{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T22:11:25Z","timestamp":1775513485466,"version":"3.50.1"},"reference-count":42,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,3,17]],"date-time":"2021-03-17T00:00:00Z","timestamp":1615939200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,3,17]],"date-time":"2021-03-17T00:00:00Z","timestamp":1615939200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Orthop Traumatol"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Total hip arthroplasty (THA) in patients with Paget\u2019s disease can be associated with technical difficulties related to deformities and altered mechanical bone properties, and hypervascularity leads to significative intra-operative bleeding. The purpose of this registry and single-institution study was to investigate overall survival and causes of failure of THA in pagetic patients, together with an analysis of the clinical and radiological complications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>Registry-based survival and complication analysis, type of fixation, intra- and post-operative complications, clinical (pharmacological history, blood transfusions, Harris hip score [HHS]) and radiographic (cup orientation, stem axial alignment, osteolysis around the cup and the stem and heterotopic ossification [HO]) data were reviewed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, 66 patients (27 males and 39 females, mean age at surgery 71.1 years for males and 74.8 years for female) from the registry study presented a 10-year survival of 89.5%. In the institutional study, involving 26 patients (14 males and 12 females, 69 years average) and 29 THAs, hip function improved significantly. Average cup orientation was 40.5\u00b0, while varus stem alignment was 13.8%. In total, 52% of hips had heterotopic ossifications. Peri-acetabular osteolysis was in 13.8% of implants and in 45% of hips was found around the stem. Allogenic and autologous blood transfusion rate were 68.2% and 31.8%, respectively, with an average transfusion of 2 units of blood (range 1\u20136 units). HHS improved by an average of 34 points, with excellent result in 64.3% of patients. Two implants failed, one due to traumatic ceramic head fracture 64\u00a0months after surgery, and one due to mobilization of the cup on the second post-operative day.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>THA surgery in Paget\u2019s patients is a safe procedure, and implant survival is only partly affected by bone remodelling and choice of fixation. The post-operative functional outcome is largely similar to that of other patients. Bleeding-related complications are the main complications; a careful pharmacological strategy should be recommended to decrease the risk of transfusions and of HO development.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>Level III<\/jats:p><\/jats:sec>","DOI":"10.1186\/s10195-021-00574-y","type":"journal-article","created":{"date-parts":[[2021,3,17]],"date-time":"2021-03-17T17:03:55Z","timestamp":1616000635000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Clinical and radiological outcomes of total hip arthroplasty in patients affected by Paget\u2019s disease: a combined registry and single-institution retrospective observational study"],"prefix":"10.1186","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0716-4951","authenticated-orcid":false,"given":"Alberto","family":"Di Martino","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Antonietta Rita","family":"Coppola","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Barbara","family":"Bordini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Niccol\u00f2","family":"Stefanini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giuseppe","family":"Geraci","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Federico","family":"Pilla","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"Traina","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cesare","family":"Faldini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,3,17]]},"reference":[{"key":"574_CR1","doi-asserted-by":"publisher","first-page":"P75","DOI":"10.1359\/jbmr.06s214","volume":"21","author":"J Parvizi","year":"2006","unstructured":"Parvizi J, Klein GR, Sim FH (2006) Surgical management of Paget\u2019s disease of bone. J Bone Miner Res 21:P75\u2013P82. https:\/\/doi.org\/10.1359\/jbmr.06s214","journal-title":"J Bone Miner Res"},{"issue":"483","key":"574_CR2","doi-asserted-by":"publisher","first-page":"500","DOI":"10.1007\/s00223-019-00522-3","volume":"104","author":"L Gennari","year":"2019","unstructured":"Gennari L, Rendina D, Falchetti A, Merlotti D (2019) Paget\u2019s disease of bone. Calcif Tissue Int 104(483):500. https:\/\/doi.org\/10.1007\/s00223-019-00522-3","journal-title":"Calcif Tissue Int"},{"key":"574_CR3","doi-asserted-by":"publisher","first-page":"485","DOI":"10.1080\/21678707.2018.1500691","volume":"6","author":"L Gennari","year":"2018","unstructured":"Gennari L, Rendina D, Picchioni T et al (2018) Paget\u2019s disease of bone: an update on epidemiology, pathogenesis and pharmacotherapy. Expert Opin Orphan Drugs 6:485\u2013496. https:\/\/doi.org\/10.1080\/21678707.2018.1500691","journal-title":"Expert Opin Orphan Drugs"},{"key":"574_CR4","doi-asserted-by":"publisher","first-page":"13S","DOI":"10.1016\/S8756-3282(99)00028-9","volume":"24","author":"J Monfort","year":"1999","unstructured":"Monfort J, Rot\u0301esSala D, Romero AB et al (1999) Epidemiological, clinical, biochemical, and imaging characteristics of monostotic and polyostotic Paget\u2019s disease. Bone 24:13S-14S. https:\/\/doi.org\/10.1016\/S8756-3282(99)00028-9","journal-title":"Bone"},{"key":"574_CR5","doi-asserted-by":"publisher","first-page":"1095","DOI":"10.1002\/art.1780231005","volume":"23","author":"PJ Meunier","year":"1980","unstructured":"Meunier PJ, Coindre JM, Edouard CM, Arlot ME (1980) Bone histomorphometry in Paget\u2019s disease. Quantitative and dynamic analysis of pagetic and nonpagetic bone tissue. Arthritis Rheum 23:1095\u20131103. https:\/\/doi.org\/10.1002\/art.1780231005","journal-title":"Arthritis Rheum"},{"key":"574_CR6","doi-asserted-by":"publisher","first-page":"357","DOI":"10.5312\/wjo.v8.i4.357","volume":"8","author":"SA Hanna","year":"2017","unstructured":"Hanna SA, Dawson-Bowling S, Millington S et al (2017) Total hip arthroplasty in patients with Paget\u2019s disease of bone: a systematic review. World J Orthop 8:357\u2013363. https:\/\/doi.org\/10.5312\/wjo.v8.i4.357","journal-title":"World J Orthop"},{"key":"574_CR7","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1097\/00003086-198704000-00012","volume":"217","author":"B Maldague","year":"1987","unstructured":"Maldague B, Malghem J (1987) Dynamic radiologic patterns of Paget\u2019s disease of bone. Clin Orthop Relat Res 217:126\u2013151","journal-title":"Clin Orthop Relat Res"},{"key":"574_CR8","doi-asserted-by":"publisher","first-page":"225","DOI":"10.2147\/DDDT.S11306","volume":"5","author":"L Michou","year":"2011","unstructured":"Michou L, Brown JP (2011) Emerging strategies and therapies for treatment of Paget\u2019s disease of bone. Drug Des Devel Ther 5:225\u2013239. https:\/\/doi.org\/10.2147\/DDDT.S11306","journal-title":"Drug Des Devel Ther"},{"key":"574_CR9","doi-asserted-by":"publisher","first-page":"6727","DOI":"10.4081\/gc.2017.6727","volume":"3","author":"L Palleschi","year":"2017","unstructured":"Palleschi L, Nunziata E (2017) Severe congestive heart failure in elderly patient with Paget\u2019s disease. Geriatr Care 3:6727. https:\/\/doi.org\/10.4081\/gc.2017.6727","journal-title":"Geriatr Care"},{"key":"574_CR10","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1016\/0221-8747(81)90041-2","volume":"3","author":"RGG Russell","year":"1981","unstructured":"Russell RGG, Beard DJ, Cameron EC et al (1981) Biochemical markers of bone turnover in Paget\u2019s disease. Metab Bone Dis Relat Res 3:255\u2013262. https:\/\/doi.org\/10.1016\/0221-8747(81)90041-2","journal-title":"Metab Bone Dis Relat Res"},{"key":"574_CR11","doi-asserted-by":"publisher","first-page":"1875","DOI":"10.1007\/s00198-015-3095-0","volume":"26","author":"AA Al Nofal","year":"2015","unstructured":"Al Nofal AA, Altayar O, BenKhadra K et al (2015) Bone turnover markers in Paget\u2019s disease of the bone: a systematic review and meta-analysis. Osteoporos Int 26:1875\u20131891. https:\/\/doi.org\/10.1007\/s00198-015-3095-0","journal-title":"Osteoporos Int"},{"key":"574_CR12","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-199912000-00025","author":"DG Lewallen","year":"1999","unstructured":"Lewallen DG (1999) Hip arthroplasty in patients with Paget\u2019s disease. Clin Orthop Relat Res. https:\/\/doi.org\/10.1097\/00003086-199912000-00025","journal-title":"Clin Orthop Relat Res"},{"key":"574_CR13","doi-asserted-by":"publisher","first-page":"577","DOI":"10.5435\/00124635-200611000-00012","volume":"14","author":"GR Klein","year":"2006","unstructured":"Klein GR, Parvizi J (2006) Surgical manifestations of Paget\u2019s disease. J Am Acad Orthop Surg 14:577\u2013586. https:\/\/doi.org\/10.5435\/00124635-200611000-00012","journal-title":"J Am Acad Orthop Surg"},{"key":"574_CR14","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1016\/s0889-8529(18)30343-8","volume":"19","author":"RL Merkow","year":"1990","unstructured":"Merkow RL, Lane JM (1990) Special Article. Endocrinol Metab Clin North Am 19:175\u2013204. https:\/\/doi.org\/10.1016\/s0889-8529(18)30343-8","journal-title":"Endocrinol Metab Clin North Am"},{"key":"574_CR15","doi-asserted-by":"publisher","first-page":"087","DOI":"10.1055\/s-0037-1603629","volume":"01","author":"E Hurley","year":"2017","unstructured":"Hurley E, Cashman J, Synnott K et al (2017) Cemented versus cementless total hip arthroplasty in Paget\u2019s disease of bone: a systematic review. J Hip Surg 01:087\u2013092. https:\/\/doi.org\/10.1055\/s-0037-1603629","journal-title":"J Hip Surg"},{"key":"574_CR16","doi-asserted-by":"publisher","first-page":"335","DOI":"10.1016\/j.surge.2019.12.002","volume":"18","author":"S Roberts","year":"2020","unstructured":"Roberts S, Makaram N, Woods L et al (2020) Long-term outcomes following total hip and total knee arthroplasty in patients with Paget\u2019s disease of bone (PDB)\u2014a national study. Elsevier 18:335\u2013343. https:\/\/doi.org\/10.1016\/j.surge.2019.12.002","journal-title":"Elsevier"},{"key":"574_CR17","unstructured":"R.I.P.O. (2018) Report of R.I.P.O. Regional register of orthopaedic prosthetic implantology overall data hip, knee and shoulder arthroplasty in Emilia-Romagna region (Italy). 106"},{"key":"574_CR18","unstructured":"WHO (2011) Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Vitamin and Mineral Nutrition Information System. Geneva, World Health Organization (WHO\/NMH\/NHD\/MNM\/11.1). http:\/\/www.who.int\/vmnis\/indicators\/haemoglobin.pdf"},{"key":"574_CR19","doi-asserted-by":"publisher","first-page":"715","DOI":"10.1054\/arth.2001.24442","volume":"16","author":"CS Ranawat","year":"2001","unstructured":"Ranawat CS, Rao RR, Rodriguez JA, Bhende HS (2001) Correction of limb-length inequality during total hip arthroplasty. J Arthroplast 16:715\u2013720. https:\/\/doi.org\/10.1054\/arth.2001.24442","journal-title":"J Arthroplast"},{"key":"574_CR20","doi-asserted-by":"publisher","first-page":"2154","DOI":"10.1007\/s11999-014-4076-x","volume":"473","author":"KT Hug","year":"2015","unstructured":"Hug KT, Alton TB, Gee AO (2015) In brief: classifications in brief: Brooker classification of heterotopic ossification after total hip arthroplasty. Clin Orthop Relat Res 473:2154\u20132157. https:\/\/doi.org\/10.1007\/s11999-014-4076-x","journal-title":"Clin Orthop Relat Res"},{"key":"574_CR21","doi-asserted-by":"publisher","first-page":"357","DOI":"10.1080\/02841858809171914","volume":"29","author":"K Herrlin","year":"1988","unstructured":"Herrlin K, Pettersson H, Selvik G (1988) Comparison of two- and three-dimensional methods for assessment of orientation of the total hip prosthesis. Acta Radiol 29:357\u2013361. https:\/\/doi.org\/10.1080\/02841858809171914","journal-title":"Acta Radiol"},{"issue":"2","key":"574_CR22","doi-asserted-by":"publisher","first-page":"217","DOI":"10.2106\/00004623-197860020-00014","volume":"60","author":"GE Lewinnek","year":"1978","unstructured":"Lewinnek GE, Lewis JL, Tarr R et al (1978) Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg Am 60(2):217\u2013220","journal-title":"J Bone Joint Surg Am"},{"key":"574_CR23","doi-asserted-by":"publisher","first-page":"198","DOI":"10.5301\/hipint.5000451","volume":"27","author":"C Faldini","year":"2017","unstructured":"Faldini C, De Fine M, Di Martino A et al (2017) Outcomes of total hip replacement in limbs affected by poliomyelitis. Hip Int 27:198\u2013204. https:\/\/doi.org\/10.5301\/hipint.5000451","journal-title":"Hip Int"},{"key":"574_CR24","doi-asserted-by":"publisher","DOI":"10.1007\/978-1-4471-5451-8_9","author":"JG DeLee","year":"1976","unstructured":"DeLee JG, Charnley J (1976) Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res. https:\/\/doi.org\/10.1007\/978-1-4471-5451-8_9","journal-title":"Clin Orthop Relat Res"},{"issue":"2","key":"574_CR25","doi-asserted-by":"publisher","first-page":"177","DOI":"10.2106\/00004623-199702000-00003","volume":"79","author":"CA Engh Jr","year":"1997","unstructured":"Engh CA Jr, Culpepper WJ, Engh CA (1997) Long-term results of use of the anatomic medullary locking prosthesis in total hip arthroplasty. JBJS 79(2):177\u2013184","journal-title":"JBJS"},{"key":"574_CR26","first-page":"17","volume":"141","author":"TA Gruen","year":"1979","unstructured":"Gruen TA, McNeice GM, Amstutz HC (1979) \u201cModes of failure\u201d of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res 141:17\u201327","journal-title":"Clin Orthop Relat Res"},{"key":"574_CR27","doi-asserted-by":"publisher","first-page":"1063","DOI":"10.1016\/j.arth.2013.10.015","volume":"29","author":"AM Imbuldeniya","year":"2014","unstructured":"Imbuldeniya AM, Tai SM, Aboelmagd T et al (2014) Cementless hip arthroplasty in Paget\u2019s disease at long-term follow-up (average of 12.3 years). J Arthroplast 29:1063\u20131066. https:\/\/doi.org\/10.1016\/j.arth.2013.10.015","journal-title":"J Arthroplast"},{"key":"574_CR28","doi-asserted-by":"publisher","DOI":"10.1177\/1120700020920178","author":"ME Tibbo","year":"2020","unstructured":"Tibbo ME, Brown TS, Hanssen AD et al (2020) Primary and revision total hip arthroplasty with uncemented acetabular components in patients with Paget\u2019s disease. HIP Int. https:\/\/doi.org\/10.1177\/1120700020920178","journal-title":"HIP Int"},{"issue":"5","key":"574_CR29","doi-asserted-by":"publisher","first-page":"752","DOI":"10.2106\/00004623-198466050-00015","volume":"66","author":"RL Merkow","year":"1984","unstructured":"Merkow RL, Pellicci P, Hely D et al (1984) Total hip replacement for Paget\u2019s disease of the hip. JBJS. 66(5):752\u2013758","journal-title":"JBJS."},{"issue":"5","key":"574_CR30","doi-asserted-by":"publisher","first-page":"766","DOI":"10.2106\/00004623-198769050-00020","volume":"69","author":"DJ McDonald","year":"1987","unstructured":"McDonald DJ, Sim F (1987) Total hip arthroplasty in Paget\u2019s disease. A follow-up note. JBJS 69(5):766\u2013772","journal-title":"JBJS"},{"key":"574_CR31","doi-asserted-by":"publisher","first-page":"692","DOI":"10.1016\/j.arth.2006.09.010","volume":"22","author":"PJ Lusty","year":"2007","unstructured":"Lusty PJ, Walter WL, Walter WK, Zicat B (2007) Cementless hip arthroplasty in Paget\u2019s disease at medium-term follow-up (average of 6.7 years). J Arthroplast 22:692\u2013696. https:\/\/doi.org\/10.1016\/j.arth.2006.09.010","journal-title":"J Arthroplast"},{"key":"574_CR32","doi-asserted-by":"publisher","first-page":"1103","DOI":"10.1007\/s00264-009-0853-7","volume":"34","author":"J Wegrzyn","year":"2010","unstructured":"Wegrzyn J, Pibarot V, Chapurlat R et al (2010) Cementless total hip arthroplasty in Paget\u2019s disease of bone: a retrospective review. Int Orthop 34:1103\u20131109. https:\/\/doi.org\/10.1007\/s00264-009-0853-7","journal-title":"Int Orthop"},{"key":"574_CR33","doi-asserted-by":"publisher","DOI":"10.1155\/2013\/157247","author":"F Traina","year":"2013","unstructured":"Traina F, De Fine M, Di Martino A, Faldini C (2013) Fracture of ceramic bearing surfaces following total hip replacement: a systematic review. Biomed Res Int. https:\/\/doi.org\/10.1155\/2013\/157247","journal-title":"Biomed Res Int"},{"key":"574_CR34","doi-asserted-by":"publisher","first-page":"724","DOI":"10.1016\/j.arth.2016.09.026","volume":"32","author":"NA Bedard","year":"2017","unstructured":"Bedard NA, Pugely AJ, Lux NR et al (2017) Recent trends in blood utilization after primary hip and knee arthroplasty. J Arthroplast 32:724\u2013727. https:\/\/doi.org\/10.1016\/j.arth.2016.09.026","journal-title":"J Arthroplast"},{"key":"574_CR35","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-319-64177-5","volume-title":"The adult hip-master case series and techniques","author":"E Tsiridis","year":"2018","unstructured":"Tsiridis E (2018) The adult hip-master case series and techniques. Springer International Publishing, Cham. https:\/\/doi.org\/10.1007\/978-3-319-64177-5"},{"key":"574_CR36","doi-asserted-by":"publisher","first-page":"526","DOI":"10.1007\/s11999-008-0532-9","volume":"467","author":"TJ Blokhuis","year":"2009","unstructured":"Blokhuis TJ, Fr\u00f6lke JPM (2009) Is radiation superior to indomethacin to prevent heterotopic ossification in acetabular fractures?: a systematic review. Clin Orthop Relat Res 467:526\u2013530. https:\/\/doi.org\/10.1007\/s11999-008-0532-9","journal-title":"Clin Orthop Relat Res"},{"key":"574_CR37","doi-asserted-by":"publisher","first-page":"434","DOI":"10.1302\/0301-620X.89B4.18845","volume":"89","author":"TN Board","year":"2007","unstructured":"Board TN, Karva A, Board RE et al (2007) The prophylaxis and treatment of heterotopic ossification following lower limb arthroplasty. JBJS Ser B 89:434\u2013440. https:\/\/doi.org\/10.1302\/0301-620X.89B4.18845","journal-title":"JBJS Ser B"},{"key":"574_CR38","doi-asserted-by":"publisher","first-page":"1078","DOI":"10.1016\/j.bone.2004.01.027","volume":"34","author":"DJP Ferguson","year":"2004","unstructured":"Ferguson DJP, Itonaga I, Maki M et al (2004) Heterotopic bone formation following hip arthroplasty in Paget\u2019s disease. Bone 34:1078\u20131083. https:\/\/doi.org\/10.1016\/j.bone.2004.01.027","journal-title":"Bone"},{"key":"574_CR39","doi-asserted-by":"publisher","DOI":"10.1186\/1749-799X-4-12","author":"EO Baird","year":"2009","unstructured":"Baird EO, Kang QK (2009) Prophylaxis of heterotopic ossification\u2014an updated review. J Orthop Surg Res. https:\/\/doi.org\/10.1186\/1749-799X-4-12","journal-title":"J Orthop Surg Res"},{"key":"574_CR40","doi-asserted-by":"publisher","first-page":"519","DOI":"10.1136\/bmj.38925.471146.4F","volume":"333","author":"M Fransen","year":"2006","unstructured":"Fransen M, Anderson C, Douglas J et al (2006) Safety and efficacy of routine postoperative ibuprofen for pain and disability related to ectopic bone formation after hip replacement surgery (HIPAID): randomised controlled trial. Br Med J 333:519\u2013521. https:\/\/doi.org\/10.1136\/bmj.38925.471146.4F","journal-title":"Br Med J"},{"key":"574_CR41","doi-asserted-by":"publisher","DOI":"10.1155\/2019\/3860142","author":"P \u0141\u0229gosz","year":"2019","unstructured":"\u0141\u0229gosz P, Otworowski M, Sibilska A et al (2019) Heterotopic ossification: a challenging complication of total hip arthroplasty: risk factors, diagnosis, prophylaxis, and treatment. Biomed Res Int. https:\/\/doi.org\/10.1155\/2019\/3860142","journal-title":"Biomed Res Int"},{"key":"574_CR42","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-200210000-00020","author":"J Parvizi","year":"2002","unstructured":"Parvizi J, Schall DM, Lewallen DG, Sim FH (2002) Outcome of uncemented hip arthroplasty components in patients with Paget\u2019s disease. Clin Orthop Relat Res. https:\/\/doi.org\/10.1097\/00003086-200210000-00020","journal-title":"Clin Orthop Relat Res"}],"container-title":["Journal of Orthopaedics and Traumatology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s10195-021-00574-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s10195-021-00574-y\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s10195-021-00574-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,21]],"date-time":"2022-12-21T20:04:25Z","timestamp":1671653065000},"score":1,"resource":{"primary":{"URL":"https:\/\/jorthoptraumatol.springeropen.com\/articles\/10.1186\/s10195-021-00574-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,17]]},"references-count":42,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["574"],"URL":"https:\/\/doi.org\/10.1186\/s10195-021-00574-y","relation":{},"ISSN":["1590-9921","1590-9999"],"issn-type":[{"value":"1590-9921","type":"print"},{"value":"1590-9999","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,17]]},"assertion":[{"value":"20 August 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 February 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 March 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The Central Emilia Wide Area Ethical Committee of the Emilia-Romagna Region (CE-AVEC) approved the study (Study HA-PAGET, protocol 0003593, 5 March 2020).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Each patient at the time of hospitalization at our institution signed a consent form for data publication. However, data are anonymized.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"13"}}