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Abdullah AH, Todo M. Prediction of Bone Mineral Density (BMD) Adaptation in Pelvis-Femur Model with Hip Arthroplasties. J Funct Biomater 2021; 12:jfb12030049. [PMID: 34564198 PMCID: PMC8482249 DOI: 10.3390/jfb12030049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/27/2021] [Accepted: 08/29/2021] [Indexed: 11/20/2022] Open
Abstract
The prediction of bone remodeling behaviour is a challenging factor in encouraging the long-term stability of hip arthroplasties. The presence of femoral components modifies the biomechanical environment of the bone and alters the bone growth process. Issues of bone loss and gait instability on both limbs are associated with the remodeling process. In this study, finite element analysis with an adaptive bone remodeling algorithm was used to predict the changes in bone mineral density following total hip and resurfacing hip arthroplasty. A three-dimensional model of the pelvis–femur was constructed from computed tomography (CT-based) images of a 79-year-old female patient with hip osteoarthritis. The prosthesis stem of the total hip arthroplasty was modelled with a titanium alloy material, while the femoral head had alumina properties. Meanwhile, resurfacing of the hip implant was completed with a cobalt-chromium material. Contact between the components and bone was designed to be perfectly bonded at the interface. Results indicate that the bone mineral density was modified over five years on all models, including hip osteoarthritis. The changes of BMD were predicted as being high between year zero and year one, especially in the proximal region. Changes were observed to be minimal in the following years. The bone remodeling process was also predicted for the non-operated femur. However, the adaptation was lower compared to the operated limbs. The reduction in bone mineral density suggested the bone loss phenomenon after a few years.
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Affiliation(s)
- Abdul Halim Abdullah
- School of Mechanical Engineering, College of Engineering, Universiti Teknologi MARA, Shah Alam 40450, Selangor, Malaysia
- Correspondence:
| | - Mitsugu Todo
- Research Institute for Applied Mechanics, Kyushu University, 6-1 Kasuga-koen, Kasuga 816-8580, Japan;
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Equal Primary Fixation of Resurfacing Stem, but Inferior Cup Fixation With Anterolateral vs Posterior Surgical Approach. A 2-Year Blinded Randomized Radiostereometric and Dual-energy X-Ray Absorptiometry Study of Metal-on-Metal Hip Resurfacing Arthroplasty. J Arthroplasty 2017. [PMID: 28641972 DOI: 10.1016/j.arth.2017.05.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The anterolateral (AntLat) surgical approach may spare the blood supply to the femoral head and improve the accuracy of cup positioning in metal-on-metal hip resurfacing arthroplasty. Thereby, potentially lessen complications such as avascular head necrosis, femoral neck narrowing and fracture, improve implant fixation, and lessen periprosthetic bone mineral density (BMD) loss. METHODS Between November 2008 and January 2012, a randomized clinical trial was performed at Aarhus University Hospital. A total of 49 patients (28 males) were allocated to metal-on-metal hip resurfacing arthroplasty by the AntLat (n = 25) or the posterior (Post; n = 24) surgical approach. Patients were followed with radiostereometric analysis, measurements of periprosthetic BMD, clinical outcome scores of Harris hip score and visual analogue scale, serum metal ions, and conventional radiographs. RESULTS At 3 months, cups in the AntLat group had higher total translations of mean 1.00 ± 0.70 mm vs mean 0.64 ± 0.45 mm in the post group (P = .04), and higher total rotations of mean 2.44° ± 1.36° vs mean 1.39° ± 1.17° in the Post group (P = .002). All migrations of cup and stem were similar at 1 and 2 years postoperative (P > .07). At 1 year, periprosthetic BMD since postoperative at the medial side of the stem was reduced to mean 98.45% ± 8.57% in the AntLat group, and increased to mean 105.57% ± 11.07% in the Post group (P = .02), but measurements were comparable at 2 years (P = .05). CONCLUSION Cups inserted by the AntLat approach migrated more until 3 months postoperative. This illustrates a less good primary cup fixation with the AntLat approach; however, all cups were well-fixed after 3 months' follow-up indicating a good secondary fixation.
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Increase in physical activity after resurfacing hip arthroplasty is associated with calcar and acetabular bone mineral density changes. Hip Int 2017; 27:140-146. [PMID: 28218380 DOI: 10.5301/hipint.5000433] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/17/2016] [Indexed: 02/04/2023]
Abstract
PURPOSE Bone preservation is an important advantage of the resurfacing hip arthroplasty (RHA) concept. We hypothesised that patients' increase in physical activity level after RHA would positively relate with periprosthetic bone mineral density (BMD) changes and thus facilitate bone preservation. METHODS BMD-changes were prospectively recorded in 38 patients after RHA. Dual-energy absorptiometry was used to quantify BMD-changes in 6 periprosthetic regions of interest preoperatively, at 6 months, 1, 2 and 3 years postoperative. The effect estimates of patients' physical activity, according to their Harris Hip Score (HHS) and University of California at Los Angeles (UCLA) Activity Score, on these BMD changes were assessed in linear mixed models. RESULTS The UCLA (coefficient = 0.02 (95% CI, 0.010-0.034); p<0.001) and HHS (coefficient = 0.002 (95% CI, 0.001-0.003); p<0.001) were associated with the BMD in the calcar region. As for BMD changes in the femoral neck only the HHS was associated (coefficient = 0.0006 (95% CI, <0.0001-0.001); p = 0.04). Both the UCLA and the HHS were inversely associated with BMD in the medial acetabular region (UCLA: coefficient = -0.02 (95% CI, -0.038 to -0.007); p = 0.005, HHS: coefficient = -0.002 (95% CI, -0.003 to -0.001), the same accounted for the HHS to BMD-change cranial to the acetabulum (-0.001 [95% CI, -0.0018 to -0.0001]; p = 0.03). For the caudal acetabular and femoral subtrochanteric region no relation with BMD-changes was found. CONCLUSIONS The increase in activity scores after RHA was indeed associated with an increase in BMD in the calcar region, however unexpectedly also with a BMD decrease on the acetabular side. Stress shielding from the implant is the most likely causative factor.
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Gaillard MD, Gross TP. Reducing the failure rate of hip resurfacing in dysplasia patients: a retrospective analysis of 363 cases. BMC Musculoskelet Disord 2016; 17:251. [PMID: 27267594 PMCID: PMC4897880 DOI: 10.1186/s12891-016-1095-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 05/24/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Arthritis secondary to developmental hip dysplasia often mandates implant surgery at a relatively young age. Hip resurfacing arthroplasty (HRA), compared with standard stemmed total hip arthroplasty (THA), affords a more active lifestyle including extreme-motion activities but stimulates concerns pertaining to implant failure. METHODS We addressed the primary modes of failure through a series of interventions, including a new guideline for achieving proper implant alignment through intraoperative x-rays. We then compared two sequential cohorts in a single-surgeon practice: patients with developmental dysplasia who underwent HRA before (Group 1; 121 hips in 105 patients) and after (Group 2; 242 hips in 210 patients) June 2008, at which time the four interventions were all in place. RESULTS Implants in Group 2 failed less frequently within two years (0.8 % vs. 6.6 %, p = 0.002) and were more likely to have projected seven-year Kaplan-Meier survivorship (99 % vs. 89 %, p < 0.0001 by log-rank test). Patients in Group 2 were more likely to have normal metal ion levels (77 % vs. 56 %, p = 0.0008) and optimum metal ion levels (99 % vs. 86 %, p = 0.0008). Patients in Group 2 also benefited from a 19-min decrease in mean operation time, a 45 % decrease in mean estimated blood loss, and a 0.9-day decrease in mean hospital stay (p < 0.0001 in each instance). CONCLUSIONS We believe the interventions reported here, combined with sufficient surgeon experience and properly designed implants, afford patients with mild developmental dysplasia a more active lifestyle with favorable implant survival.
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MESH Headings
- Adult
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Hip/instrumentation
- Arthroplasty, Replacement, Hip/methods
- Female
- Follow-Up Studies
- Hip Dislocation, Congenital/complications
- Hip Dislocation, Congenital/surgery
- Hip Joint/diagnostic imaging
- Hip Joint/physiopathology
- Hip Joint/surgery
- Hip Prosthesis/adverse effects
- Humans
- Intraoperative Care/methods
- Ions/blood
- Life Style
- Male
- Metal-on-Metal Joint Prostheses/adverse effects
- Metals/blood
- Middle Aged
- Osteoarthritis, Hip/etiology
- Osteoarthritis, Hip/surgery
- Postoperative Complications/epidemiology
- Practice Guidelines as Topic
- Prospective Studies
- Prosthesis Design
- Prosthesis Failure
- Radiography
- Range of Motion, Articular
- Reoperation/statistics & numerical data
- Retrospective Studies
- Risk Factors
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Affiliation(s)
- Melissa D Gaillard
- Midlands Orthopaedics & Neurosurgery PA, 1910 Blanding Street, Columbia, SC, USA.
| | - Thomas P Gross
- Midlands Orthopaedics & Neurosurgery PA, 1910 Blanding Street, Columbia, SC, USA
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Tice A, Kim P, Dinh L, Ryu JJ, Beaulé PE. A randomised controlled trial of cemented and cementless femoral components for metal-on-metal hip resurfacing: a bone mineral density study. Bone Joint J 2016; 97-B:1608-14. [PMID: 26637673 DOI: 10.1302/0301-620x.97b12.36110] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The primary purpose of this study of metal-on-metal (MoM) hip resurfacing was to compare the effect of using a cementless or cemented femoral component on the subsequent bone mineral density (BMD) of the femoral neck. This was a single-centre, prospective, double-blinded control trial which randomised 120 patients (105 men and 15 women) with a mean age of 49.4 years (21 to 68) to receive either a cemented or cementless femoral component. Follow-up was to two years. Outcome measures included total and six-point region-of-interest BMD of the femoral neck, radiological measurements of acetabular inclination, neck-shaft and stem-shaft angles, and functional outcome scores including the Harris hip score, the Western Ontario and McMaster Universities Osteoarthritis Index and the University of California at Los Angeles activity scale. In total, 17 patients were lost to follow-up leaving 103 patients at two years. There were no revisions in the cementless group and three revisions (5%) in the cemented group (two because of hip pain and one for pseudotumour). The total BMD was significantly higher in the cementless group at six months (p < 0.001) and one year (p = 0.01) than in the cemented group, although there was a loss of statistical significance in the difference at two years (p = 0.155). All patient outcomes improved significantly: there were no significant differences between the two groups. The results show better preservation of femoral neck BMD with a cementless femoral component after two years of follow-up. Further investigation is needed to establish whether this translates into improved survivorship.
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Affiliation(s)
- A Tice
- University of Ottawa/The Ottawa Hospital, Ottawa, Ontario, Canada
| | - P Kim
- University of Ottawa/The Ottawa Hospital, Ottawa, Ontario, Canada
| | - L Dinh
- University of Ottawa/The Ottawa Hospital, Ottawa, Ontario, Canada
| | - J J Ryu
- University of Ottawa/The Ottawa Hospital, Ottawa, Ontario, Canada
| | - P E Beaulé
- University of Ottawa/The Ottawa Hospital, Ottawa, Ontario, Canada
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6
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Activity intensity, assistive devices and joint replacement influence predicted remodelling in the proximal femur. Biomech Model Mechanobiol 2015; 15:181-94. [DOI: 10.1007/s10237-015-0678-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 04/17/2015] [Indexed: 10/23/2022]
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Cadossi M, Tedesco G, Savarino L, Baldini N, Mazzotti A, Greco M, Giannini S. Effect of acetabular cup design on metal ion release in two designs of metal-on-metal hip resurfacing. J Biomed Mater Res B Appl Biomater 2014; 102:1595-601. [DOI: 10.1002/jbm.b.33191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 02/14/2014] [Accepted: 04/12/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Matteo Cadossi
- Department I of Orthopaedics and Traumatology; Rizzoli Orthopaedic Institute; Bologna Italy
- Bologna University; Bologna Italy
| | - Giuseppe Tedesco
- Department I of Orthopaedics and Traumatology; Rizzoli Orthopaedic Institute; Bologna Italy
- Bologna University; Bologna Italy
| | - Lucia Savarino
- Complex Orthopedic-Trauma Pathology Department; Laboratory for Orthopaedic Pathophysiology and Regenerative Medicine; Rizzoli Orthopaedic Institute; Bologna Italy
| | - Nicola Baldini
- Bologna University; Bologna Italy
- Complex Orthopedic-Trauma Pathology Department; Laboratory for Orthopaedic Pathophysiology and Regenerative Medicine; Rizzoli Orthopaedic Institute; Bologna Italy
| | - Antonio Mazzotti
- Department I of Orthopaedics and Traumatology; Rizzoli Orthopaedic Institute; Bologna Italy
- Bologna University; Bologna Italy
| | - Michelina Greco
- Complex Orthopedic-Trauma Pathology Department; Laboratory for Orthopaedic Pathophysiology and Regenerative Medicine; Rizzoli Orthopaedic Institute; Bologna Italy
| | - Sandro Giannini
- Department I of Orthopaedics and Traumatology; Rizzoli Orthopaedic Institute; Bologna Italy
- Bologna University; Bologna Italy
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Haider IT, Speirs AD, Beaulé PE, Frei H. Influence of ingrowth regions on bone remodelling around a cementless hip resurfacing femoral implant. Comput Methods Biomech Biomed Engin 2014; 18:1349-57. [DOI: 10.1080/10255842.2014.903931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Malviya A, Ng L, Hashmi M, Rawlings D, Holland JP. Patterns of changes in femoral bone mineral density up to five years after hip resurfacing. J Arthroplasty 2013; 28:1025-30. [PMID: 23434108 DOI: 10.1016/j.arth.2012.09.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 08/30/2012] [Accepted: 09/27/2012] [Indexed: 02/01/2023] Open
Abstract
This is a prospective study of 26 patients (29 hips) on the patterns of change in the Bone Mineral Density (BMD) in various zones of the femoral neck and proximal femur five years after hip resurfacing. We have found that BMD continues to positively change up to five years after hip resurfacing. This was observed primarily in the trochanteric and superior neck regions. In both these regions BMD had decreased by up to 10% at six-weeks and three-months after surgery and then had recovered to preoperative level by one year. A regression analysis to assess the influence of age, gender, BMI, preoperative BMD, component size and orientation revealed that the best predictor of change in BMD at five years in the trochanteric area was acetabular component inclination.
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Affiliation(s)
- Ajay Malviya
- Wansbeck General Hospital, Northumbria Healthcare NHS Trust, Ashington, NE63 9JJ, UK
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Abstract
There is little information regarding the clinical performance of hip resurfacing arthroplasty (HRA) in older patients. Eighty-seven patients (99 hips) aged 65 years or older received HRA while a control group of 52 patients (64 hips) received a primary THA. The average age was 69.2 years for the HRA group and 71.9 years for the THA group. Follow-up ranged from 2 to 13 years. UCLA walking, function and activity scores and SF-12 scores were higher in the HRA group. At 10 years, the Kaplan-Meier overall survivorship rates were 96.7% for the HRA group and 91.2% for the THA group (p = 0.3174). We suggest considering hip resurfacing for patients 65 or older in centres where there is expertise in performing this procedure.
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Penny JO, Brixen K, Varmarken JE, Ovesen O, Overgaard S. Changes in bone mineral density of the acetabulum, femoral neck and femoral shaft, after hip resurfacing and total hip replacement. ACTA ACUST UNITED AC 2012; 94:1036-44. [DOI: 10.1302/0301-620x.94b8.28222] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
It is accepted that resurfacing hip replacement preserves the bone mineral density (BMD) of the femur better than total hip replacement (THR). However, no studies have investigated any possible difference on the acetabular side. Between April 2007 and March 2009, 39 patients were randomised into two groups to receive either a resurfacing or a THR and were followed for two years. One patient’s resurfacing subsequently failed, leaving 19 patients in each group. Resurfaced replacements maintained proximal femoral BMD and, compared with THR, had an increased bone mineral density in Gruen zones 2, 3, 6, and particularly zone 7, with a gain of 7.5% (95% confidence interval (CI) 2.6 to 12.5) compared with a loss of 14.6% (95% CI 7.6 to 21.6). Resurfacing replacements maintained the BMD of the medial femoral neck and increased that in the lateral zones between 12.8% (95% CI 4.3 to 21.4) and 25.9% (95% CI 7.1 to 44.6). On the acetabular side, BMD was similar in every zone at each point in time. The mean BMD of all acetabular regions in the resurfaced group was reduced to 96.2% (95% CI 93.7 to 98.6) and for the total hip replacement group to 97.6% (95% CI 93.7 to 101.5) (p = 0.4863). A mean total loss of 3.7% (95% CI 1.0 to 6.5) and 4.9% (95% CI 0.8 to 9.0) of BMD was found above the acetabular component in W1 and 10.2% (95% CI 0.9 to 19.4) and 9.1% (95% CI 3.8 to 14.4) medial to the implant in W2 for resurfaced replacements and THRs respectively. Resurfacing resulted in a mean loss of BMD of 6.7% (95% CI 0.7 to 12.7) in W3 but the BMD inferior to the acetabular component was maintained in both groups. These results suggest that the ability of a resurfacing hip replacement to preserve BMD only applies to the femoral side.
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Affiliation(s)
- J. O. Penny
- University of Southern Denmark, Department
of Orthopaedic Surgery and Traumatology, Odense
University Hospital, Sdr. Boulevard 29, 5000
Odense C, Denmark
| | - K. Brixen
- University of Southern Denmark, Department
of Endocrinology, Odense University Hospital, Sdr.
Boulevard 29, 5000 Odense C, Denmark
| | - J. E. Varmarken
- Naestved Hospital, Department
of Orthopaedic Surgery, Naestved Hospital, Ringstedgade
61, 4700 Naestved, Denmark
| | - O. Ovesen
- University of Southern Denmark, Department
of Orthopaedic Surgery and Traumatology, Odense
University Hospital, Sdr. Boulevard 29, 5000
Odense C, Denmark
| | - S. Overgaard
- University of Southern Denmark, Department
of Orthopaedic Surgery and Traumatology, Odense
University Hospital, Sdr. Boulevard 29, 5000
Odense C, Denmark
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Hakulinen MA, Borg H, Häkkinen A, Parviainen T, Kiviranta I, Jurvelin JS. Influence of different DXA acquisition modes on monitoring the changes in bone mineral density after hip resurfacing arthroplasty. J Clin Densitom 2012; 15:72-7. [PMID: 22071027 DOI: 10.1016/j.jocd.2011.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Revised: 08/05/2011] [Accepted: 08/05/2011] [Indexed: 11/26/2022]
Abstract
Dual-energy X-ray absorptiometry (DXA) is a technique enabling the measurement of bone mineral density (BMD) around prostheses after hip resurfacing arthroplasty (HRA). In this study, we evaluated the consistency of different DXA acquisition modes with 33 patients who had undergone HRA. Patients were scanned with DXA immediately after surgery and at 3-, 6-, and 12-mo time points. All the patients were scanned with dual femur and orthopedic hip acquisition modes and analyzed using 10-region ROI model. With both acquisition modes, a statistically significant decrease (p<0.05, Wilcoxon's test) in BMD at 3mo was revealed in 3 ROIs, located to upper and lateral upper femur. Both acquisition modes detected similarly (p<0.01) preservation of the femoral bone stock within 12mo in all but 1 ROI. The applied acquisition protocols involved the use of different footplates for hip fixation. Because the differences between acquisition modes ranged between +1.6% and -7.1% and the reproducibility of BMD values can vary by as much as 28% due to hip rotation, it is proposed that both dual femur and orthopedic hip acquisition modes can be used to monitor the changes in BMD after HRA. However, the same hip rotation is recommended for all DXA measurements.
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Affiliation(s)
- Mikko A Hakulinen
- Department of Clinical Physiology, Kuopio University Hospital, Kuopio, Finland.
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