Structural and intermediary determinants in sexual health care access in migrant populations: a scoping review.

OBJECTIVES: Addressing migrant population's sexual health needs is essential, given the high vulnerability of this population, especially during migratory trajectories and when accessing health care in destination countries. The aim of this scoping review is to identify and describe the structural and intermediary determinants and their dimensions, which negatively influence sexual healthcare access in migrant population in the world in the last 20 years. STUDY DESIGN: Scoping review. METHODS: The search strategy was carried out in the databases PubMed/MEDLINE, Web of Science, EMBASE, and CINAHL. The inclusion criteria were primary studies published in English or Spanish from 2000 to 2022, describing determinants or barriers to access to sexual health for international migrants, refugees, and asylum seekers. The construction of the results was based on the social determinants of health framework. RESULTS: A total of 44 studies were included. Thirteen categories that negatively affect access to sexual health in migrants were identified-structural determinants: language and communication barriers, religious and cultural values, VIH stigma and discrimination, irregular migration status, financial constraints, racism and discrimination, gender inequalities, and lack of knowledge and awareness about sexuality and sexual health; and intermediary determinants: financial health coverage, privacy and confidentiality, health system navigation; health system and facilities, and psychosocial factors. CONCLUSION: The most relevant dimensions identified as barriers to access to health services were "culture and societal values" and "health system". Identifying the determinants that affect migrants' access to sexual health is relevant for the formulation of public policies with sociocultural relevance and an intersectional and human rights approach.

Biomedical doctoral students' research practices when facing dilemmas: two vignette-based randomized control trials.

Our aim was to describe the research practices of doctoral students facing a dilemma to research integrity and to assess the impact of inappropriate research environments, i.e. exposure to (a) a post-doctoral researcher who committed a Detrimental Research Practice (DRP) in a similar situation and (b) a supervisor who did not oppose the DRP. We conducted two 2-arm, parallel-group randomized controlled trials. We created 10 vignettes describing a realistic dilemma with two alternative courses of action (good practice versus DRP). 630 PhD students were randomized through an online system to a vignette (a) with (n = 151) or without (n = 164) exposure to a post-doctoral researcher; (b) with (n = 155) or without (n = 160) exposure to a supervisor. The primary outcome was a score from - 5 to + 5, where positive scores indicated the choice of DRP and negative scores indicated good practice. Overall, 37% of unexposed participants chose to commit DRP with important variation across vignettes (minimum 10%; maximum 66%). The mean difference [95%CI] was 0.17 [- 0.65 to 0.99;], p = 0.65 when exposed to the post-doctoral researcher, and 0.79 [- 0.38; 1.94], p = 0.16, when exposed to the supervisor. In conclusion, we did not find evidence of an impact of postdoctoral researchers and supervisors on student research practices.Trial registration: NCT04263805, NCT04263506 (registration date 11 February 2020).

Physical effectiveness of corn silage fractions stratified with the Penn State Particle Separator for lactating dairy cows.

This study evaluated the physical effectiveness of whole-plant corn silage (CS) particles stratified with the Penn State Particle Separator, composed of 19- and 8-mm-diameter sieves and a pan, for lactating dairy cows. Eight Holstein cows (27.6 ± 2.8 kg/d of milk, 611 ± 74 kg body weight; 152 ± 83 d in milk) were assigned to two 4 × 4 Latin squares (22-d periods, 16-d adaptation), where one square was formed with rumen-cannulated cows. Three CS particle fractions were manually isolated using the 8- and 19-mm diameter sieves and re-ensiled in 200-L drums. The 4 experimental diets were (% dry matter): (1) CON (control): 17% forage neutral detergent fiber (NDF) from CS (basal roughage), 31.5% starch, and 31.9% NDF; (2) PSPan: 17% forage NDF from CS + 9% NDF from CS particles <8 mm, 25.9% starch, and 37.9% NDF; (3) PS8: 17% forage NDF from CS + 9% NDF from CS particles 8 to 19 mm, 25.5% starch, and 38.3% NDF; and (4) PS19: 17% forage NDF from CS + 9% NDF from CS particles >19 mm, 24.9% starch, and 38.8% NDF. Cows fed PS8 had greater dry matter intake and energy-corrected milk yield (22.4 and 26.9 kg/d, respectively) than cows fed CON (20.8 and 24.7 kg/d) and PS19 (21.2 and 24.8 kg/d), but no difference was detected between PSPan (21.6 and 25.8 kg/d) and other treatments. Milk fat concentration was greater for PS8 than CON, with intermediate values for PSPan and PS19. Milk fat yield was greater for cows fed PS8 than CON and PS19, and cows fed PSPan secreted more fat than CON cows but were not different from cows fed the other 2 diets. Cows fed CON had a lower meal frequency than cows fed PSPan, shorter meal and rumination times than PS8, and greater meal size and lower rates of rumination and chewing than the other 3 diets. Total chewing per unit of NDF was higher for PS8 than PSPan, although neither treatment differed from CON or PS19. Cows fed PS19 had higher refusal of feed particles >19 mm than cows fed CON and PSPan. The refusal of dietary NDF and undigested NDF in favor of starch were all greater for PS19 than on the other treatments. Cows fed PS19 had a greater proportion of the swallowed bolus and rumen digesta with particles >19 mm than the other 3 diets. Cows fed CON had the lowest ruminal pH and greatest lactate concentration relative to the other 3 diets. Plasma lipopolysaccharide was higher for cows fed CON and PSPan than for cows fed PS8 and PS19, and serum d-lactate tended to be lower on PSPan than for CON and PS8. In summary, the inclusion of CS fractions in a low-forage fiber diet (CON) reduced signs of ruminal acidosis. Compared with CS NDF <8 and >19 mm, CS NDF with 8- to 19-mm length promoted better rumen health and performance of dairy cows. These results highlight the importance of adjusting CS harvest and formulating dairy diets based on the proportion of particles retained between the 8- and 19-mm sieves.

Past and projected temporal trends in arthroscopic hip surgery in Spain between 1998 and 2018. / Tendencias temporales pasadas y proyectadas en la cirugía artroscópica de cadera en España entre 1998 y 2018.

OBJECTIVE: Describe the population incidence of hip arthroscopy from 1998 to 2018 and to project the trends for the year 2030, as well as to describe the variations in the population incidence between the autonomous communities. MATERIAL AND METHOD: A retrospective review of the minimum basic data set from 1998 to 2018 was carried out. Temporal evolution was analyzed and the variables associated with the indication (age, sex, regions) were identified. For each region, the crude rate per 100,000 inhabitants was calculated. The 2019-2030 projection was made using linear regression. RESULTS: In Spain between 1998 and 2018 a total of 10,663 arthroscopic hip surgeries were carried out. The population incidence in 1998 was 0.14 CAC per 100,000 inhabitants, while in 2018 it was 4.09. For the year 2030 an increase of 156.9% in the number of arthroscopic hip surgeries is expected (P<.001). On average, 57.7% of all procedures (95% CI 55.2-60.2) were done in men and the highest incidence was found in ages ≤44 years. The geographical variation was 81%, being up to 15.4 times the difference in incidence per 100,000 inhabitants between some regions. CONCLUSIONS: The number of hip arthroscopies in Spain has been increasing in the 1998-2018 period and this growing trend is expected to continue until 2030. In Spain, hip arthroscopic procedures are performed more frequently in male patients and in under 45 years old. The variability of the population incidence between the autonomous communities is high.

[Translated article] Past and projected temporal trends in arthroscopic hip surgery in Spain between 1998 and 2018.

OBJECTIVE: Describe the population incidence of hip arthroscopy from 1998 to 2018 and to project the trends for the year 2030, as well as to describe the variations in the population incidence between the autonomous communities. MATERIAL AND METHOD: A retrospective review of the minimum basic data set from 1998 to 2018 was carried out. Temporal evolution was analysed and the variables associated with the indication (age, sex, regions) were identified. For each region, the crude rate per 100,000 inhabitants was calculated. The 2019-2030 projection was made using linear regression. RESULTS: In Spain between 1998 and 2018 a total of 10,663 arthroscopic hip surgeries were carried out. The population incidence in 1998 was 0.14 CAC per 100,000 inhabitants, while in 2018 it was 4.09. For the year 2030 an increase of 156.9% in the number of arthroscopic hip surgeries is expected (p<.001). On average, 57.7% of all procedures (95% CI 55.2-60.2) were done in men and the highest incidence was found in ages≤44 years. The geographical variation was 81%, being up to 15.4 times the difference in incidence per 100,000 inhabitants between some regions. CONCLUSIONS: The number of hip arthroscopies in Spain has been increasing in the 1998-2018 period and this growing trend is expected to continue until 2030. In Spain, hip arthroscopic procedures are performed more frequently in male patients and in under 45 years old. The variability of the population incidence between the autonomous communities is high.

[Translated article] Results of cementless total knee arthroplasty in patients over 70 years of age.

OBJECTIVE: To analyse the clinical and radiologic results, the survival and complications obtained in 70 year or older patients who underwent cementless total knee arthroplasty (TKA). MATERIAL AND METHOD: An observational study of patients operated between January 2014 and December 2016 was carried out according to the Natural Knee model (Zimmer®, USA). The main variables were the Oxford Knee Score, the visual analogue scale, the presence of radiolucencies, complications, survival and reasons for revision. RESULTS: Of 104 TKA, 86 were available for revision. The median age was 76 years. The mean follow-up was 5.4 years (range 3.7-6.9). The Oxford Knee Score punctuation showed a median of 17 presurgical (range 0-40) and 37 post surgical (range 5-48), P<.001. The 87.2% of the patients obtained a clinically significant improvement. The median visual analogue scale punctuation was 8 for presurgical (range 4-10) and 2 for post surgical (range 1-9), P<.001. The 88.3% of the patients obtained a clinically significant decrease. Three months after the surgery, the 55.81% of the TKAs presented radiolucencies around the tibial plateau. At the end of the follow-up, radiolucencies were present in 30.23% of the TKAs. Survival from all causes was 91.86% at 77.2 months and 96.5% due to aseptic loosening. CONCLUSION: Cementless knee prostheses are a valid option in patients aged 70 or older, presenting good clinical, radiological and survival results.

Inducing a topological transition in graphene nanoribbon superlattices by external strain.

Armchair graphene nanoribbons, when forming a superlattice, can be classified into different topological phases, with or without edge states. By means of tight-binding and classical molecular dynamics (MD) simulations, we studied the electronic and mechanical properties of some of these superlattices. MD shows that fracture in modulated superlattices is brittle, as for unmodulated ribbons, and occurs at the thinner regions, with staggered superlattices achieving a larger fracture strain than inline superlattices. We found a general mechanism to induce a topological transition with strain, related to the electronic properties of each segment of the superlattice, and by studying the sublattice polarization we were able to characterize the transition and the response of these states to the strain. For the cases studied in detail here, the topological transition occurred at ∼3-5% strain, well below the fracture strain. The topological states of the superlattice - if present - are robust to strain even close to fracture. The topological transition was characterized by means of the sublattice polarization of the states.

Results of cementless total knee arthroplasty in patients over 70 years of age. / Resultados de la artroplastia total de rodilla no cementada en pacientes mayores de 70 años.

OBJECTIVE: To analyze the clinical and radiologic results, the survival and complications obtained in 70 year or older patients who underwent cementless total knee arthroplasty (TKA). MATERIAL AND METHOD: An observational study of patients operated between January 2014 and December 2016 was carried out according to the Natural Knee model (Zimmer®, USA). The main variables were the Oxford Knee Score, the visual analog scale, the presence of radiolucencies, complications, survival and reasons for revision. RESULTS: Of 104 TKA, 86 were available for revision. The median age was 76 years. The mean follow-up was 5.4 years (range 3.7-6.9). The Oxford Knee Score punctuation showed a median of 17 presurgical (range 0-40) and 37 post surgical (range 5-48), P<.001. The 87.2% of the patients obtained a clinically significant improvement. The median visual analog scale punctuation was 8 for presurgical (range 4-10) and 2 for post surgical (range 1-9), P<.001. The 88.3% of the patients obtained a clinically significant decrease. Three months after the surgery, the 55.81% of the TKAs presented radiolucencies around the tibial plateau. At the end of the follow-up, radiolucencies were present in 30.23% of the TKAs. Survival from all causes was 91.86% at 77.2 months and 96.5% due to aseptic loosening. CONCLUSION: Cementless knee prostheses are a valid option in patients aged 70 or older, presenting good clinical, radiological and survival results.

Trend in Spain in the use of total ankle arthroplasty versus arthrodesis in the period 1997-2017. / Tendencia en España en el uso de artroplastia total de tobillo frente a artrodesis en el periodo 1997-2017.

OBJECTIVE: The main objective of this study is to compare proportionally the incidence of total ankle arthroplasty (TAA) versus ankle arthrodesis and to determine the variables that may have influenced its indication. The secondary objective is to analyse the trend in the use of TAA using a population-based analysis and to compare our results with those reported by national registries in other countries. MATERIAL AND METHOD: A retrospective review of the Minimum Basic Data Set from 1997-2017 was performed. Subjects were categorised according to surgical procedure. Their temporal evolution was analysed and hospital variables associated with the indication (age, sex, hospital complexity) were identified. In order to compare the trend in Spain with respect to other countries, the information was standardised as number of procedures per 100,000 inhabitants/year and a projection was made for the five-year period 2020-2025. RESULTS: In the period 1997-2017, 11,669 ankle arthrodesis and 1,049 TAAs were performed. The trend was increasing and significant for both procedures, however, in the last 10 years analysed the proportional trend of TAA decreased significantly. Being female (OR 1.32), being 65 years or older (OR 1.50) and being operated in a complex hospital (OR 1.31) were associated with the indication for a TAA. Compared to other countries, Spain has much lower rates of TAA utilisation, with minimal growth estimated for the year 2025. CONCLUSION: Although the use of TAA has increased, its growth has been lower than that of ankle arthrodesis and its current trend is proportionally decreasing, with female sex, age≥65 years and the patient being operated in a medium/high complexity hospital being associated with the indication for TAA. Compared with other countries, Spain has much lower rates of use and its projection over the next five years, although increasing, is expected to be minimal.

Effect of sealing strategy on the feeding value of corn silage for growing dairy heifers.

Our objective was to compare the performance of dairy heifers fed diets based on whole-plant corn silage stored in bunker silos sealed with either standard polyethylene film (white-on-black, actual thickness 121 ± 3.1 µm) covering the top surface, held in place with rows of tires every 3 m (PE) or an oxygen barrier system comprised of an ethylene-vinyl alcohol film (actual thickness 46.7 ± 2.5 µm) lining side walls and covering the silage, protected with a woven anti-UV cover and gravel bags placed around the edges and every 3 m across the silo (OB). Whole-plant corn was mechanically harvested at 39% dry matter (DM), packed in bunker silos, and sealed with PE or OB covering methods. After 6 mo of storage, silos were opened and fed to 26 Holstein heifers (260 ± 89.1 kg of shrunk body weight) for 60 d. Heifers were blocked by initial weight (13 blocks with 2 heifers each block) and housed in individual pens. Diets contained (on a DM basis) 80% corn silage (PE or OB), 17.5% soybean meal, and 2.5% mineral mix. Dry matter intake was measured daily, whereas shrunk body weight, hip height, heart girth, and body condition score were measured at the beginning and end of the experiment. Feeding behavior was recorded on d 24 and 46, and total-tract digestibility was measured from d 26 to 30 and 48 to 52. Data of intake, feeding behavior, and digestibility were averaged by animal for the whole feeding period before the statistical analysis. Data of animal performance were analyzed as a randomized complete block design. Initial shrunk body weight was used as a covariate for analyses of intake and body measures. During feed-out, silage quality was also assessed at the top (15 cm depth from upper surface) and bottom layer (135 cm depth from upper surface) and analyzed as a split-plot design. Silage stored under the OB sealing system had less yeast, mold, and NH3-N, and more lactic acid and ethanol-soluble carbohydrates. An interaction between sealing strategy and silo layer showed that OB silage had lower values of temperature, pH, anaerobic spores, acetic acid, and DM loss, and greater in vitro DM digestibility and aerobic stability, especially in the top layer. The proportion of inedible silage was lower in OB than in PE treatment (0.82 vs. 4.00% DM). Total-tract digestibility was similar between treatments, but animals that received the OB diet had higher DM intake by approximately 9% (9.39 vs. 10.20 kg/d) due to a faster eating rate and a greater number of meals per day. Therefore, OB treatment increased the digestible energy intake by 8% (26.3 vs. 28.3 Mcal/d) and average daily gain by 12% (1.08 vs. 1.21 kg/d). Body condition score change was similar between treatments, but heifers fed OB had greater heart girth and tended to have higher hip height. In conclusion, replacing a standard PE film with an OB sealing system improved silage conservation and performance of growing dairy heifers.

Using WhatsApp® in our clinical practice: a pilot study. / El uso del WhatsApp® en nuestra práctica clínica: estudio piloto.

OBJECTIVE: To evaluate the use of WhatsApp as a clinical tool and determine the perception of orthopaedic surgeons of its usefulness. MATERIAL AND METHODS: Orthopaedic surgeons attending a scientific meeting were invited to complete an anonymous and structured survey on the use of the application in the clinical setting. RESULTS: A total of 41 (38%) surveys were correctly completed. Of the respondents, 100% had been either senders or receivers of clinical information via the application. Ninety-three percent had used the application to consult in relation to a clinical case. Of the respondents, 78% belonged to a WhatsApp group in which clinical information is shared: 71% agreed that communication between clinicians through WhatsApp is a useful tool for making therapeutic decisions. CONCLUSION: The use of WhatsApp for clinical purposes by orthopaedic surgeons is widespread. Most consider it a useful tool in therapeutic decision making.

Internet searches by the Spanish population for unqualified information on the treatment of osteoarthritis. / Búsqueda en Internet de información no cualificada sobre el tratamiento de la artrosis por la población española.

OBJECTIVE: There is a current trend in the population to search the Internet for unqualified medical information that may affect the recommendations given in specialist consultation. The aim of this study was to analyse the tendency of the Spanish population to search the Internet for unqualified information on current treatments for osteoarthritis. MATERIAL AND METHOD: Google Trends was used analyse the information gathered from the Internet, combining potential key search terms related to the current treatment of osteoarthritis. For each term the relative search volume was calculated, and its trend between 2009 and 2019. Spearman's correlation was used to study the direction of the trend. RESULTS: All the infiltration methods had increasing trends and no statistically significant differences were found between them (P=.769). The term that showed the best correlation over time was «prp¼ with Spearman's correlation =.90, and the term with the highest relative search volume was «growth factors¼. Prosthetic treatment generated more interest than conservative treatments, where there was more interest in knee replacement than hip replacement (P<.001). CONCLUSION: In Spain, the search for unqualified information on the treatment of osteoarthritis has increased over the past 10 years. There is more interest in prosthetic treatment than the more conservative treatments. There is more interest in knee replacement than hip replacement. There are no differences with regard to the different methods of joint injections.

[Image-guided brachyablation for hepatocarcinoma. Report of one case]. / Image-Guided BrachyAblation (IGBA) en hepatocarcinoma. Descripción de la técnica y reporte del primer caso en Chile.

Eighty percent of hepatocarcinomas are inoperable at the moment of diagnosis. Liver transplantation is the treatment of choice in these cases, but local therapies are another alternative. Among these, Image-Guided BrachyAblation is a safe choice. We report a 76-year-old male with a hepatocarcinoma, who was considered inoperable due to the high surgical risk of the patient. A local treatment with Image-Guided BrachyAblation was decided. A brachytherapy needle was placed in the tumor under computed tomography guidance and a 15 Gy single dose was delivered from an Iridium-192 source. The patient had no immediate complications and at one month of follow up he continued without incidents.

Obesity in Patients with Endometrial Cancer: May It Affect the Surgical Outcomes of Laparoscopic Approach?

OBJECTIVE: To evaluate the impact of obesity on surgical outcomes for women with endometrial cancer (EC) managed by laparoscopic surgery. Minimal invasive surgery has been incorporated in the surgical management of EC, improving perioperative outcomes. However, this approach may become more challenging in case of obesity. So it is important to accurately evaluate and establish the most appropriate surgical approach for these patients. MATERIALS AND METHODS: From January 2008 through April 2016, we conducted a prospective observational study, including all consecutive patients with a histological diagnosis of EC undergoing surgical staging by laparoscopy at our institution. Patients were classified in two groups (obese vs non-obese) according to their body mass index. Information about short- and long-term outcomes were recorded and analyzed during an outpatient follow-up. RESULTS: Between January 2008 and April 2016, 83 women underwent laparoscopic surgery for EC at our institution. Forty-six (56.6%) of them were classified as obese. Surgical outcomes were similar in both groups. No significant difference was reported in surgical time, number of lymph nodes removed, blood loss, length of hospital stay, and incidence of intra- or postoperative complications. Also, long-term outcomes did not show any statistical significant difference: recurrence rate was 6.4% (3/47) among obese patients and 13.9% (5/36) among non-obese (p = 0.251). No difference was reported even in time to recurrence (log-rank p = 0.280) and in survival time (log-tank p = 0.132) between the two groups. CONCLUSIONS: Our results show that obesity did not impair the outcomes of laparoscopic surgery for EC. This surgical approach may be offered to obese patients with the same level of safety, radicality, and efficiency as for the normal-weight population.

Image-Guided BrachyAblation (IGBA) en hepatocarcinoma: descripción de la técnica y reporte del primer caso en Chile / Image-guided brachyablation for hepatocarcinoma: report of one case

Eighty percent of hepatocarcinomas are inoperable at the moment of diagnosis. Liver transplantation is the treatment of choice in these cases, but local therapies are another alternative. Among these, Image-Guided BrachyAblation is a safe choice. We report a 76-year-old male with a hepatocarcinoma, who was considered inoperable due to the high surgical risk of the patient. A local treatment with Image-Guided BrachyAblation was decided. A brachytherapy needle was placed in the tumor under computed tomography guidance and a 15 Gy single dose was delivered from an Iridium-192 source. The patient had no immediate complications and at one month of follow up he continued without incidents.

Factors predicting one-year mortality of patients over 80 years operated after femoral neck fracture. / Factores predictivos de la mortalidad al año en pacientes mayores de 80 años intervenidos de fractura del cuello femoral.

INTRODUCTION: In the Spanish population, previous studies related to mortality after hip fracture are based on patients aged 60 to 102years and did not stratify patients according to the type of fracture. The objective of this study was to identify the factors with influence on mortality at one postoperative year in patients aged 80years or older after a femoral neck fracture. MATERIAL AND METHOD: Retrospective study of cases and controls. Consecutive patients operated between 2015 and 2016 were included. Baseline characteristics, medical history and previous medication, analytical parameters, Charlson index, ASA scale, Barthel index and Pfeiffer questionnaire were studied. Surgical data and complications were recorded during follow-up. Survival was assessed by the Kaplan-Meier method and the variables that affected it by Cox regression. RESULTS: Mortality one year postoperatively was 21.1% and mean survival 10.3months (95%CI: 9.7-10.9). The Cox regression showed that age >87years, Barthel score ≤85 and the combination of anticoagulants with INR ≥1.5 were significant predictors of mortality during the first year of follow-up. CONCLUSION: The predictors of mortality during the first postoperative year after femoral neck fracture in octogenarian or older patients were: age>87years, physical dependence measured by a Barthel index score ≤85, and the use of anticoagulants with a INR ≥1.5 at admission.

Lack of correlation between left ventricular outflow tract velocity time integral and stroke volume index in mechanically ventilated patients.

OBJECTIVE: To assess the correlation between left ventricular outflow tract velocity time integral (LVOT VTI) and stroke volume index (SVI) calculated by thermodilution methods in ventilated critically ill patients. DESIGN: A prospective, descriptive, multicenter study was performed. SETTING: Five intensive care units from university hospitals. PATIENTS: Patients older than 17 years needing mechanical ventilation and invasive hemodynamic monitoring were included. INTERVENTIONS: LVOT VTI was measured by pulsatile Doppler echocardiography. Calculations of SVI were performed through a floating pulmonary artery catheter (PAC) or a Pulse index Contour Cardiac Output (PiCCO®) thermodilution methods. MAIN VARIABLES: The relation between LVOT VTI and SVI was tested by linear regression analysis. RESULTS: One hundred and fifty-six paired measurements were compared. Mean LVOT VTI was 20.83±4.86cm and mean SVI was 41.55±9.55mL/m2. Pearson correlation index for these variables was r=0.644, p<0.001; ICC was 0.52 (CI 95% 0.4-0.63). When maximum LVOT VTI was correlated with SVI, Pearson correlation index was r=0.62, p<0.001. Correlation worsened for extreme values, especially for those with higher LVOT VTI. CONCLUSIONS: LVOT VTI could be a complementary hemodynamic evaluation in selected patients, but does not eliminate the need for invasive monitoring at the present time. The weak correlation between LVOT VTI and invasive monitoring deserves additional assessment to identify the factors affecting this disagreement.

Primary total hip arthroplasty with fourth-generation ceramic bearings: Clinical and survival results with a minimum follow-up of 5 years. / Prótesis total de cadera primaria con par de fricción cerámica sobre cerámica de cuarta generación: resultados clínicos y de supervivencia con un seguimiento mínimo de 5 años.

OBJECTIVE: To evaluate the clinical results and survival of primary hip prosthesis with ceramic delta bearings (C-C) with a minimum follow-up of 5years. MATERIAL AND METHOD: A total of 205 primary hip arthroplasties performed between 2008 and 2012 were studied. The clinical results, pre-surgical and at 5years of follow-up were evaluated using the Harris Hip Score (HHS), the Short Form-36 (SF-36), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the visual analogue scale (VAS). The position of the prosthetic components, periprosthetic osteolysis, loosening of the prosthetic components and ruptures of the ceramic components were studied radiologically. The adverse events related to bearings were recorded according to their diameter, paying special attention to prosthetic dislocations and the presence of noise. Survival with an endpoint of prosthetic revision for any cause was estimated using the Kaplan-Meier method. RESULTS: Significant improvements were obtained in the HHS (88.7% of good/excellent results), SF36, WOMAC and EVA, P<.001. There were 19 adverse events related to the prosthesis (4 periprosthetic fractures, 4 dislocations, 2 superficial infections, 1 mobilization of the cup, 2 noises, 4 aseptic loosenings and 2 breaks of the prosthetic neck); 47.3% needed revision. The cumulative survival of the prostheses was 97.5% (95%CI: 96.4-98.5). No differences were found in survival, prosthetic adverse events, noise incidence or dislocations and clinical results among the different diameters used. CONCLUSIONS: Primary hip prostheses with fourth-generation ceramic bearings showed good survival in the medium term, and good clinical results.