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Puijk R, Puijk RH, Laende EK, Dunbar MJ, Plevier JWM, Nolte PA, Pijls BGCW. 6-month migration sufficient for evaluation of total knee replacements: a systematic review and meta-analysis. Acta Orthop 2023; 94:577-587. [PMID: 38038237 PMCID: PMC10690979 DOI: 10.2340/17453674.2023.24579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 10/22/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND AND PURPOSE This updated meta-analysis evaluates the migration pattern of the tibial component of primary total knee replacements measured with radiostereometric analysis (RSA). We aimed to evaluate whether 6-month maximum total point motion (MTPM) values could be used instead of 1-year MTPM for RSA threshold testing and to present the pooled migration patterns for different implant designs that can be used as a benchmark. PATIENTS AND METHODS The search included all published RSA studies on migration patterns of tibial components until 2023. Study groups were classified according to their prosthesis brand, fixation, and insert (PFI). Sub-analyses were performed to compare the mean tibial component migration patterns of different implant variables, stratified according to fixation. RESULTS 96 studies (43 new studies), including 197 study groups and 4,706 knees, were included. Most migration occurred within the first 6 postoperative months (126 study groups: mean 0.58 mm, 95% confidence interval [CI] 0.50-0.65), followed by minimal migration between 6 and 12 months (197 study groups: mean 0.04 mm, CI 0.03-0.06), irrespective of the fixation method used. Distinct migration patterns were observed among the different fixation methods. No differences were found in migration patterns among cemented components in any of the sub-group analyses conducted. For uncemented implants, trabecular metal surfaced components seemed to migrate less than porous-coated or uncoated components Conclusion: Based on the small difference between MTPM values at 6 months and 1 year, MTPM at 6 months could be used instead of MTPM at 1 year for RSA threshold testing. The pooled migration patterns can be used as benchmark for evaluation of new implants by defining fixation-specific RSA thresholds when combined with implant survival.
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Affiliation(s)
- Raymond Puijk
- Department of Orthopaedics, Spaarne Gasthuis, Hoofddorp, the Netherlands.
| | - Rowan H Puijk
- Department of Orthopaedics, Spaarne Gasthuis, Hoofddorp, the Netherlands
| | - Elise K Laende
- Mechanical and Materials Engineering, Queen's University, Kingston, Ontario, Canada; Division of Orthopaedics, Department of Surgery, Dalhousie University and QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Michael J Dunbar
- Division of Orthopaedics, Department of Surgery, Dalhousie University and QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada; School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada
| | - José W M Plevier
- Walaeus Library, Leiden University Medical Center, Leiden, The Netherlands
| | - Peter A Nolte
- Department of Orthopaedics, Spaarne Gasthuis, Hoofddorp, the Netherlands; Department of Oral Cell Biology, Academic Centre for Dentistry (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Bart G C W Pijls
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
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Koster LA, Kaptein BL, Pijls BG, Nelissen RG. Letter to the Editor: How Large a Study is Needed to Detect TKA Revision Rate Reductions Attributable to Robotic or Navigated Technologies? A Simulation-based Power Analysis. Clin Orthop Relat Res 2022; 480:836-837. [PMID: 35081049 PMCID: PMC8923568 DOI: 10.1097/corr.0000000000002123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 01/10/2022] [Indexed: 01/31/2023]
Affiliation(s)
- Lennard A. Koster
- marked for authors Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
| | - Bart L. Kaptein
- marked for authors Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
| | - Bart G. Pijls
- marked for authors Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
| | - Rob G.H.H. Nelissen
- marked for authors Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
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Hickey MD, Anglin C, Masri B, Hodgson AJ. Reply to the Letter to the Editor: How Large a Study is Needed to Detect TKA Revision Rate Reductions Attributable to Robotic or Navigated Technologies? A Simulation-based Power Analysis. Clin Orthop Relat Res 2022; 480:838. [PMID: 35081071 PMCID: PMC8923595 DOI: 10.1097/corr.0000000000002124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 01/10/2022] [Indexed: 01/31/2023]
Affiliation(s)
- Matthew D. Hickey
- School of Biomedical Engineering, the University of British Columbia, Vancouver, BC, Canada
| | - Carolyn Anglin
- Biomedical Engineering and Civil Engineering, University of Calgary, Calgary, AB, Canada
| | - Bassam Masri
- Department of Orthopaedics, The University of British Columbia, Vancouver, BC, Canada
| | - Antony J. Hodgson
- Department of Mechanical Engineering, The University of British Columbia, Vancouver, BC, Canada
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Gothesen O, Skaden O, Dyrhovden GS, Petursson G, Furnes ON. Computerized Navigation: A Useful Tool in Total Knee Replacement. JBJS Essent Surg Tech 2020; 10:e0022. [PMID: 32944412 PMCID: PMC7478328 DOI: 10.2106/jbjs.st.19.00022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The purpose of computer assistance in a total knee replacement is to achieve optimal alignment, size, and positioning of the implant. The method is safe and accurate and may be particularly useful in cases with abnormal anatomy.
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Affiliation(s)
- Oystein Gothesen
- Hospital for Rheumatic Diseases, Haugesund, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | | | - Gro S Dyrhovden
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Gunnar Petursson
- Lovisenberg Diaconal Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ove N Furnes
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
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Use of National Joint Registries to Evaluate a New Knee Arthroplasty Design. J Arthroplasty 2020; 35:413-416. [PMID: 31629622 DOI: 10.1016/j.arth.2019.09.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 08/24/2019] [Accepted: 09/12/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The introduction of new technology in joint replacement surgery requires close monitoring to identify early successes and failures. This monitoring can be effectively performed through the analysis of registry data and radiostereometric analysis studies. This study examined the revision rates of a contemporary knee system for total knee arthroplasty (TKA) using National Joint Replacement Registries. METHODS A review of the literature was performed to identify comparative studies and registry databases reporting the revision rates of a specific contemporary knee design between 2013 and 2018. The total number of TKA cases performed using this implant was recorded. The latest follow-up or duration of monitoring through a registry database was used to report implant survivorship. RESULTS There were 4 registry databases and 1 comparative study reporting the revision rates of the contemporary knee system. A total of 41,483 cases were identified with a follow-up range of 1.5-5.0 years. The all-cause revision rate ranged from 0.7% to 2.5% at latest follow-up. This was comparable to all-cause revision rates of other knee systems reported in the registries, ranging from 0.8% to 5.6% over similar follow-up periods. CONCLUSIONS Evaluation of data from multiple national joint registries demonstrated the revision rate for this contemporary knee system to be comparable to other TKA systems at latest follow-up. None of the registries have identified any concerning rates of revision compared to other devices at this length of follow-up. National Joint Registries are an important resource in evaluating the short-term, mid-term, and long-term results of new implant designs introduced to the market.
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Does Accelerometer-based Navigation Have Any Clinical Benefit Compared with Conventional TKA? A Systematic Review. Clin Orthop Relat Res 2019; 477:2017-2029. [PMID: 30839317 PMCID: PMC7000086 DOI: 10.1097/corr.0000000000000660] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Accelerometer-based navigation is a handheld navigation tool that was introduced to offer a simpler technique compared with more-cumbersome computer-assisted surgery (CAS). Considering the increasing number of adopters, it seems important to evaluate the potential clinical benefits of this technology compared with conventional TKA. QUESTIONS/PURPOSES In this systematic review, we asked: (1) Is accelerometer-based navigation more accurate than conventional TKA? (2) Does accelerometer-based navigation provide better functional outcome than conventional TKA? (3) Does accelerometer-based navigation increase surgical time or decrease the risk of complications or reoperations compared with conventional TKA? METHODS This systematic review included all comparative prospective and retrospective studies published in the MEDLINE/PubMed and Cochrane libraries over the last 10 years. Inclusion criteria were all studies in English that compared accelerometer-based navigation with conventional TKA. Eleven studies met these criteria with 621 knees in accelerometer-based navigation group and 677 knees in conventional TKA group. Results related to alignment, objective and subjective functional scores, duration of surgery, complications and reoperations were extracted and compared between accelerometer-based-navigation and conventional TKA. Methodological quality was assessed using Methodological Index for Non-Randomized Studies (MINORS) tool (for nonrandomized control trials) and Cochrane Risk of Bias (for randomized control trials (RCTs). All studies with fair or better quality were included. Four RCTs and six nonrandomized studies comparing accelerometer-based navigation to conventional TKA were found. RESULTS Inconsistent evidence on mechanical axis alignment was found, with five of nine studies slightly favoring the accelerometer-based navigation group, and the other four showing no differences between the groups. Only two of eight studies favored accelerometer-based navigation in terms of tibial component alignment in the coronal plane; the other six found no between-group differences. Similarly, mixed results were found regarding other metrics related to component alignment; a minority of studies favored accelerometer-based navigation by a small margin, and most studies found no between-group differences. Only three studies evaluated functional outcome and none of them showed a difference in range of motion or patient-reported outcomes. Most studies, six of seven, found no between-group differences concerning surgical time; one study demonstrated a slight increase in time with accelerometer-based navigation. There were no between-group differences in terms of the risk of complications, which generally were uncommon in both groups, and no reoperations or revisions were reported in either group. CONCLUSIONS We found conflicting evidence about whether accelerometer-based navigation reduces the number of coronal-plane outliers or improves alignment to a clinically important degree, and we found no evidence that it improves patient-reported outcomes or reduces the risk of complications or reoperations. Accelerometer-based navigation may increase surgical time. The overall quality of the evidence was low, which suggested that any observed benefits were overestimated. Given the absence of higher-quality evidence demonstrating compelling benefits of this accelerometer-based navigation technology, it should not be widely adopted. LEVEL OF EVIDENCE Level III, therapeutic study.
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Turgeon TR, Gascoyne TC, Laende EK, Dunbar MJ, Bohm ER, Richardson CG. The assessment of the stability of the tibial component of a novel knee arthroplasty system using radiostereometric analysis. Bone Joint J 2018; 100-B:1579-1584. [DOI: 10.1302/0301-620x.100b12.bjj-2018-0566.r1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims The introduction of a novel design of total knee arthroplasty (TKA) must achieve outcomes at least as good as existing designs. A novel design of TKA with a reducing radius of the femoral component and a modified cam-post articulation has been released and requires assessment of the fixation to bone. Radiostereometric analysis (RSA) of the components within the first two postoperative years has been shown to be predictive of medium- to long-term fixation. The aim of this study was to assess the stability of the tibial component of this system during this period of time using RSA. Patients and Methods A cohort of 30 patients underwent primary, cemented TKA using the novel posterior stabilized fixed-bearing (ATTUNE) design. There was an even distribution of men and women (15:15). The mean age of the patients was 64 years (sd 8) at the time of surgery; their mean body mass index (BMI) was 35.4 kg/m 2 (sd 7.9). RSA was used to assess the stability of the tibial component at 6, 12, and 24 months compared with a six-week baseline examination. Patient-reported outcome measures were also assessed. Results The mean maximum total point motion (MTPM) of the tibial component between 12 and 24 months postoperatively was 0.08 mm (sd 0.08), which is well below the published threshold of 0.2 mm (p < 0.001). Patient-reported outcome measures consistently improved. Conclusion The tibial component of this novel design of TKA showed stability between assessment 12 and 24 months postoperatively, suggesting an acceptably low risk of medium- to long-term failure due to aseptic loosening.
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Affiliation(s)
- T. R. Turgeon
- Division of Orthopaedics, Department of Surgery, University of Manitoba, Winnipeg, Canada; Concordia Hip and Knee Institute, Winnipeg, Canada
| | - T. C. Gascoyne
- Orthopaedic Innovation Centre, Concordia Hip and Knee Institute, Winnipeg, Canada
| | - E. K. Laende
- Division of Orthopaedics, Department of Surgery, QEII Health Sciences Centre, Halifax, Canada; Dalhousie University, Halifax, Canada
| | - M. J. Dunbar
- Division of Orthopaedics, Department of Surgery, QEII Health Sciences Centre, Halifax, Canada; Dalhousie University, Halifax, Canada
| | - E. R. Bohm
- Division of Orthopaedics, Department of Surgery, University of Manitoba, Winnipeg, Canada; Concordia Hip and Knee Institute, Winnipeg, Canada
| | - C. G. Richardson
- Division of Orthopaedics, Department of Surgery, QEII Health Sciences Centre, Halifax, Canada; Dalhousie University, Halifax, Canada
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Affiliation(s)
- Max Gordon
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institute, Stockholm, Sweden,
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9
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Petursson G, Fenstad AM, Gøthesen Ø, Dyrhovden GS, Hallan G, Röhrl SM, Aamodt A, Furnes O. Computer-Assisted Compared with Conventional Total Knee Replacement: A Multicenter Parallel-Group Randomized Controlled Trial. J Bone Joint Surg Am 2018; 100:1265-1274. [PMID: 30063588 DOI: 10.2106/jbjs.17.01338] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND We previously reported the short-term radiographic and functional results of a randomized controlled trial (RCT) comparing computer-assisted and conventionally performed total knee replacement. We currently report the 2-year clinical results from this trial. METHODS One hundred and ninety patients were randomly allocated to undergo either computer-assisted or conventional total knee replacement. One hundred and seventy-two patients were available for clinical evaluation at 2 years, and 167 (97%) of those answered all patient-reported outcome measures (PROMs), including the Knee Injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Society Score (KSS), visual analog scale (VAS), and EuroQol-5 Dimensions (EQ-5D). Patients and clinical evaluators were blinded to the method of surgery. Surgical outcome was assessed using the Outcome Measures in Rheumatology-Osteoarthritis Research Society International (OMERACT-OARSI) criteria to calculate responder rates, divided into high responders, moderate responders, and nonresponders. RESULTS The computer-assisted group had significantly more improvement than the conventional group in the mean scores for 2 subscales of the KOOS (7.4 for symptoms [p = 0.02] and 16.2 for sport and recreation [p < 0.01]) and in 1 subscale of the WOMAC (8.8 for stiffness [p = 0.03]).The computer-assisted group also had significantly more high responders (82.8%) than the conventional group (68.8%; p = 0.03) at 2 years, with the number needed to treat determined to be 8. CONCLUSIONS In this study, the use of computer navigation provided better pain relief and restored better function than the use of the conventional surgical technique at 2 years after total knee replacement. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Gunnar Petursson
- Lovisenberg Diaconal Hospital, Oslo, Norway.,The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Anne Marie Fenstad
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Øystein Gøthesen
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway.,Haugesund Sanitetsforenings Hospital for Rheumatic Diseases, Haugesund, Norway
| | - Gro Sævik Dyrhovden
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Geir Hallan
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Stephan M Röhrl
- Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | | | - Ove Furnes
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
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Di Benedetto P, Di Benedetto ED, Buttironi MM, Beltrame A, Gissoni R, Cainero V, Causero A. Computer assisted total knee arthroplasty: a real navigation to better results? ACTA BIO-MEDICA : ATENEI PARMENSIS 2017; 88:48-53. [PMID: 28657564 DOI: 10.23750/abm.v88i2 -s.6513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 06/01/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM OF THE WORK Computer assisted surgery in knee replacement is still in discussion, but majority of papers affirm an increase of the accuracy in alignment. Aim of our study is to evaluate the accuracy of mechanical axis, the posterior tibial slope and the femoral component rotation with navigation, x-ray and CT data. METHODS We have analysed 145 patients who underwent total knee arthroplasty between January 2012 and December 2014. We have checked each patient at 6, 12 and 24 months of follow-up. During each visit, we did a clinical evaluation checking the ROM and a clinical score (KOOS). At 2 years, we did a CT evaluation and a plain x-ray evaluation. RESULTS 125 patients have completed the follow-up. Mean follow-up time was 2,6 years. Both ROM and KOOS values increased during follow-up. About the mechanical axis, both x-ray and CT data showed a mean deviation <2° from the target. About posterior tibial slope and femoral component rotation, CT data showed a mean deviation of <3° from the target. Mean difference between navigation and CT data was <1°. CONCLUSIONS According to literature data, our data confirm that computer assisted surgery in knee replacement have a good accuracy of coronal alignment, rotational alignment and posterior tibial slope.
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Benedetto PD, Benedetto EDD, Buttironi MM, Beltrame A, Gisonni R, Cainero V, Causero A. Computer assisted total knee arthroplasty: a real navigation to better results? ACTA BIO-MEDICA : ATENEI PARMENSIS 2017. [PMID: 28657564 PMCID: PMC6179005 DOI: 10.23750/abm.v88i2-s.6513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND AIM OF THE WORK Computer assisted surgery in knee replacement is still in discussion, but majority of papers affirm an increase of the accuracy in alignment. Aim of our study is to evaluate the accuracy of mechanical axis, the posterior tibial slope and the femoral component rotation with navigation, x-ray and CT data. METHODS We have analysed 145 patients who underwent total knee arthroplasty between January 2012 and December 2014. We have checked each patient at 6, 12 and 24 months of follow-up. During each visit, we did a clinical evaluation checking the ROM and a clinical score (KOOS). At 2 years, we did a CT evaluation and a plain x-ray evaluation. RESULTS 125 patients have completed the follow-up. Mean follow-up time was 2,6 years. Both ROM and KOOS values increased during follow-up. About the mechanical axis, both x-ray and CT data showed a mean deviation <2° from the target. About posterior tibial slope and femoral component rotation, CT data showed a mean deviation of <3° from the target. Mean difference between navigation and CT data was <1°. CONCLUSIONS According to literature data, our data confirm that computer assisted surgery in knee replacement have a good accuracy of coronal alignment, rotational alignment and posterior tibial slope.
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Affiliation(s)
- Paolo Di Benedetto
- Correspondence: Paolo Di Benedetto, MD, PhD Clinica Ortopedica Azienda Sanitaria - Universitaria Integrata di Udine P.le S.Maria della Misericordia, 15 - 33100 Udine Tel. +39 0432 559464 Fax +39 0432 559298 E-mail:
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