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Chrzan AJ, Arnold ND, Chan K, Hess DE, Duquette SP, Hinkelman LL, Kelpin J, Bush TR. Kinematic Investigation of Healthy, Arthritic, and Postsurgery Thumbs: Is the Metacarpophalangeal Joint the Gateway to Carpometacarpal Arthritis? J Biomech Eng 2024; 146:071006. [PMID: 38456821 DOI: 10.1115/1.4065006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/22/2024] [Indexed: 03/09/2024]
Abstract
The thumb carpometacarpal (CMC) joint is one of the most likely joints to develop osteoarthritis (OA). If conservative treatments fail to alleviate symptoms, surgery may be pursued. Kinematic outcomes of CMC surgery techniques have been described, but current tools have limitations in capturing motion abilities. The goals of this study were (1) develop a new and robust set of kinematic outcome measures, and apply them to (2) a cohort of younger and older control individuals without CMC OA to determine age and sex-related changes, and (3) a cohort of participants with CMC OA before, 3 months, and 6 months after undergoing thumb ligament reconstruction with tendon interposition surgery to detect the impacts of surgery. 52 (26 males, 26 females) control and 18 (3 males, 15 females) surgical participants were tested. Kinematics were investigated using motion capture by mapping the three-dimensional motion space of the whole thumb, and two-dimensional motion boundaries of the metacarpal (MC) and proximal phalange (PP). Visual analog pain score was recorded. Older control participants had shifted regions of motion compared to younger participants (p ≤ 0.027), suggesting asymptomatic CMC wear. Control females had 31% more metacarpophalangeal (MCP) motion than control males (p = 0.013), which could alter loading paths through the CMC joint and increase OA risk. Pain at 6 months postsurgery was 72% less than presurgery (p < 0.001), but motion abilities were 20-28% less than presurgery (p ≤ 0.074) and 24-40% less than control participants (p ≤ 0.066). These techniques have the possibility of identifying presymptomatic motion changes, including those at the metacarpophalangeal joint in CMC OA progression.
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Affiliation(s)
- Adam J Chrzan
- Mechanical Engineering, Michigan State University, East Lansing, MI 48824-4403
| | - Nicole D Arnold
- Mechanical Engineering, Michigan State University, East Lansing, MI 48824-4403
| | - Kevin Chan
- Orthopedic Hand and Upper Extremity Surgery, Corewell Health West, Grand Rapids, MI 49546
| | - Daniel E Hess
- Orthopedic Hand and Upper Extremity Surgery, Corewell Health West, Grand Rapids, MI 49546
| | - Stephen P Duquette
- Orthopedic Hand and Upper Extremity Surgery, Corewell Health West, Grand Rapids, MI 49546
| | - Levi L Hinkelman
- Orthopedic Hand and Upper Extremity Surgery, Corewell Health West, Grand Rapids, MI 49546
| | - John Kelpin
- Orthopedic Hand and Upper Extremity Surgery, Corewell Health West, Grand Rapids, MI 49546
| | - Tamara Reid Bush
- Mechanical Engineering Department, Michigan State University, 428 S. Shaw Lane, 2555, East Lansing, MI 48824
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Arnold ND, Chrzan AJ, Chan K, Bush TR. The Female Thumb Carpometacarpal Joint: Motion and Force Changes Due to Arthritis and Surgical Intervention. J Biomech Eng 2024; 146:060902. [PMID: 38270931 DOI: 10.1115/1.4064551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 01/19/2024] [Indexed: 01/26/2024]
Abstract
Thumb carpometacarpal (CMC) osteoarthritis (OA) has been one of the most common locations of hand OA. CMC OA disproportionately occurs in females over males. In severe cases, surgical intervention may be needed. However, to determine the effects of surgical treatment, normative, pre-, and postsurgery function must be understood. The goals of this work were to compare the thumb motion and force abilities of older healthy (OH) females without CMC OA to those of females with CMC OA and who received ligament reconstruction with tendon interposition (LRTI) surgery at time points presurgery, 3- and 6-months postsurgery. On average, CMC OA participants 3- and 6-months postsurgery showed 35.6% and 32.9% less overall metacarpal motion compared to presurgery, 31.9% and 29.1% less than OH, and exhibited altered motion. Metacarpal flexion/extension and abduction/adduction ranges were 51.9 deg and 43.4 deg for OH, 52.9 deg and 40.3 deg presurgery, 39.9 deg and 33.5 deg at 3-months, and 42.6 deg and 32.7 deg at 6-months postsurgery. On average, participants had increased force generation at 6-months postsurgery compared to presurgery, and 20% of participants returned to the level of OH females. These data sets highlight changes in thumb metacarpal movement and thumb force generation due to disease and surgical intervention. This work has the ability to support both surgeons and patients through improved outcome assessments as well as additional data to inform the decision process on intervention.
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Affiliation(s)
- Nicole D Arnold
- Mechanical Engineering, Michigan State University, East Lansing, MI 48824
| | - Adam J Chrzan
- Mechanical Engineering, Michigan State University, East Lansing, MI 48824
| | - Kevin Chan
- Orthopedic Hand and Upper Extremity Surgery, Spectrum Health, Grand Rapids, MI 49546
| | - Tamara Reid Bush
- Mechanical Engineering, Michigan State University, 428 S. Shaw Lane, 2555, East Lansing, MI 48824
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Richards T, Trickett RW. A systematic review of management options for symptomatic scaphometacarpal impingement after trapeziectomy. J Hand Surg Eur Vol 2024:17531934241240858. [PMID: 38534133 DOI: 10.1177/17531934241240858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
Pain after trapeziectomy is a vexing problem, most commonly due to scaphometacarpal impingement. A number of treatment strategies have been described and are examined in this systematic review. In total, 27 studies describing revision surgery for unsatisfactory results after trapeziectomy were included. Results after soft tissue or synthetic suspensionplasties, arthrodesis procedures, implant arthroplasty and costochondral autografting were included. Most studies were heterogeneous in terms of patient selection and procedure performed, and the level of evidence and methodological quality were uniformly low. Autologous suspensionplasty procedures are the best studied and most rigorously reported techniques, with modest improvements in pain widely reported. Newer techniques using synthetic suture button suspension are encouraging with the benefit of earlier mobilization but require further study. Due to high incidences of complication and revision, the literature does not support the use of implant arthroplasty after trapeziectomy. Arthrodesis appears to be a reasonable last resort when attempts at suspension have failed.
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Affiliation(s)
- Tomos Richards
- Swansea Department of Hand Surgery, Heol Maes Eglwys, Swansea, UK
| | - Ryan W Trickett
- Department of Trauma & Orthopaedic Surgery, University Hospital of Wales, Cardiff, UK
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Ling K, Wang KE, Kim ND, Komatsu DE, Wang ED. Body Mass Index as a Predictor for Postoperative Complications Following Carpometacarpal Arthroplasty. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2023; 5:787-792. [PMID: 38106953 PMCID: PMC10721512 DOI: 10.1016/j.jhsg.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 06/24/2023] [Indexed: 12/19/2023] Open
Abstract
Purpose Carpometacarpal (CMC) arthroplasty is an effective surgical treatment to relieve pain and improve function for osteoarthritis of the CMC joint. The association between body mass index (BMI) and postoperative complications has been studied for other orthopedic procedures, including total knee arthroplasty, total hip arthroplasty, and total shoulder arthroplasty. However, BMI has not been studied as a risk factor for postoperative complications following CMC arthroplasty. The purpose of this study was to determine the postoperative complications associated with different categories of BMI following CMC arthroplasty. We hypothesized that increasing BMI is associated with more severe complications. Methods The American College of Surgeons National Surgical Quality Improvement Program database was queried for all patients who underwent CMC arthroplasty between 2015 and 2020. Patient demographics, comorbidities, surgical characteristics, and 30-day postoperative complication data were collected. Patients were stratified into cohorts based on BMI as follows: underweight (BMI < 18.5 kg/m2), normal/reference (18.5 kg/m2 ≤ BMI < 30.0 kg/m2), obese (30.0 kg/m2 ≤ BMI < 35.0 kg/m2), severely obese (35.0 kg/m2 ≤ BMI < 40.0 kg/m2), and morbidly obese (BMI ≥ 40.0 kg/m2). Multivariate logistic regression was used to identify postoperative complications associated with each cohort. Results In total, 6,432 patients were included in this study: 3,622 (56.3%) patients were included in the normal/reference cohort, 77 (1.2%) patients were included in the underweight cohort, 1,479 (23.0%) patients were included in the obese cohort, 718 (11.2%) patients were included in the severely obese cohort, and 536 (8.3%) patients were included in the morbidly obese cohort. The obese cohort was independently associated with a higher rate of superficial incisional surgical-site infection (odds ratio [OR], 2.11; 95% confidence interval [CI], 1.00-4.44; P = .050). The morbidly obese cohort was independently associated with readmission (OR, 3.35; 95% CI, 1.15-9.74; P = .026) and reoperation (OR, 3.40; 95% CI, 1.04-1.11; P = .043). Conclusions Morbid obesity is a clinically significant predictor for readmission and reoperation within 30 days following CMC arthroplasty. Obesity is a clinically significant predictor for superficial incisional surgical-site infection within 30 days following CMC arthroplasty. Clinical relevance A better understanding of BMI as a risk factor for postoperative complications may allow surgeons to improve preoperative risk stratification and patient counseling. Type of study/level of evidence Prognostic III.
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Affiliation(s)
- Kenny Ling
- Department of Orthopaedics, Stony Brook University, Stony Brook, NY
| | - Katherine E. Wang
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY
| | - Noah D. Kim
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY
| | - David E. Komatsu
- Department of Orthopaedics, Stony Brook University, Stony Brook, NY
| | - Edward D. Wang
- Department of Orthopaedics, Stony Brook University, Stony Brook, NY
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Ling K, Fassler R, Burgan J, Komatsu DE, Wang ED. Readmission and Reoperation Following Carpometacarpal Arthroplasty. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2023; 5:661-666. [PMID: 37790819 PMCID: PMC10543817 DOI: 10.1016/j.jhsg.2023.06.014] [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: 05/29/2023] [Accepted: 06/21/2023] [Indexed: 10/05/2023] Open
Abstract
Purpose Carpometacarpal (CMC) arthroplasty is an effective surgical treatment for osteoarthritis of the CMC joint. Risk factors for readmission and reoperation have been studied for other joint arthroplasty procedures but have not yet been studied for CMC arthroplasty. The purpose of this study was to identify patient demographics and comorbidities associated with 30-day readmission and 30-day reoperation after CMC arthroplasty. Methods The American College of Surgeons National Surgical Quality Improvement Program database was queried for all records of patients who underwent CMC arthroplasty between 2015 and 2020. Variables collected in this study included patient demographics, comorbidities, surgical characteristics, and 30-day postsurgical complication data. Multivariate logistic regression was used to identify independent associations between patient characteristics and readmission and reoperation after CMC arthroplasty. Results In total, 6,432 records were included in this study: 34 (0.5%) were readmitted within 30 days, and 27 (0.4%) underwent reoperation within 30 days. Compared with the non-readmission cohort, the readmission cohort was significantly associated with higher rates of age ≥ 75 years (P = .003), body mass index (BMI) ≥ 40 kg/m2 (P = .005), American Society of Anesthesiologists classification (ASA) ≥ 3; P < .001), insulin-dependent diabetes (P = .016), and chronic obstructive pulmonary disease (COPD; P = .009). Compared with the non-reoperation cohort, the reoperation cohort was significantly associated with higher rates of age ≥ 75 years (P = .003), BMI ≥ 40 kg/m2 (P = .005), ASA ≥ 3 (P < .001), insulin-dependent diabetes (p = .016), and COPD (P = .009). Conclusion The clinically significant predictors for 30-day readmission and 30-reoperation after CMC arthroplasty were age ≥ 75 years, BMI ≥ 40 kg/m2, ASA ≥ 3, insulin-dependent diabetes, and COPD. Of these risk factors, age and BMI were identified as independent predictors for 30-day readmission. A better understanding of presurgical risk factors for postsurgical complications may help surgeons with risk stratification and optimization of outcomes. Type of study/level of evidence Prognostic III.
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Affiliation(s)
- Kenny Ling
- Department of Orthopaedics, Stony Brook University, Stony Brook, NY
| | - Richelle Fassler
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY
| | - Jane Burgan
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY
| | - David E. Komatsu
- Department of Orthopaedics, Stony Brook University, Stony Brook, NY
| | - Edward D. Wang
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY
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Matsuo T, Suzuki T, Hayakawa K, Kimura H, Matsumura N, Iwamoto T. Comparative study on the effectiveness of bone grafting for arthrodesis of the thumb carpometacarpal arthritis. J Hand Surg Eur Vol 2023; 48:309-315. [PMID: 36428223 DOI: 10.1177/17531934221138917] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The aim of this retrospective study was to assess the effectiveness of autogenous bone grafting for arthrodesis of the thumb carpometacarpal joint by comparing the bone union rates with and without bone grafting. We included 36 patients who underwent arthrodesis of the thumb carpometacarpal joint for arthritis (20 patients with bone grafts and 16 without bone grafts). Implants used for internal fixation were K-wire, tension band wiring, headless compression screw and locking plate. The presence of bone union and the time from surgery to bone union were evaluated. The bone union rate was 20/20 (100%) in the bone grafting group and 12/16 (75%) in the non-bone grafting group (p = 0.03). There were no significant differences between the two groups in the time from surgery to bone union and patient characteristics. In conclusion, autogenous bone grafting may contribute to the bone union in the arthrodesis of thumb carpometacarpal arthritis.Level of evidence: III.
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Affiliation(s)
- Tomoki Matsuo
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Taku Suzuki
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | | | - Hiroo Kimura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Noboru Matsumura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Takuji Iwamoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
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Hoogendam L, van der Oest MJW, Vermeulen GM, Feitz R, Hovius SER, Zuidam JM, Slijper HP, Selles RW, Wouters RM. Prevalence of complications and association with patient-reported outcomes after trapeziectomy with a Weilby sling: A cohort study. J Hand Surg Am 2023; 48:469-478. [PMID: 36932010 DOI: 10.1016/j.jhsa.2023.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 12/28/2022] [Accepted: 01/18/2023] [Indexed: 03/19/2023]
Abstract
PURPOSE The primary aim of this study was to report complications during the first year after trapeziectomy with Weilby sling using a standardized tool designed by the International Consortium for Health Outcome Measures. The secondary aim was to determine the association of complications and patient-reported outcomes 12 months after surgery. METHODS We included patients who underwent trapeziectomy with Weilby sling between November 2013 and December 2018. All complications during the first year were scored using the International Consortium for Health Outcomes Measurement Complications in Hand and Wrist conditions (ICHAW) tool. Pain and hand function were measured before surgery and 12 months after surgery using the Michigan Hand Outcomes Questionnaire (MHQ). Minimally Important Change thresholds of 18.6 for MHQ pain and 9.4 for MHQ function were used to determine clinical importance. RESULTS Of 531 patients after trapeziectomy with Weilby sling, 65% had an uneventful recovery, 16% experienced ICHAW Grade 1 deviations only, and 19% experienced Grade 2 or 3 deviations, including requiring antibiotics, corticosteroid injections, or additional surgery. On average, patients improved in pain and hand function, even in the presence of ICHAW events. Although all ICHAW grades were associated with poorer patient-reported outcomes 12 months after surgery, Grade 2 and 3 exceeded the Minimally Important Change threshold for pain and/or function. CONCLUSIONS In 531 patients, 65% had an uneventful recovery, 16% experienced ICHAW Grade 1 deviations only, and 19% experienced grade 2 or 3 deviations. We recommend describing Grade 1 as "adverse protocol deviations" and grade 2 and 3 as complications, because of clinically relevant poorer patient-reported outcomes 12 months after surgery. The ICHAW is a promising tool to evaluate systematically and compare complications in hand surgery, although we recommend further evaluation. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Lisa Hoogendam
- From the Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, The Netherlands; Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, The Netherlands; Xpert Clinics, Hand and Wrist Center, Zeist, the Netherlands.
| | - Mark J W van der Oest
- From the Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, The Netherlands; Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, The Netherlands; Xpert Clinics, Hand and Wrist Center, Zeist, the Netherlands
| | | | - Reinier Feitz
- Xpert Clinics, Hand and Wrist Center, Zeist, the Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Radboudumc University Hospital, Nijmegen, The Netherlands
| | - Steven E R Hovius
- Xpert Clinics, Hand and Wrist Center, Zeist, the Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Radboudumc University Hospital, Nijmegen, The Netherlands
| | - J Michiel Zuidam
- From the Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Harm P Slijper
- Xpert Clinics, Hand and Wrist Center, Zeist, the Netherlands
| | - Ruud W Selles
- From the Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, The Netherlands; Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, The Netherlands
| | | | - Robbert M Wouters
- From the Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, The Netherlands; Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, The Netherlands
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Williams DC, Sánchez Ruas J, Del Piñal F. Thumb and fingertip ischaemia after trapeziectomy. J Hand Surg Eur Vol 2023; 48:587-589. [PMID: 36708222 DOI: 10.1177/17531934231151215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Daniel C Williams
- Piñal & Associates, Calle Serrano, Madrid, Spain.,Griffith University School of Medicine and Dentistry, Southport, Queensland, Australia
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Newton A, Talwalkar S. Arthroplasty in thumb trapeziometacarpal (CMC joint) osteoarthritis: An alternative to excision arthroplasty. J Orthop 2023; 35:134-139. [PMID: 36471695 PMCID: PMC9719001 DOI: 10.1016/j.jor.2022.11.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 11/15/2022] [Accepted: 11/18/2022] [Indexed: 11/27/2022] Open
Abstract
Trapeziectomy for base of thumb arthritis is well established, but base of thumb arthroplasty offers potential advantages. The review covers the development of arthroplasty for the thumb from interposition arthroplasty to total joint replacement. It discusses contemporary prosthesis designs and results, including trapezial component geometry, bearing surfaces, and dual mobility.
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Patel MIA, Lane JCE, Furniss D. Letter Regarding "Risk of Infection in Thumb Carpometacarpal Surgery After Corticosteroid Injection". J Hand Surg Am 2022; 47:e11. [PMID: 35393070 DOI: 10.1016/j.jhsa.2021.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 11/17/2021] [Indexed: 02/02/2023]
Affiliation(s)
- Manal I A Patel
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, United Kingdom
| | - Jennifer C E Lane
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, United Kingdom
| | - Dominic Furniss
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, United Kingdom; Department of Plastic Surgery, Oxford University Hospitals NHS Foundation Trust, Nuffield Orthopaedic Centre, Oxford, United Kingdom
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