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Physiological Offset Parameters of the Adult Shoulder Joint-A MRI Study of 800 Patients. Diagnostics (Basel) 2022; 12:diagnostics12102507. [PMID: 36292196 PMCID: PMC9600260 DOI: 10.3390/diagnostics12102507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/10/2022] [Accepted: 10/12/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Humeral offset (HO) and glenoidal offset (GO) are important morphological parameters in diagnostics and therapy for shoulder pathologies. However, physiological reference values have not yet been sufficiently determined. The aim of the present study was to establish physiological reference values for shoulder offset parameters (SOPs). Methods: MRI images of the shoulder joints of 800 patients (mean age: 50.13 years [±16.01]) were analysed retrospectively. HO, GO, lateral glenoidal humeral offset (LGHO), humeral shaft axis offset (HAO) and cortical offset (CO) were measured. SOPs were examined for associations with age, gender, side and osteoarthritis. Results: The mean HO was 26.19 (±2.70), the mean GO was 61.79 (±5.67), the mean LGHO was 54.49 (±4.69), the mean HAO was 28.17 (±2.82) and the mean CO was 16.70 (±3.08). For all SOPs, significantly higher values were measured in male shoulders. There was a significantly (p < 0.001) higher mean value for HO, GO and LGHO in right shoulders. There was a significant correlation between age and LGHO, and HAO and CO, but not between age and HO or GO. Shoulders with osteoarthritis and non-osteoarthritis did not differ in the mean value of HO, GO, LGHO and HAO, except for CO (p = 0.049). Conclusion: Reference values for SOPs in the adult shoulder joint were determined for the first time. Significant gender-specific differences were found for all measured SOPs. In addition, it was seen that for some SOPs, the joint side and the patient’s age has to be taken into account in shoulder diagnostics and surgery.
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Robertson DD, Sharma GB, McMahon PJ, Karas SG. Glenoid Version Assessment When the CT Field of View Does Not Permit the Friedman Method: The Robertson Method. Orthop J Sports Med 2022; 10:23259671221083589. [PMID: 35571972 PMCID: PMC9096205 DOI: 10.1177/23259671221083589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 12/23/2021] [Indexed: 11/20/2022] Open
Abstract
Background: To improve spatial resolution, current clinical shoulder cross-sectional imaging studies reduce the field of view of the shoulder, excluding the medial scapula border and preventing glenoid version measurement according to the Friedman method. Purpose: To evaluate a method to accurately and reliably measure glenoid version on cross-sectional shoulder images when the medial scapula border is not included in the field of view, and to establish measurements equivalent to the Friedman method. Study Design: Controlled laboratory study. Methods: Sixty-five scapulae underwent computed tomography (CT) scanning with an optimal shoulder CT-positioning protocol. Glenoid version was measured on CT images of the full scapula using the Friedman method. We developed a measurement method (named the Robertson method) based on the glenoid vault version from partial scapula images, with a correction angle subtracted from the articular-surface-glenoid vault measurement. Comparison with the Friedman method defined the accuracy of the Robertson method. Three observers tested inter- and intraobserver reliability of the Robertson method. Accuracy was statistically evaluated with t tests and reliability with the intraclass correlation coefficient (ICC). Results: The statistical distribution of glenoid version was similar to published data,–0.5° ± 3° [mean ± SD]. The initial measurement using the Robertson method resulted in a more retroverted angle compared with the Friedman method, and a correction angle of 7° was then applied. After this adjustment, the difference between the 2 methods was nonsignificant (0.1° ± 4°; P > .65). Reliability of the Robertson method was excellent, as the interrater ICC was 0.77, the standard error of measurement (SEM) was 1.1° with P < .001. The intrarater ICC ranged between 0.84 and 0.92, the SEM ranged between 0.9° and 1.2° with P < .01. Conclusion: A validated glenoid version measurement method is now available for current clinical shoulder CT protocols that reliably create Friedman-equivalent values. Clinical Relevance: Friedman-equivalent values may be made from common clinical CTs of the shoulder and compared with prior and future Friedman measurements of the scapula.
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Affiliation(s)
- Douglas D. Robertson
- Author deceased
- Emory Orthopaedics and Spine Center, Atlanta, Georgia, USA
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA
| | - Gulshan B. Sharma
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Patrick J. McMahon
- VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
- Department of Orthopedic Surgery and Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Spero G. Karas
- Emory Orthopaedics and Spine Center, Atlanta, Georgia, USA
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA
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Exploring Alternative Sites for Glenoid Component Fixation Through Three-Dimensional Digitization of the Glenoid Vault: An Anatomic Analysis. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2020; 4:e20.00199-9. [PMID: 33278183 PMCID: PMC7714053 DOI: 10.5435/jaaosglobal-d-20-00199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Glenoid component loosening has remained one of the most common complications for total shoulder arthroplasty. Three-dimensional modeling of the glenoid may reveal novel information regarding glenoid vault morphology, providing a foundation for implant designs that possess the potential to extend the survivorship of the prosthesis.
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Jung HJ, Nam TS, Park D, Jeon IH. Three-Dimensional Morphometric Analysis of Penetrative Depth and Size of Nonarthritic and Degenerative Arthritic Glenoids: Implications for Glenoid Replacement in Shoulder Arthroplasty. Clin Orthop Surg 2020; 12:224-231. [PMID: 32489545 PMCID: PMC7237260 DOI: 10.4055/cios19088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 07/25/2019] [Indexed: 11/15/2022] Open
Abstract
Background Shoulder arthroplasty is technically demanding and relies heavily on the precision of surgical techniques. Proper glenoid component sizing plays a crucial role in successful shoulder arthroplasty. We measured the size and penetrative depth of the glenoid for peg or screw fixation in nonarthritic and degenerative arthritic shoulders by using three-dimensional computed tomography to determine the reference dimensions of the glenoid in nonarthritic and degenerative arthritic shoulders. Methods From January 2010 to January 2011, data on two groups of patients were collected and reviewed. Group 1 comprised 38 patients who underwent surgical treatment due to fracture of the proximal humerus and who had no evidence of a pathological glenoid. Group 2 comprised 14 patients who underwent surgical treatment due to osteoarthritis of the glenohumeral joint. The height (maximal superoinferior diameter) of the glenoid was measured, and the width (anteroposterior [AP] diameter) of the glenoid was measured at five different levels (H1–H5). Axial images were taken at H1–H5 levels, the AP glenoid diameter of each was divided into eight areas, and division points were labeled as W1–W7. The penetrative depths between the near cortex and far cortex of the glenoid (thickness) at each point (W1–W7) were measured. Results The overall mean glenoid height was 37.67 ± 4.09 mm in nonarthritic glenoids and 39.42 ± 3.54 mm in degenerative arthritic glenoids. The nonarthritic glenoid was significantly thicker than the degenerative arthritic glenoid at the H1W3, H1W4, H1W5, H2W7, H3W1, H3W6, H3W7, H4W5, H4W6, H4W7, H5W4, H5W5, H5W6, and H5W7 points. The posteroinferior quadrant had the smallest penetrative depth in both nonarthritic and degenerative arthritic glenoids. Also, the degenerative arthritic glenoids were significantly thinner than the nonarthritic glenoids along the posterior and inferior parts of the glenoid. Conclusions The posterior and inferior parts of the degenerative arthritic glenoid appears thinner than the nonarthritic glenoid. Thus, caution has to be taken when drilling the screw hole or inserting screws into the posteroinferior parts, where the glenoid is thinner than 15 mm on average, to avoid penetration of the far cortex.
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Affiliation(s)
- Hong Jun Jung
- Department of Orthopedic Surgery, Sahmyook Medical Center, Seoul, Korea
| | - Tae-Seok Nam
- Department of Orthopedic Surgery, Sahmyook Medical Center, Seoul, Korea
| | - Daewon Park
- Department of Orthopedic Surgery, Sahmyook Medical Center, Seoul, Korea
| | - In-Ho Jeon
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Kramer A, Allon R, Werner F, Lavi I, Wolf A, Wollstein R. Distinct Wrist Patterns Founded on Measurements in Plain Radiographs. J Wrist Surg 2018; 7:366-374. [PMID: 30349748 PMCID: PMC6196083 DOI: 10.1055/s-0038-1660811] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 05/10/2018] [Indexed: 10/28/2022]
Abstract
Background In joints, structure dictates function and consequently pathology. Interpreting wrist structure is complicated by the existence of multiple joints and variability in bone shapes and anatomical patterns in the wrist. Previous studies evaluated lunate and capitate shape in the midcarpal joint, and two distinct patterns have been identified. Purpose Our purpose was to further characterize the two wrist patterns in normal wrist radiographs using measurements of joint contact and position. Our hypothesis was that we will find significant differences between the two distinct anatomical patterns. Patients and Methods A database of 172 normal adult wrist posteroanterior (PA) radiographs was evaluated for radial inclination, height, length, ulnar variance, volar tilt, radial-styloid-scaphoid distance, and lunate and capitate types. We measured and calculated percent of capitate facet that articulates with the lunate, scapholunate ligament, scaphoid, and trapezoid. These values were compared between the wrist types and whole population. Results Type-1 wrists (lunate type-1 and spherical proximal capitate) were positively associated with a longer facet between capitate and distal lunate ( p = 0.01), capitate and base of middle metacarpal ( p = 0.004), and shorter facet between the capitate and hamate ( p = 0.004). The odds ratio of having a type-1 wrist when the interface between the capitate and lunate measures >8.5 mm is 2.71 (confidence interval [CI] 1.07, 6.87) and when the line between the capitate and the base of middle metacarpal >9.5 mm is 3.5 (CI 1.38, 9.03). Conclusion We characterized the two-wrist patterns using intracarpal measurements. Translating these differences into three-dimensional contact areas may help in the understanding of biomechanical transfer of forces through the wrist. Level of Evidence This is a Level II, diagnostic study.
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Affiliation(s)
- Aviv Kramer
- School of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Raviv Allon
- School of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Frederick Werner
- Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, New York
| | - Idit Lavi
- Department of Community Medicine and Epidemiology, Carmel Medical Center, Haifa, Israel
| | - Alon Wolf
- School of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Ronit Wollstein
- School of Medicine, Technion Israel Institute of Technology, Haifa, Israel
- Department of Orthopedic Surgery, New York University, New York, New York
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Breighner RE, Endo Y, Konin GP, Gulotta LV, Koff MF, Potter HG. Technical Developments: Zero Echo Time Imaging of the Shoulder: Enhanced Osseous Detail by Using MR Imaging. Radiology 2018; 286:960-966. [DOI: 10.1148/radiol.2017170906] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ryan E. Breighner
- From the Department of Radiology and Imaging (R.E.B., Y.E., G.P.K., M.F.K., H.G.P.) and Department of Orthopedic Surgery and Sports Medicine (L.V.G.), Hospital for Special Surgery, 535 E 70th St, New York, NY 10021
| | - Yoshimi Endo
- From the Department of Radiology and Imaging (R.E.B., Y.E., G.P.K., M.F.K., H.G.P.) and Department of Orthopedic Surgery and Sports Medicine (L.V.G.), Hospital for Special Surgery, 535 E 70th St, New York, NY 10021
| | - Gabrielle P. Konin
- From the Department of Radiology and Imaging (R.E.B., Y.E., G.P.K., M.F.K., H.G.P.) and Department of Orthopedic Surgery and Sports Medicine (L.V.G.), Hospital for Special Surgery, 535 E 70th St, New York, NY 10021
| | - Lawrence V. Gulotta
- From the Department of Radiology and Imaging (R.E.B., Y.E., G.P.K., M.F.K., H.G.P.) and Department of Orthopedic Surgery and Sports Medicine (L.V.G.), Hospital for Special Surgery, 535 E 70th St, New York, NY 10021
| | - Matthew F. Koff
- From the Department of Radiology and Imaging (R.E.B., Y.E., G.P.K., M.F.K., H.G.P.) and Department of Orthopedic Surgery and Sports Medicine (L.V.G.), Hospital for Special Surgery, 535 E 70th St, New York, NY 10021
| | - Hollis G. Potter
- From the Department of Radiology and Imaging (R.E.B., Y.E., G.P.K., M.F.K., H.G.P.) and Department of Orthopedic Surgery and Sports Medicine (L.V.G.), Hospital for Special Surgery, 535 E 70th St, New York, NY 10021
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Bryant J, Yi P, Miller L, Peek K, Lee D. Potential Sex Bias Exists in Orthopaedic Basic Science and Translational Research. J Bone Joint Surg Am 2018; 100:124-130. [PMID: 29342062 DOI: 10.2106/jbjs.17.00458] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Potential sex bias has been shown in general surgery basic science and translational research, with unequal representation of male and female specimens. Because basic science research forms the foundation for clinical studies on which patient care is based, it is important that this research equally consider both sexes. The purpose of this study was to determine if potential sex bias exists in the basic science and translational orthopaedic literature. METHODS A systematic review was conducted of all articles published in 2014 in The Journal of Bone & Joint Surgery, Clinical Orthopaedics and Related Research, The Bone & Joint Journal, and the Journal of Orthopaedic Research (JOR). All original research articles utilizing animals, cells, or cadavers were included. The data abstracted included study type, sex of specimen studied, and presence of sex-based reporting of data. A second review was performed of all basic science articles published in JOR in 1994, 2004, and 2014 to compare sex bias trends across 3 decades. Distributions of variables were compared using the Fisher exact test, with significance defined as p < 0.05. RESULTS Of 1,693 articles reviewed, 250 (15%) were included: 122 animal-based studies (49%), 71 cell-based studies (28%), and 57 human cadaver-based studies (23%). Overall, authors in 88 studies (35%) did not report the sex of animals, cells, or cadavers used. Of 162 studies in which the authors did report sex, 69 (43%) utilized male only, 40 (25%) utilized female only, and 53 (33%) utilized both sexes. Of those studies that used both sexes, authors in only 7 studies (13%) reported sex-based results. A subanalysis of JOR articles across 3 decades revealed a significant increase in studies specifying sex (p = 0.01) from 2004 to 2014. CONCLUSIONS Potential sex bias exists in orthopaedic surgery basic science and translational research, with an overrepresentation of male specimens. CLINICAL RELEVANCE Inequality in sex representation must be addressed as basic science and translational research creates the foundation for subsequent clinical research, which ultimately informs clinical care.
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Affiliation(s)
- Jessica Bryant
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California
| | - Paul Yi
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California
| | - Liane Miller
- Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kacy Peek
- Department of Orthopaedic Surgery, University of Washington, Seattle, Washington
| | - Daniel Lee
- Albany Medical College, Albany, New York
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Kramer A, Allon R, Wolf A, Kalimian T, Lavi I, Wollstein R. Anatomical Wrist Patterns on Plain Radiographs. Curr Rheumatol Rev 2017; 15:168-171. [PMID: 28413989 DOI: 10.2174/1573397113666170417124711] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 09/08/2016] [Accepted: 03/26/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Interpreting the structure in the wrist is complicated by the existence of multiple joints as well as variability in bone shapes and anatomical patterns. Previous studies have evaluated lunate and capitate shape in an attempt to understand functional anatomical patterns. OBJECTIVE The purpose of this study was to describe anatomical shapes and wrist patterns in normal wrist radiographs. We hypothesized that there is a significant relationship in the midcarpal joint with at least one consistent pattern of wrist anatomy. METHODS Seventy plain posteroanterior (PA) and lateral wrist radiographs were evaluated. These radiographs were part of a previously established normal database, had all been read by a radiologist as normal, and had undergone further examination by 2 hand surgeons for quality. Evaluation included: lunate and capitate shape (type 1 and 2 lunate shape according to the classification system by Viegas et al.), ulnar variance, radial inclination and height, and volar tilt. RESULTS A significant association was found between lunate and capitate shape using a dichotomal classification system for both lunate and capitate shapes (p=0.003). Type 1 wrists were defined as lunate type1and a spherical distal capitate. Type 2 wrists had a lunate type 2 and a flat distal capitate. No statistically significant associations were detected between these wrist types and measurements of the radiocarpal joint. CONCLUSION There was a significant relationship between the bone shapes within the midcarpal joint. These were not related to radiocarpal anatomical shape. Further study is necessary to better describe the two types of wrist patterns that were defined and to understand their influence on wrist biomechanics and pathology.
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Affiliation(s)
- Aviv Kramer
- Carmel Lady Davis Medical Center, Department of Plastic Surgery, Haifa, Israel
| | - Raviv Allon
- Technion Israel Institute of Technology, Haifa, Israel
| | - Alon Wolf
- Technion Israel Institute of Technology, Haifa, Israel
| | - Tal Kalimian
- Technion Israel Institute of Technology, Haifa, Israel
| | - Idit Lavi
- Department of Community Medicine and Epidemiology, Carmel Medical Center, Haifa, Israel
| | - Ronit Wollstein
- Carmel Lady Davis Medical Center, Department of Plastic Surgery, Haifa, Israel.,Technion Israel Institute of Technology, Haifa, Israel.,Department of Plastic and Reconstructive Surgery, University of Pittsburgh Medical School, Pittsburgh, PA, United States
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Damas CN, Silva J, Sá MC, Torres J. Computed tomography morphological analysis of the scapula and its implications in shoulder arthroplasty. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2015; 26:127-32. [PMID: 26577505 DOI: 10.1007/s00590-015-1721-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 10/25/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Healthy shoulder morphology is still unclear. Since bone morphology influences prosthetic features, this is relevant for glenohumeral joint reconstruction. The objective of this study was to assess the normal values of glenoid version, maximum width, base width and vault depth on computed tomography scans. METHODS Axial cut CT scans of 1072 healthy glenoids were retrospectively reviewed. Values of glenoid version, maximum glenoid width, glenoid base width and glenoid vault depth were measured by two different observers. Differences were determined between genders, and reproducibility and interrater reliability assessed. RESULTS Glenoid version was 37.71° ± 10.75°, range -6.20° to 71.30°; maximum glenoid width was 26.06 ± 3.27 mm, range 15.40-36.90 mm; glenoid base width was 16.59 ± 2.61 mm, range 8.90-25.40 mm; glenoid vault depth was 9.72 ± 1.62 mm, range 4.70-15.90 mm. All measurements except for glenoid version were significantly higher in males than in females. Reproducibility was good for every measurement, except glenoid vault depth. CONCLUSION We found differences in maximum glenoid width, base width and vault depth by gender in a large sample. Glenoid components' maximum width was defined, as was reaming extension and orientation, the space available for implantation of the glenoid component, placement of pegs or keels in anatomic prostheses and the target for glenoid screws in inverted prostheses. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Catarina N Damas
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal. .,Hospital S. João, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal. .,Residência Universitária WORLD, Rua do Monte da Estação, Porta B, 4300-342, Porto, Portugal.
| | - Joana Silva
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal.,Hospital S. João, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Márcia C Sá
- Primary Healthcare Unit "Saúde em Família", Rua de Angola, n.180, 4425-616, Pedrouços, Maia, Portugal
| | - João Torres
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal.,Hospital S. João, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal.,Orthopaedics Department, Centro Hospitalar de S. João, Porto, Portugal
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Frontiers in Medical Device Design: An Approach for Making Arthroplasty Affordable Globally. J Am Acad Orthop Surg 2015; 23:e58-9. [PMID: 26320163 DOI: 10.5435/jaaos-d-15-00350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Indexed: 02/01/2023] Open
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