHsp" style=""></span>UU&#46;&#41; a trav&#233;s de un abordaje parapatelar medial est&#225;ndar con eversi&#243;n de la r&#243;tula&#46; Todos los componentes tibiales fueron cementados&#44; en tanto que los componentes femorales fueron cementados en las pr&#243;tesis PS y no cementados en las CR&#46; Tanto para las cirug&#237;as navegadas como para las realizadas con instrumental convencional se emple&#243; la t&#233;cnica de equilibrio de espacios con liberaci&#243;n secuencial de partes blandas&#46; Para la realizaci&#243;n de todas las intervenciones quir&#250;rgicas asistidas por ordenador se emple&#243; el sistema de navegaci&#243;n Total Knee Surgetics<span class="elsevierStyleSup">&#174;</span> &#40;PRAXIM SA&#44; La Tronche&#44; Francia&#41; versi&#243;n 7&#46;9&#46; Este es un sistema de navegaci&#243;n cerrado&#44; sin im&#225;genes previas&#44; que emplea el an&#225;lisis cinem&#225;tico de cadera&#44; rodilla y tobillo y un mapeo anat&#243;mico de las superficies articulares de rodilla para construir un modelo de trabajo&#46; Tras colocar los captadores de infrarrojos mediante fijaci&#243;n bicortical en las met&#225;fisis distal de f&#233;mur y proximal de tibia y resecar los osteofitos&#44; se realiz&#243; un corte tibial a 90¿ sobre el eje mec&#225;nico de la tibia en el plano coronal con 4&#176; de pendiente posterior en el plano sagital y&#44; aplicando la t&#233;cnica de cortes dependientes mediante liberaciones secuenciales con un distractor&#44; se calcul&#243; el corte femoral para obtener unos espacios sim&#233;tricos en extensi&#243;n y en flexi&#243;n de 90¿ con igual tensi&#243;n de partes blandas&#46; El tiempo medio de intervenci&#243;n fue de 78<span class="elsevierStyleHsp" style=""></span>min para la artroplastia convencional y de 83<span class="elsevierStyleHsp" style=""></span>min para las cirug&#237;as navegadas &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#41;&#46; Todos los pacientes siguieron el mismo r&#233;gimen de rehabilitaci&#243;n postoperatoria&#44; con movilizaci&#243;n precoz y carga inmediata&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Seguimiento y evaluaci&#243;n</span><p id="par0025" class="elsevierStylePara elsevierViewall">La evaluaci&#243;n cl&#237;nica se realiz&#243; preoperatoriamente&#44; a los 3 meses y a los 12&#44; 24 y 36 meses tras la cirug&#237;a&#46; En todos los casos fueron cumplimentados el <span class="elsevierStyleItalic">Western Ontario and McMaster&#39;s Universities Osteoarthritis Index</span> &#40;WOMAC&#41;&#44; el KSS y el <span class="elsevierStyleItalic">Short Form-12 Health Survey</span> &#40;SF-12&#41;&#46; Para la evaluaci&#243;n radiol&#243;gica&#44; se utilizaron proyecciones anteroposteriores y laterales simples&#44; as&#237; como telemetr&#237;a en bipedestaci&#243;n para medir el &#225;ngulo cadera-rodilla-tobillo&#46; Las mediciones se realizaron digitalmente sobre radiograf&#237;as tomadas con los miembros inferiores en extensi&#243;n completa&#44; con las tuberosidades tibiales anteriores mirando al frente y los mal&#233;olos mediales separados 30<span class="elsevierStyleHsp" style=""></span>cm&#46; El &#225;ngulo mec&#225;nico fue determinado de manera ciega por 2 observadores independientes conectando el centro de la cabeza femoral&#44; el centro de la rodilla y el centro del tobillo&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">El an&#225;lisis incluy&#243; la evaluaci&#243;n zonal de la integridad de la fijaci&#243;n del implante en las &#225;reas definidas en el <span class="elsevierStyleItalic">Knee Society Total Knee Arthroplasty Roentgenographic Evaluation and Scoring System</span><a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">14</span></a>&#46; La evaluaci&#243;n radiol&#243;gica de la osteointegraci&#243;n del implante se clasific&#243; de acuerdo con los criterios presentados por Engh et al&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">15</span></a>&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">El estudio fue aprobado por el Comit&#233; Regional de &#201;tica &#40;n&#250;mero de identificaci&#243;n&#58; CP03 &#47; 2014&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">An&#225;lisis estad&#237;stico</span><p id="par0040" class="elsevierStylePara elsevierViewall">Se comprob&#243; que todas las variables a estudio presentaban una distribuci&#243;n normal con el test de Kolmogorov-Smirnov&#46; Para la comparaci&#243;n de variables cualitativas &#40;navegaci&#243;n&#44; alineaci&#243;n<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3¿ o no&#41; se emple&#243; el test de Chi cuadrado&#46; Para las comparaciones totales de medias entre los 2 grupos &#8212;de navegaci&#243;n y convencional&#8212; se emple&#243; el test t de Student&#46; Los resultados en los diferentes momentos del estudio fueron evaluados mediante el modelo general lineal de medidas repetidas&#44; donde las variables intrasujetos fueron las 7 escalas de evaluaci&#243;n&#44; KSS&#40;2&#41;&#44; SF-12&#40;2&#41; y WOMAC&#40;3&#41;&#44; medidos en 2 momentos &#8212;preoperatorio y a 36 meses&#8212; y el factor intersujetos fue si se us&#243; o no navegaci&#243;n&#46; Se consideraron significativos valores de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">El an&#225;lisis estad&#237;stico de datos se realiz&#243; utilizando el paquete estad&#237;stico SPSS de 2012 &#40;IBM SPSS Statistics para Windows&#44; versi&#243;n 21&#46;0&#44; IBM Corporation&#44; Armonk&#44; Nueva York&#44; EE&#46;<span class="elsevierStyleHsp" style=""></span>UU&#46;&#41;&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Resultados</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Resultados cl&#237;nicos</span><p id="par0050" class="elsevierStylePara elsevierViewall">No hubo diferencias significativas en la distribuci&#243;n por sexo &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;67&#41;&#44; lado &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;68&#41;&#44; edad &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;65&#41; e IMC &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;71&#41; entre los 2 grupos&#46; El grupo de ATR convencional se caracteriz&#243; por una menor prevalencia de alineaci&#243;n en varo preoperatorio en comparaci&#243;n con el grupo de ATR navegada &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Los resultados cl&#237;nicos se describen en la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#46; Hubo una mejor&#237;a en todos los par&#225;metros cl&#237;nicos medidos&#44; que era ya significativa al tercer mes postoperatorio y que en la mayor&#237;a de los casos se estabilizaba al a&#241;o de seguimiento manteni&#233;ndose hasta el final de este&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">La mejor&#237;a fue significativamente superior en el grupo navegado&#44; que part&#237;a de peores valores basales medios en todas las escalas&#46; Al final del seguimiento&#44; el grupo de ATR navegada mostr&#243; resultados significativamente mejores en todas las escalas&#44; con excepci&#243;n del KSS espec&#237;fico de la rodilla&#44; en el que el grupo de ATR convencional obtuvo puntuaciones m&#225;s altas &#40;83&#44;8 vs&#46; 79&#44;2 puntos&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41; debido a un mejor rango de flexi&#243;n con una media de 125&#176; y una DE de 10&#176; frente a 110&#176; y DE de 15&#176;&#44; respectivamente&#46; Independientemente de la t&#233;cnica quir&#250;rgica&#44; aquellos pacientes con un &#225;ngulo mec&#225;nico femorotibial comprendido entre 3&#176; de varo y 3&#176; de valgo presentaron mayores puntuaciones en todas las escalas en todos los momentos del seguimiento &#8212;a excepci&#243;n del KSS espec&#237;fico&#44; en el que solo se encontraron diferencias significativas en el preoperatorio&#8212; que aquellos con alineaciones fuera de estos valores &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Resultados radiol&#243;gicos</span><p id="par0065" class="elsevierStylePara elsevierViewall">A los 36 meses&#44; el examen radiol&#243;gico confirm&#243; la buena fijaci&#243;n de los componentes en todos los pacientes&#46; Las caracter&#237;sticas de osteointegraci&#243;n radiol&#243;gica de los implantes tambi&#233;n resultaron &#243;ptimas en todos los casos&#44; tanto en los planos coronal como sagital&#44; sin observarse migraci&#243;n de implantes ni radiolucencias progresivas en ning&#250;n paciente&#46; El porcentaje de pacientes que mostraban una alineaci&#243;n &#243;ptima postoperatoria&#44; es decir&#44; un &#225;ngulo mec&#225;nico femorotibial comprendido entre 3&#176; de varo y 3&#176; de valgo&#44; fue significativamente mayor en el grupo de ATR navegada&#44; 93&#37; &#40;111 pacientes&#41;&#44; frente al 71&#37; &#40;56 pacientes&#41; en el grupo de ATR convencional &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46; La desviaci&#243;n con respecto al eje mec&#225;nico neutro fue de 0&#44;77<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleUnderline">&#43;</span><span class="elsevierStyleHsp" style=""></span>4&#44;3&#176; en el grupo convencional y de 1&#44;19<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleUnderline">&#43;</span><span class="elsevierStyleHsp" style=""></span>5&#44;8&#176; en el grupo CAO &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#41;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Las tasas de complicaciones fueron similares en los 2 grupos&#46; En el grupo de ATR convencional hubo un caso de seroma y en el grupo de ATR navegada una infecci&#243;n superficial que se resolvi&#243; con tratamiento antibi&#243;tico&#46; No se observaron complicaciones en relaci&#243;n con el uso de los tornillos en las rodillas navegadas&#46; Para ambos procedimientos quir&#250;rgicos&#44; la supervivencia a los 36 meses fue del 100&#37;&#44; excepto para el paciente retirado del estudio debido a la infecci&#243;n profunda&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discusi&#243;n</span><p id="par0075" class="elsevierStylePara elsevierViewall">La CAO ha demostrado su ventaja como instrumento quir&#250;rgico para mejorar la precisi&#243;n de la alineaci&#243;n postoperatoria y reducir el n&#250;mero de valores at&#237;picos<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">2-11</span></a>&#46; Aunque algunos autores han obtenido resultados dispares<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">16-18</span></a>&#44; hay un consenso general en que la alineaci&#243;n coronal postoperatoria es el factor m&#225;s importante para garantizar la supervivencia y prevenir el aflojamiento as&#233;ptico de la artroplastia de rodilla<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">19&#44;20</span></a>&#46; Si bien el per&#237;odo de seguimiento de nuestro estudio no fue suficiente para evaluar la supervivencia de los implantes&#44; se encontraron mejores resultados cl&#237;nicos en todas las escalas evaluadas cuando el eje mec&#225;nico estaba dentro del intervalo de 3&#176; del eje mec&#225;nico neutro&#46; Si bien algunos autores no han encontrado influencia de la alineaci&#243;n en los resultados cl&#237;nicos<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">21</span></a>&#44; nuestros resultados coinciden con los reportados por Kamat et al&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">22</span></a>&#44; tambi&#233;n con navegaci&#243;n&#44; a los 3 a&#241;os de seguimiento&#44; pero este hallazgo ha sido de aparici&#243;n m&#225;s precoz en nuestra serie&#44; manifest&#225;ndose ya desde el tercer mes postoperatorio&#46; El efecto de la navegaci&#243;n sobre los resultados funcionales en ATR sigue siendo controvertido y los resultados obtenidos hasta ahora se basan en gran medida en estudios a corto plazo con un n&#250;mero limitado de casos como el nuestro&#46; Los metaan&#225;lisis realizados hasta la fecha han revisado estudios muy heterog&#233;neos en metodolog&#237;a y cuestionarios cl&#237;nicos&#46; Bauwens et al&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">7</span></a>&#44; por ejemplo&#44; con objeto de disponer de un n&#250;mero de estudios adecuado&#44; incluyeron estudios seudoaleatorios&#44; no aleatorios y retrospectivos en su metaan&#225;lisis y concluyeron que la navegaci&#243;n ofrec&#237;a pocas ventajas sobre la cirug&#237;a convencional&#46; En 2012 se publicaron otros 2 metaan&#225;lisis de estudios controlados y aleatorios<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">8&#44;9</span></a>&#44; pero ninguno de ellos incluy&#243; resultados cl&#237;nicos&#46; En su revisi&#243;n sistem&#225;tica sobre el &#233;xito&#44; la seguridad y la eficacia de la ATR navegada&#44; Zamora et al&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">10</span></a> incluyeron solamente resultados cl&#237;nicos basados exclusivamente en el KSS&#44; y concluyeron que la navegaci&#243;n no proporcionaba mejores resultados cl&#237;nicos&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Rebal et al&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">11</span></a> realizaron un metaan&#225;lisis de las puntuaciones del KSS a corto y medio plazo concluyendo que el uso de la navegaci&#243;n proporcionaba mejores resultados funcionales&#44; pero incluyendo trabajos con un tiempo de seguimiento inferior al nuestro&#44; de m&#225;ximo 32 meses&#46; Estos resultados fueron consistentes con los del metaan&#225;lisis realizado por Moskal et al&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">12</span></a>&#44; los cuales encontraron que el uso de la navegaci&#243;n se asociaba con mayores puntuaciones de KSS y WOMAC&#46; Nuestro trabajo ha mostrado una mayor evoluci&#243;n de los resultados objetivos obtenidos en el KSS ya que&#44; si bien en el seguimiento final los valores del KSS espec&#237;fico fueron mayores en el grupo de cirug&#237;a convencional debido a que presentaban mayores valores de flexi&#243;n m&#225;xima&#44; el cambio positivo global fue muy superior en el grupo de navegaci&#243;n&#44; que part&#237;a de una peor situaci&#243;n cl&#237;nica&#46; Este menor rango de flexi&#243;n se debe probablemente a que los pacientes intervenidos mediante cirug&#237;a navegada part&#237;an tambi&#233;n de un menor rango de flexi&#243;n preoperatoria y no es atribuible a un sesgo de selecci&#243;n&#44; ya que la t&#233;cnica empleada fue &#250;nica en cada uno de los hospitales&#46; Las medidas cl&#237;nicas objetivas se consideran cada vez menos representativas de los resultados desde la perspectiva del paciente<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">23</span></a>&#46; En consonancia con esta tendencia&#44; ahora se hace mayor hincapi&#233; en las medidas de resultado referidas por los pacientes &#40;PROMs&#41; para definir el &#233;xito despu&#233;s de la cirug&#237;a de reemplazo articular<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">24</span></a>&#46; La mayor parte de los estudios realizados muestran escasa o nula influencia de la navegaci&#243;n en sus resultados&#46; Roberts et al&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">25</span></a>&#44; en un estudio que compar&#243; el mayor n&#250;mero de pr&#243;tesis implantadas con cirug&#237;a navegada versus no navegada&#44; analizaron 3&#46;329 y 5&#46;725 casos respectivamente&#44; todos ellos utilizando el mismo modelo de pr&#243;tesis&#44; extra&#237;dos del Registro Conjunto de Nueva Zelanda&#44; y no encontraron diferencias en la puntuaci&#243;n del <span class="elsevierStyleItalic">Oxford Knee Score</span> &#40;OKS&#41; a los 6 meses y 5 a&#241;os de seguimiento&#46; Singisetti et al&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">26</span></a> realizaron un estudio retrospectivo de 351 artroplastias de rodilla navegadas y no navegadas con un seguimiento de 2 a&#241;os&#44; analizando las puntuaciones de WOMAC y SF-36&#44; y encontraron diferencias significativas solo en las puntuaciones del SF-36 al a&#241;o de seguimiento&#46; Sin embargo&#44; no encontraron diferencias significativas en las puntuaciones del SF-36 entre los 2 grupos m&#225;s adelante&#46; Finalmente&#44; Song et al&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">27</span></a>&#44; en un estudio prospectivo aleatorizado comparando ATR navegada versus ATR convencional&#44; analizaron el KSS&#44; el WOMAC y el <span class="elsevierStyleItalic">Hospital for Special Surgery Score</span> &#40;HSS&#41; sin encontrar diferencias despu&#233;s de un seguimiento de 9 a&#241;os&#46; En nuestro estudio&#44; sin embargo&#44; la evoluci&#243;n de las puntuaciones de WOMAC y SF-12 fue mucho m&#225;s satisfactoria en el grupo de ATR navegadas&#44; con diferencias significativas observadas despu&#233;s del tercer mes postoperatorio&#46; Estos resultados no ser&#237;an atribuibles a la estabilidad del implante&#44; como lo demuestran varios estudios en los que no se observaron diferencias significativas en la laxitud postoperatoria de las rodillas implantadas ni influencia de esta en los resultados cl&#237;nicos en funci&#243;n del tipo de t&#233;cnica aplicada<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">28-30</span></a>&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Las limitaciones de este estudio incluyen la ausencia de un proceso controlado de aleatorizaci&#243;n y un corto per&#237;odo de seguimiento&#46; Los pacientes fueron sometidos a cirug&#237;a en 3 centros por 3 diferentes cirujanos con 2 tipos de implantes&#46; Sin embargo&#44; es poco probable que el uso de implantes PS o CR implique un sesgo&#44; ya que la literatura no muestra diferencias estad&#237;sticamente significativas en los resultados cl&#237;nicos y radiol&#243;gicos entre ambos tipos de pr&#243;tesis<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">31</span></a>&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conclusiones</span><p id="par0090" class="elsevierStylePara elsevierViewall">El uso de la CAO en ATR proporciona una alineaci&#243;n mec&#225;nica m&#225;s precisa y resultados funcionales superiores a corto plazo en comparaci&#243;n con ATR convencional&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Nivel de evidencia</span><p id="par0095" class="elsevierStylePara elsevierViewall">Nivel de evidencia II&#46; Estudio prospectivo comparativo&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Responsabilidades &#233;ticas</span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Protecci&#243;n de personas y animales</span><p id="par0100" class="elsevierStylePara elsevierViewall">Los autores declaran que para esta investigaci&#243;n no se han realizado experimentos en seres humanos ni en animales&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Confidencialidad de los datos</span><p id="par0105" class="elsevierStylePara elsevierViewall">Los autores declaran que han seguido los protocolos de su centro de trabajo sobre la publicaci&#243;n de datos de pacientes&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Derecho a la privacidad y consentimiento informado</span><p id="par0110" class="elsevierStylePara elsevierViewall">Los autores declaran que en este art&#237;culo no aparecen datos de pacientes&#46;</p></span></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Conflicto de intereses</span><p id="par0115" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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            0 => "Artroplastia total de rodilla"
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            2 => "Navegaci&#243;n"
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    "resumen" => array:2 [
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La navegaci&#243;n en la artroplastia total de rodilla &#40;ATR&#41; ha demostrado obtener una alineaci&#243;n de implantes m&#225;s precisa comparada con la instrumentaci&#243;n convencional&#46; Aunque se deber&#237;a esperar una supervivencia m&#225;s prolongada de los implantes y resultados cl&#237;nicos superiores mediante la cirug&#237;a navegada&#44; la evidencia disponible no apoya esta hip&#243;tesis&#46; El objetivo de este estudio fue comparar los resultados cl&#237;nicos y radiol&#243;gicos de la ATR navegada con la ATR convencional tras un seguimiento de 3 a&#241;os bajo la hip&#243;tesis de que la navegaci&#243;n proporcionar&#237;a mejores resultados&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material y m&#233;todo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio prospectivo multic&#233;ntrico de 119 pacientes intervenidos de ATR navegada y 80 pacientes con instrumentaci&#243;n convencional&#46; Todos ellos fueron evaluados preoperatoriamente&#44; a los 3&#44; 12&#44; 24 y 36 meses&#46; El an&#225;lisis incluy&#243; los cuestionarios <span class="elsevierStyleItalic">Western Ontario and McMaster&#39;s Universities Osteoarthritis Index</span> &#40;WOMAC&#41;&#44; <span class="elsevierStyleItalic">Knee Society Score</span> &#40;KSS&#41; y <span class="elsevierStyleItalic">Short Form-12 Health Survey</span> &#40;SF-12&#41;&#44; adem&#225;s de la evaluaci&#243;n radiogr&#225;fica&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Todas las puntuaciones cl&#237;nicas mejoraron para todos los pacientes durante el seguimiento&#44; pero fueron significativamente mejores en el grupo de navegaci&#243;n&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">El porcentaje de pacientes que mostraban un &#225;ngulo mec&#225;nico femorotibial comprendido entre 3&#176; de varo y 3&#176; de valgo fue significativamente mayor en el grupo de ATR navegada &#40;93&#37;&#41; que en el grupo de ATR convencional &#40;71&#37;&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El uso de la cirug&#237;a asistida por ordenador en la ATR proporciona una alineaci&#243;n mec&#225;nica m&#225;s precisa y resultados funcionales superiores a corto plazo en comparaci&#243;n con la cirug&#237;a convencional&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objective</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Computer-assisted surgery application in total knee arthroplasty &#40;TKA&#41; has shown more accurate implant alignment compared with conventional instrumentation and is associated with more homogeneous alignment results&#46; Although longer implant survival and superior clinical outcomes should be expected from navigated TKA&#44; currently available evidence does not support this hypothesis&#46; The aim of this study was to compare navigated TKA with conventional TKA regarding clinical and radiological outcomes after a 3-year follow-up under the hypothesis that navigated TKA would provide better outcomes than conventional TKA&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material and method</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">In a prospective multicentre study&#44; 119 patients underwent navigated TKA and 80 patients received conventional instrumentation&#46; Patients were evaluated at the baseline and at postoperative months 3&#44; 12&#44; 24&#44; and 36&#46; Analysis included the American Knee Society Score &#40;KSS&#41;&#44; Western Ontario and McMaster Universities Osteoarthritis Index &#40;WOMAC&#41;&#44; Short Form-12 &#40;SF12&#41; Health Survey&#44; and radiographic assessment&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">All clinical scores improved significantly for all patients during the follow-up but were significantly better in the navigation group&#46;</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">The percentage of patients showing a mechanical axis between 3&#176; of varus and 3&#176; of valgus was significantly higher in the ATR group &#40;93&#37;&#41; than in the conventional TKA group &#40;71&#37;&#41; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">The use of computer-assisted surgery in TKA provides more accurate mechanical alignment and superior short-term functional outcomes compared to conventional TKA&#46;</p></span>"
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                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Edad</td><td class="td" title="table-entry  " align="left" valign="top">S&#237;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22 &#40;27&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">57 &#40;72&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">Eje</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Neutro &#40;0&#176;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Varo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Valgo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;2&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">107 &#40;89&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9 &#40;7&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21 &#40;26&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">49 &#40;62&#44;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9 &#40;11&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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          "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas de los pacientes</p>"
        ]
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        "etiqueta" => "Tabla 2"
        "tipo" => "MULTIMEDIATABLA"
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">DE&#58; desviaci&#243;n est&#225;ndar&#59; KSS&#58; <span class="elsevierStyleItalic">Knee Society Score</span>&#59; Nav&#58; navegaci&#243;n&#59; SF-12&#58; <span class="elsevierStyleItalic">Short Form-12 Health Survey</span>&#59; WOMAC&#58; <span class="elsevierStyleItalic">Western Ontario and McMaster&#39;s Universities Osteoarthritis Index</span>&#46;</p>"
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                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-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Escala&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">KSS Rodilla</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">KSS Funci&#243;n</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">SF-12 F&#237;sico</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">SF-12 Mental</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">WOMAC Dolor</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">WOMAC Rigidez</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">WOMAC Capacidad funcional</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Nav&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Media&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">DE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Media&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">DE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Media&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">DE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Media&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">DE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Media&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">DE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Media&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">DE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Media&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">DE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Preoperatorio</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">46&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001</td><td class="td" title="table-entry  " align="left" valign="top">60&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001</td><td class="td" title="table-entry  " align="left" valign="top">26&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">0&#44;026</td><td class="td" title="table-entry  " align="left" valign="top">46&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001</td><td class="td" title="table-entry  " align="left" valign="top">13&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001</td><td class="td" title="table-entry  " align="left" valign="top">5&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001</td><td class="td" title="table-entry  " align="left" valign="top">43&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">39&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">55&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">1 mes</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">78&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001</td><td class="td" title="table-entry  " align="left" valign="top">70&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">0&#44;743</td><td class="td" title="table-entry  " align="left" valign="top">43&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">0&#44;170</td><td class="td" title="table-entry  " align="left" valign="top">43&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">0&#44;514</td><td class="td" title="table-entry  " align="left" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">0&#44;028</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">0&#44;002</td><td class="td" title="table-entry  " align="left" valign="top">16&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">64&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">72&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">40&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">45&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">3 meses</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">81&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">0&#44;012</td><td class="td" title="table-entry  " align="left" valign="top">78&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001</td><td class="td" title="table-entry  " align="left" valign="top">43&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001</td><td class="td" title="table-entry  " align="left" valign="top">46&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">0&#44;037</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001</td><td class="td" title="table-entry  " align="left" valign="top">12&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">76&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">91&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">51&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">57&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">12 meses</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">82&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">0&#44;036</td><td class="td" title="table-entry  " align="left" valign="top">80&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001</td><td class="td" title="table-entry  " align="left" valign="top">45&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001</td><td class="td" title="table-entry  " align="left" valign="top">46&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001</td><td class="td" title="table-entry  " align="left" valign="top">11&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">79&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">95&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">53&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">58&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">36 meses</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">83&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001</td><td class="td" title="table-entry  " align="left" valign="top">79&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001</td><td class="td" title="table-entry  " align="left" valign="top">44&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001</td><td class="td" title="table-entry  " align="left" valign="top">46&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001</td><td class="td" title="table-entry  " align="left" valign="top">12&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">79&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">96&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">54&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">59&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#44;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "es" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Evoluci&#243;n de las escalas cl&#237;nicas seg&#250;n la t&#233;cnica quir&#250;rgica</p>"
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          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">DE&#58; desviaci&#243;n est&#225;ndar&#59; KSS&#58; <span class="elsevierStyleItalic">Knee Society Score</span>&#59; SF-12&#58; <span class="elsevierStyleItalic">Short Form-12 Health Survey</span>&#59; WOMAC&#58; <span class="elsevierStyleItalic">Western Ontario and McMaster&#39;s Universities Osteoarthritis Index</span>&#46;</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">KSS Rodilla</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">KSS Funci&#243;n</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">SF-12 F&#237;sico</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">SF-12 Mental</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">WOMAC Dolor</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">WOMAC Rigidez</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">WOMAC Capacidad funcional</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Grupo 0 a 3&#176;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Grupo &#62;<span class="elsevierStyleHsp" style=""></span>3&#176;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Grupo 0 a 3&#176;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Grupo &#62;<span class="elsevierStyleHsp" style=""></span>3&#176;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Grupo 0 a 3&#176;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Grupo &#62;<span class="elsevierStyleHsp" style=""></span>3&#176;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Grupo 0 a 3&#176;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Grupo &#62;<span class="elsevierStyleHsp" style=""></span>3&#176;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Grupo 0 a 3&#176;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Grupo &#62;<span class="elsevierStyleHsp" style=""></span>3&#176;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Grupo 0 a 3&#176;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Grupo &#62;<span class="elsevierStyleHsp" style=""></span>3&#176;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Grupo 0 a 3&#176;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Grupo &#62;<span class="elsevierStyleHsp" style=""></span>3&#176;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Preoperatorio</td><td class="td" title="table-entry  " align="left" valign="top">Media&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26&#44;72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38&#44;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001</td><td class="td" title="table-entry  " align="left" valign="top">41&#44;47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">52&#44;65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001</td><td class="td" title="table-entry  " align="left" valign="top">24&#44;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&#44;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">0&#44;745</td><td class="td" title="table-entry  " align="left" valign="top">36&#44;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">43&#44;66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001</td><td class="td" title="table-entry  " align="left" valign="top">14&#44;91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#44;28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">0&#44;252</td><td class="td" title="table-entry  " align="left" valign="top">6&#44;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#44;60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">0&#44;013</td><td class="td" title="table-entry  " align="left" valign="top">54&#44;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">47&#44;73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">0&#44;001</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">DE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#44;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19&#44;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&#44;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23&#44;96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#44;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#44;96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#44;36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#44;85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#44;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#44;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#44;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#44;37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">3 meses</td><td class="td" title="table-entry  " align="left" valign="top">Media&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">78&#44;60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">78&#44;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">0&#44;969</td><td class="td" title="table-entry  " align="left" valign="top">91&#44;86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">82&#44;23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001</td><td class="td" title="table-entry  " align="left" valign="top">52&#44;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">45&#44;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001</td><td class="td" title="table-entry  " align="left" valign="top">56&#44;91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&#44;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">0&#44;002</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001</td><td class="td" title="table-entry  " align="left" valign="top">5&#44;78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#44;97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">0&#44;001</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">DE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#44;85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#44;44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#44;90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#44;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#44;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#44;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#44;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#44;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#44;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#44;79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">36 meses</td><td class="td" title="table-entry  " align="left" valign="top">Media&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">79&#44;63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">81&#44;82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">0&#44;097</td><td class="td" title="table-entry  " align="left" valign="top">97&#44;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">84&#44;87&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001</td><td class="td" title="table-entry  " align="left" valign="top">54&#44;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">47&#44;67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001</td><td class="td" title="table-entry  " align="left" valign="top">59&#44;88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">51&#44;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">0&#44;001</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#44;97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">DE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#44;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#44;76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#44;62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&#44;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#44;70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#44;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#44;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#44;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#44;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#44;71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#44;52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "es" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Evoluci&#243;n de los resultados cl&#237;nicos en funci&#243;n del &#225;ngulo femorotibial mec&#225;nico</p>"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Computer assisted knee replacement"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "S&#46;L&#46; Delp"
                            1 => "S&#46;D&#46; Stulberg"
                            2 => "B&#46; Davies"
                            3 => "F&#46; Picard"
                            4 => "F&#46; Leitner"
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                        "tituloSerie" => "Clin Orthop Relat Res&#46;"
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                      "titulo" => "Imageless computer assisted versus conventional knee replacement&#46; A Bayesian meta-analysis of 23 comparative studies"
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                          "etal" => false
                          "autores" => array:5 [
                            0 => "Y&#46;S&#46; Brin"
                            1 => "V&#46;S&#46; Nicolaou"
                            2 => "L&#46; Joseph"
                            3 => "D&#46;J&#46; Zukor"
                            4 => "J&#46; Antoniou"
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                    0 => array:2 [
                      "doi" => "10.1007/s00264-010-1008-6"
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                        "tituloSerie" => "Int Orthop&#46;"
                        "fecha" => "2011"
                        "volumen" => "35"
                        "paginaInicial" => "331"
                        "paginaFinal" => "339"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20376440"
                            "web" => "Medline"
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              "identificador" => "bib0170"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Does computer-assisted surgery improve postoperative leg alignment and implant positioning following total knee arthroplasty&#63; A meta-analysis of randomized controlled trials&#63;"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "T&#46; Cheng"
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                            3 => "X&#46; Zhang"
                          ]
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                      ]
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                      "doi" => "10.1007/s00167-011-1588-8"
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                        "tituloSerie" => "Knee Surg Sports Traumatol Arthrosc&#46;"
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                        "paginaInicial" => "1307"
                        "paginaFinal" => "1322"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21732057"
                            "web" => "Medline"
                          ]
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              "etiqueta" => "4"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Alignment outcomes in navigated total knee arthroplasty&#58; A meta-analysis"
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                        0 => array:2 [
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                          "autores" => array:4 [
                            0 => "Y&#46; Fu"
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                            2 => "Y&#46; Liu"
                            3 => "Q&#46; Fu"
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                      "doi" => "10.1007/s00167-011-1695-6"
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                        "tituloSerie" => "Knee Surg Sports Traumatol Arthrosc&#46;"
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Información del artículo
ISSN: 18884415
Idioma original: Español
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