1
|
Larsen BM, Borgwardt A, Ribel-Madsen S, Zerahn B. False profile view is independently associated with serum metal levels in patients with metal-on-metal hip arthroplasty. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 31:1029-1036. [PMID: 33244659 DOI: 10.1007/s00590-020-02839-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 11/16/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Elevated levels of serum metal ions can be found in some patients with metal-on-metal (MoM) hip replacements. This study seeks to identify whether there is a significant association between the contact patch to rim distance (CPRD) and the anterior center edge angle (ACEA), respectively, and serum cobalt (Co) and chromium (Cr) levels in patients treated with unilateral MoM hip replacements by using standing anteroposterior and false profile view radiographs. METHODS This is a retrospective analysis on 53 patients with either unilateral ReCap or M2a-Magnum MoM hip replacements operated in 2006 or 2007. Univariate linear regression and multivariable linear regression (MLR) analyses were performed using the CPRD and ACEA along with risk factors for elevated serum levels of Co and Cr previously suggested in the literature as explanatory variables. Serum Co and Cr were measured using inductively coupled plasma mass spectrometry. RESULTS The MLR model showed that the same three variables (gender, CPRD and ACEA) were significantly associated with serum levels of both Co and Cr explaining approximately half of the variation. A univariate analysis showed a polynomial association between both anteversion angle and the ACEA with serum levels of Co and Cr. The vertex of the polynomial function was located at approximately 20° and 40°, respectively. CONCLUSION Gender, CPRD and ACEA are independently associated with serum levels of Co and Cr. Both ACEA and anteversion angles have optimae associated with low serum metal levels which may be useful for post-surgery evaluation of cup positioning.
Collapse
Affiliation(s)
- Bo Madvig Larsen
- Department of Orthopaedic Surgery, Bispebjerg and Frederiksberg University Hospital, Nordre Fasanvej 57, 2000, Frederiksberg, Denmark.
| | - Arne Borgwardt
- Department of Orthopaedic Surgery, Bispebjerg and Frederiksberg University Hospital, Nordre Fasanvej 57, 2000, Frederiksberg, Denmark
| | - Søren Ribel-Madsen
- Department of Orthopaedic Surgery, Bispebjerg and Frederiksberg University Hospital, Nordre Fasanvej 57, 2000, Frederiksberg, Denmark
| | - Bo Zerahn
- Department of Clinical Physiology and Nuclear Medicine, Herlev University Hospital, Borgmester Ib Juuls Vej 1, Herlev, 2730, Denmark
| |
Collapse
|
2
|
Zhao JX, Su XY, Zhao Z, Xiao RX, Zhang LC, Tang PF. Radiographic assessment of the cup orientation after total hip arthroplasty: a literature review. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:130. [PMID: 32175423 DOI: 10.21037/atm.2019.12.150] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Optimal acetabular cup orientation is of substantial importance to good long-term function and low complication rates after total hip arthroplasty (THA). The radiographic anteversion (RA) and inclination (RI) angles of the cup are typically studied due to the practicability, simplicity, and ease of interpretation of their measurements. A great number of methods have been developed to date, most of which have been performed on pelvic or hip anteroposterior radiographs. However, there are primarily two influencing factors for these methods: X-ray offset and pelvic rotation. In addition, there are three types of pelvic rotations about the transverse, longitudinal, and anteroposterior axes of the body. Their effects on the RA and RI angles of the cup are interactively correlated with the position and true orientation of the cup. To date, various fitted or analytical models have been established to disclose the correlations between the X-ray offset and pelvic rotation and the RA and RI angles of the cup. Most of these models do not incorporate all the potential influencing parameters. Advanced methods for performing X-ray offset and pelvic rotation corrections are mainly performed on a single pelvic AP radiograph, two synchronized radiographs, or a two-dimensional/three-dimensional (2D-3D) registration system. Some measurement systems, originally developed for evaluating implant migration or wear, could also be used for correcting the X-ray offset and pelvic rotation simultaneously, but some drawbacks still exist with these systems. Above all, the 2D-3D registration technique might be an alternative and powerful tool for accurately measuring cup orientation. In addition to the current methods used for postoperative assessment, navigation systems and augmented reality are also used for the preoperative planning and intraoperative guidance of cup placement. With the continuing development of artificial intelligence and machine learning, these techniques could be incorporated into robot-assisted orthopaedic surgery in the future.
Collapse
Affiliation(s)
- Jing-Xin Zhao
- Department of Orthopaedics, the First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing 100853, China
| | - Xiu-Yun Su
- Department of Orthopaedics, the First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China.,Intelligent and Digital Surgery Innovation Center, Southern University of Science and Technology Hospital, Shenzhen, Guangdong 518055, China
| | - Zhe Zhao
- Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - Ruo-Xiu Xiao
- School of Computer and Communication Engineering, University of Science and Technology Beijing, Beijing 100083, China
| | - Li-Cheng Zhang
- Department of Orthopaedics, the First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing 100853, China
| | - Pei-Fu Tang
- Department of Orthopaedics, the First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing 100853, China
| |
Collapse
|
3
|
Zhao JX, Su XY, Xiao RX, Zhao Z, Zhang LH, Zhang LC, Tang PF. A mathematical method for precisely calculating the radiographic angles of the cup after total hip arthroplasty. Med Eng Phys 2016; 38:1376-1381. [PMID: 27720337 DOI: 10.1016/j.medengphy.2016.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 08/18/2016] [Accepted: 09/23/2016] [Indexed: 11/19/2022]
Abstract
We established a mathematical method to precisely calculate the radiographic anteversion (RA) and radiographic inclination (RI) angles of the acetabular cup based on anterior-posterior (AP) pelvic radiographs after total hip arthroplasty. Using Mathematica software, a mathematical model for an oblique cone was established to simulate how AP pelvic radiographs are obtained and to address the relationship between the two-dimensional and three-dimensional geometry of the opening circle of the cup. In this model, the vertex was the X-ray beam source, and the generatrix was the ellipse in radiographs projected from the opening circle of the acetabular cup. Using this model, we established a series of mathematical formulas to reveal the differences between the true RA and RI cup angles and the measurements results achieved using traditional methods and AP pelvic radiographs and to precisely calculate the RA and RI cup angles based on post-operative AP pelvic radiographs. Statistical analysis indicated that traditional methods should be used with caution if traditional measurements methods are used to calculate the RA and RI cup angles with AP pelvic radiograph. The entire calculation process could be performed by an orthopedic surgeon with mathematical knowledge of basic matrix and vector equations.
Collapse
Affiliation(s)
- Jing-Xin Zhao
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing 100853, People's Republic of China.
| | - Xiu-Yun Su
- Department of Orthopaedics, Affiliated Hospital of the Academy of Military Medical Sciences, No. 8 Dongdajie Road, Beijing 100071, People's Republic of China; Department of Orthopaedics, Chinese PLA General Hospital, Beijing 100853, People's Republic of China.
| | - Ruo-Xiu Xiao
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing 100084, People's Republic of China.
| | - Zhe Zhao
- Department of Orthopaedics, Beijing Tsinghua Chang Gung Hospital, No. 1 Block Tiantongyuan North, Beijing 102218, People's Republic of China; Department of Orthopaedics, Chinese PLA General Hospital, Beijing 100853, People's Republic of China.
| | - Li-Hai Zhang
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing 100853, People's Republic of China.
| | - Li-Cheng Zhang
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing 100853, People's Republic of China.
| | - Pei-Fu Tang
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing 100853, People's Republic of China.
| |
Collapse
|
4
|
Radiographic Assessment of Femoral Stem Torsion in Total Hip Arthroplasty-A Comparison of a Caput-Collum-Diaphyseal Angle-Based Technique With the Budin View. J Arthroplasty 2016; 31:1117-22. [PMID: 26781395 DOI: 10.1016/j.arth.2015.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 10/14/2015] [Accepted: 11/09/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Correct assessment of femoral stem torsion is crucial in total hip arthroplasty (THA). In this study, we aimed to compare a recently published novel method based on anteroposterior (AP) hip radiographs using the projected caput-collum-diaphyseal (CCD) angle (AP CCD) with the modified posteroanterior Budin view. METHOD AP radiographs, modified Budin views, and 3-dimensional computed tomography (3D-CT) images were obtained in 30 patients after minimally invasive, cementless THA. Radiographic measurements performed by 4 observers twice in a 6-week interval were compared with 3D-CT measurements. Furthermore, correlations between the radiographic deviation to 3D-CT and patient specific characteristics were evaluated. RESULTS We found a mean difference of 2.2 ± 6.8° between AP CCD and 3D-CT measurements of femoral stem torsion and -0.5 ± 4.2° between the modified Budin view and 3D-CT. We found a high correlation between mean radiographic and 3D-CT stem torsion (r = 0.78, P < .001 for AP CCD and r = 0.84, P < .001 for Budin view). The observers had excellent agreements within (intraclass correlation coefficient, ≥0.88 for AP CCD and intraclass correlation coefficient, ≥0.94 for Budin view) and between (mean concordance correlation coefficient, ≥0.79 for AP CCD and concordance correlation coefficient, ≥0.86 for Budin view) their radiographic measurements. CONCLUSION Both radiographic methods enable a simple orientation and a practical conventional radiographic estimation of stem torsion on hip radiographs after THA. However, CT remains the golden standard for exact estimation of stem torsion.
Collapse
|
5
|
Treatment of acetabular defects during revision total hip arthroplasty--preliminary clinical and radiological outcome using bone substitute materials. Hip Int 2014; 23:46-53. [PMID: 23397205 DOI: 10.5301/hip.2013.10713] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2012] [Indexed: 02/04/2023]
Abstract
Acetabular defects are a particular challenge during THR revision. Defects may be filled with autologous bone grafts, allografts or synthetic bone substitute materials. In this preliminary, retrospective study, 22 patients were treated with an oval shaped revision cup and a combination of synthetic bone substitute materials, namely hydroxyapatite and beta-tricalcium phosphate. The postoperative outcome was evaluated regarding the functional clinical outcome and quality of life using the Harris hip score, the WOMAC and the SF-36. Signs of loosening and changes of the implant position were evaluated from plain radiographs. Follow up examinations were performed after an average duration of 20.5 months (7-33 months). Postoperatively, we found a significant increase of the Harris hip score, and an increase in both the SF-36 and the WOMAC scores (without statistical significance). No radiographic signs of loosening were evident at the time of follow up. The use of synthetic bone substitute materials offers a possible alternative to the use of autologous and allogenic bone grafts in acetabular revision surgery. Further randomised controlled long-term studies are needed to verify the promising short-term results and to determine potential side effects, such as possible third body wear.
Collapse
|
6
|
Nomura T, Naito M, Nakamura Y, Ida T, Kuroda D, Kobayashi T, Sakamoto T, Seo H. An analysis of the best method for evaluating anteversion of the acetabular component after total hip replacement on plain radiographs. Bone Joint J 2014; 96-B:597-603. [DOI: 10.1302/0301-620x.96b.33013] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Several radiological methods of measuring anteversion of the acetabular component after total hip replacement (THR) have been described. These studies used different definitions and reference planes to compare methods, allowing for misinterpretation of the results. We compared the reliability and accuracy of five current methods using plain radiographs (those of Lewinnek, Widmer, Liaw, Pradhan, and Woo and Morrey) with CT measurements, using the same definition and reference plane. We retrospectively studied the plain radiographs and CT scans in 84 hips of 84 patients who underwent primary THR. Intra- and inter-observer reliability were high for the measurement of inclination and anteversion with all methods on plain radiographs and CT scans. The measurements of inclination on plain radiographs were similar to the measurements using CT (p = 0.043). The mean difference between CT measurements was 0.6° (-5.9° to 6.8°). Measurements using Widmer’s method were the most similar to those using CT (p = 0.088), with a mean difference between CT measurements of -0.9° (-10.4° to 9.1°), whereas the other four methods differed significantly from those using CT (p < 0.001). This study has shown that Widmer’s method is the best for evaluating the anteversion of the acetabular component on plain radiographs. Cite this article: Bone Joint J 2014; 96-B:597–603.
Collapse
Affiliation(s)
- T. Nomura
- Department of Orthopaedic Surgery, Faculty
of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - M. Naito
- Department of Orthopaedic Surgery, Faculty
of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Y. Nakamura
- Department of Orthopaedic Surgery, Faculty
of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - T. Ida
- Department of Orthopaedic Surgery, Faculty
of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - D. Kuroda
- Department of Orthopaedic Surgery, Faculty
of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - T. Kobayashi
- Department of Orthopaedic Surgery, Faculty
of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - T. Sakamoto
- Department of Orthopaedic Surgery, Faculty
of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - H. Seo
- Department of Orthopaedic Surgery, Faculty
of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| |
Collapse
|
7
|
Meermans G, Van Doorn WJ, Koenraadt K, Kats J. The use of the transverse acetabular ligament for determining the orientation of the components in total hip replacement. Bone Joint J 2014; 96-B:312-8. [DOI: 10.1302/0301-620x.96b3.32989] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The orientation of the acetabular component can influence both the short- and long-term outcomes of total hip replacement (THR). We performed a prospective, randomised, controlled trial of two groups, comprising of 40 patients each, in order to compare freehand introduction of the component with introduction using the transverse acetabular ligament (TAL) as a reference for anteversion. Anteversion and inclination were measured on pelvic radiographs. With respect to anteversion, in the freehand group 22.5% of the components were outside the safe zone versus 0% in the transverse acetabular ligament group (p = 0.002). The mean angle of anteversion in the freehand group was 21° (2° to 35°) which was significantly higher compared with 17° (2° to 25°) in the TAL group (p = 0.004). There was a significant difference comparing the variations of both groups (p = 0.008). With respect to inclination, in the freehand group 37.5% of the components were outside the safe zone versus 20% in the TAL group (p = 0.14). There was no significant difference regarding the accuracy or variation of the angle of inclination when comparing the two groups. The transverse acetabular ligament may be used to obtain the appropriate anteversion when introducing the acetabular component during THR, but not acetabular component inclination. Cite this article: Bone Joint J 2014;96-B:312–18.
Collapse
Affiliation(s)
- G. Meermans
- Lievensberg Hospital, Boerhaaveplein
1, 4624 VT Bergen Op Zoom, the
Netherlands
| | | | - K. Koenraadt
- Lievensberg Hospital, Bergen
Op Zoom, the Netherlands
| | - J. Kats
- Lievensberg Hospital, Bergen
Op Zoom, the Netherlands
| |
Collapse
|
8
|
A new method for the measurement of anteversion of the acetabular cup after total hip arthroplasty. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2013; 24:897-903. [PMID: 24253955 DOI: 10.1007/s00590-013-1353-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 10/30/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Many methods of determining the anteversion of the acetabular cup have been described in the literature. The advantages and disadvantages of each of these methods are discussed in this paper. We present a new method of measuring the acetabular anteversion at the anteroposterior hip. MATERIALS AND METHODS The formula designed by the authors was anteversion angle (α) = arc sin |PK|/√ |AK| × |BK|. The formula was tested using the AutoCAD software, and an experimental study was conducted to evaluate the accuracy. Three groups were created, and 16 X-ray images were taken and coded. Ten orthopaedic surgeons measured the acetabular anteversion from these X-rays using our formula. RESULTS The results in Group 1 were closer to the actual value; in contrast, the results in Group 2 differed from the actual values. The results in Group 3 were as close to the actual anteversion values as were those in Group 1. CONCLUSION Developments in technology often bring an increase in complications. Despite newly developed surgical methods and technology, the position of the acetabular cup is still used to determine the results of a total hip arthroplasty. Our method is simple, cost-effective and achieves almost 100 % accuracy.
Collapse
|
9
|
An evaluation of CT-scan to locate the femoral head centre and its implication for hip surgeons. Surg Radiol Anat 2013; 36:259-63. [PMID: 23881154 DOI: 10.1007/s00276-013-1172-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Accepted: 07/09/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The aim of this preliminary study was to determine the accuracy of CT-scan to locate the femoral head centre. METHODS Eleven dried femurs were included for study. Three techniques were compared to determine femoral head centre (FHC) location: CT-scan, Motion Analysis and Faro-Arm. Markers were stuck on each femur to create a system of coordinates. Femurs lied on their posterior parts (bicondylar plane). Several points around the femoral head were palpated (Motion Analysis and Faro-Arm) or determined (Amira software for CT-scans). By a least-square regression method, the FHC location in 3D was defined for each technique. RESULTS The results of the FHC location determined by the CT-scan technique were compared with those measured by the faro-arm and the Motion Analysis techniques. The coordinates (X, Y, Z) of the FHC were compared between the three methods, and no statistical difference was found (p = 0.99). In a 3D plot, this gave a mean difference of 1.3 mm. The mean radius of the femoral head was of 22.5 mm (p = 0.6). CONCLUSIONS CT-scan is as accurate and reliable as gold-standard techniques (motion and faro-arm). Locating FHC before and after hip arthroplasty would allow hip surgeons to determine and compare 3D orientation of the upper-end of femur: offset, height and anteversion.
Collapse
|
10
|
Lazennec JY, Brusson A, Rousseau MA. THA Patients in Standing and Sitting Positions: A Prospective Evaluation Using the Low-Dose “Full-Body” EOS® Imaging System. ACTA ACUST UNITED AC 2012. [DOI: 10.1053/j.sart.2013.01.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
11
|
Kadar T, Furnes O, Aamodt A, Indrekvam K, Havelin LI, Haugan K, Espehaug B, Hallan G. The influence of acetabular inclination angle on the penetration of polyethylene and migration of the acetabular component. ACTA ACUST UNITED AC 2012; 94:302-7. [DOI: 10.1302/0301-620x.94b3.27460] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In this prospective study we studied the effect of the inclination angle of the acetabular component on polyethylene wear and component migration in cemented acetabular sockets using radiostereometric analysis. A total of 120 patients received either a cemented Reflection All-Poly ultra-high-molecular-weight polyethylene or a cemented Reflection All-Poly highly cross-linked polyethylene acetabular component, combined with either cobalt–chrome or Oxinium femoral heads. Femoral head penetration and migration of the acetabular component were assessed with repeated radiostereometric analysis for two years. The inclination angle was measured on a standard post-operative anteroposterior pelvic radiograph. Linear regression analysis was used to determine the relationship between the inclination angle and femoral head penetration and migration of the acetabular component. We found no relationship between the inclination angle and penetration of the femoral head at two years’ follow-up (p = 0.9). Similarly, our data failed to reveal any statistically significant correlation between inclination angle and migration of these cemented acetabular components (p = 0.07 to p = 0.9).
Collapse
Affiliation(s)
- T. Kadar
- Haukeland University Hospital, Department
of Orthopaedic Surgery, Jonas Liesvei 65, Bergen
5021, Norway
| | - O. Furnes
- Haukeland University Hospital, Department
of Orthopaedic Surgery, Jonas Liesvei 65, Bergen
5021, Norway
| | - A. Aamodt
- Trondheim University Hospital, Department
of Orthopaedic Surgery, PostBox 3250 Sluppen, Trondheim
NO-7006, Norway
| | | | - L. I. Havelin
- Haukeland University Hospital, Department
of Orthopaedic Surgery, Jonas Liesvei 65, Bergen
5021, Norway
| | - K. Haugan
- Trondheim University Hospital, Department
of Orthopaedic Surgery, PostBox 3250 Sluppen, Trondheim
NO-7006, Norway
| | - B. Espehaug
- Haukeland University Hospital, Department
of Orthopaedic Surgery, Jonas Liesvei 65, Bergen
5021, Norway
| | - G. Hallan
- Haukeland University Hospital, Department
of Orthopaedic Surgery, Jonas Liesvei 65, Bergen
5021, Norway
| |
Collapse
|