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Borsinger TM, Chandi SK, Belay ES, Chiu YF, Gausden EB, Sculco TP, Westrich GH. Femoral Component Debonding Frequently Missed on Advanced Imaging Prior to Revision of a Recalled Total Knee Arthroplasty. J Arthroplasty 2024:S0883-5403(24)00365-6. [PMID: 38642850 DOI: 10.1016/j.arth.2024.04.041] [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: 12/07/2023] [Revised: 04/11/2024] [Accepted: 04/12/2024] [Indexed: 04/22/2024] Open
Abstract
BACKGROUND Identification of femoral component debonding in the work-up of painful total knee arthroplasty (TKA) often poses a diagnostic challenge. The purpose of this study was to compare the sensitivity and specificity of radiographs, computed tomography (CT), and magnetic resonance imaging (MRI) for identifying femoral component loosening with debonding at the time of revision of a primary TKA with a recalled polyethylene insert. METHODS Using an institutional database, we identified all cases of revision TKA performed for this specific implant recall following a primary TKA between 2014 and 2022. Patients who had a preoperative radiograph, CT, and MRI were included (n = 77). Sensitivity, specificity, and positive and negative likelihood ratio (LR) for predicting loosening were compared among the imaging modalities, using the intraoperative evidence of implant loosening as the gold standard. RESULTS At the time of revision surgery, the femoral component was noted to have aseptic loosening with debonding in 46 of the 77 (60%) of the TKAs. There were no significant differences in demographics in the cohort with femoral debonding compared to those with well-fixed implants. The CT demonstrated a sensitivity of 28% and a specificity of 97%, while the MRI demonstrated a sensitivity of 37% and a specificity of 94% for detecting femoral loosening due to debonding. Both CT and MRI demonstrated poor negative LRs for femoral loosening (LR 0.7). CONCLUSIONS In this series of revision TKAs for a specific recalled component, neither CT nor MRI accurately diagnosed femoral component debonding. For patients who have this implant, it is imperative to interrogate the implant-cement interface intraoperatively and prepare for full revision surgery as well as marked bone loss secondary to osteolysis.
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Affiliation(s)
- Tracy M Borsinger
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York; Department of Orthoapedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Sonia K Chandi
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Elshaday S Belay
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Yu-Fen Chiu
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Elizabeth B Gausden
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Thomas P Sculco
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Geoffrey H Westrich
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
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Brenneis M, Flevas DA, Bornes TD, Braun S, Meurer A, Sculco PK, Quevedo-González FJ, Boettner F. Tibial bone defect prediction based on preoperative artefact-reduced CT imaging is superior to standard radiograph assessment. Knee Surg Sports Traumatol Arthrosc 2023; 31:4842-4850. [PMID: 37558747 PMCID: PMC10598107 DOI: 10.1007/s00167-023-07527-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/23/2023] [Indexed: 08/11/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the accuracy of preoperative CT-based Anderson Orthopaedic Research Institute (AORI)-grading and to correlate Computed tomography (CT)-based volumetric defect measurements with intraoperative AORI findings. METHODS 99 patients undergoing revision total knee arthroplasty (rTKA) with preoperative CT-images were identified in an institutional revision registry. CT-image segmentation with 3D-Slicer Software was used to create 3D tibial bone defects which were then graded according to the AORI-classification. The AORI classification categorizes tibial defects into three types: Type I has healthy cortical and cancellous bone near the joint line, Type II involves metaphyseal bone loss affecting one or both condyles, and Type III indicates deficient metaphyseal bone with distal defects and potential damage to the patellar tendon and collateral ligament attachments. These 3D-CT gradings were compared to preoperative X-ray and intraoperative AORI grading. The Friedman test was used to investigate differences between AORI values of each measurement method. Volumetric 3D-bone defect measurements were used to investigate the relationship between AORI classification and volumetric defect size in the three anatomic zones of the tibia. RESULTS Substantial agreements between preoperative 3D-CT AORI and intraoperative AORI (kappa = 0.663; P < 0.01) and fair agreements between preoperative X-ray AORI and intraoperative AORI grading (kappa = 0.304; P < 0.01) were found. Moderate correlations between volume of remaining bone and intraoperative AORI grading were found in epiphysis (rS = - 0.529; P < 0.001), metaphysis (rS = - 0.557; P < 0.001) and diaphysis (rS = - 0.421; P < 0.001). Small volumetric differences between AORI I vs. AORI II defects and relatively large differences between AORI II and AORI III defects in each zone were detected. CONCLUSION Tibial bone defect prediction based on preoperative 3D-CT segmentation showed a substantial agreement with intraoperative findings and is superior to standard radiograph assessment. The relatively small difference in defect volume between AORI I, IIa and IIb suggests that updated CT-based classifications might hold benefits for the planning of rTKA. LEVEL OF EVIDENCE Retrospective Cohort Study; III.
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Affiliation(s)
- Marco Brenneis
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA.
- Department of Orthopaedics (Friedrichsheim), University Hospital, Goethe University Frankfurt, Frankfurt/Main, Germany.
| | - Dimitrios A Flevas
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA
| | - Troy D Bornes
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA
- Division of Orthopaedic Surgery, Royal Alexandra Hospital, University of Alberta, Edmonton, Canada
| | - Sebastian Braun
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA
- Department of Orthopaedics (Friedrichsheim), University Hospital, Goethe University Frankfurt, Frankfurt/Main, Germany
| | - Andrea Meurer
- Department of Orthopaedics (Friedrichsheim), University Hospital, Goethe University Frankfurt, Frankfurt/Main, Germany
- Medical Park Klinik, Bad Wiessee, Germany
| | - Peter K Sculco
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA
| | | | - Friedrich Boettner
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
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Dual-energy CT and ceramic or titanium prostheses material reduce CT artifacts and provide superior image quality of total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2019; 27:1552-1561. [PMID: 29881885 PMCID: PMC6527539 DOI: 10.1007/s00167-018-5001-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 05/28/2018] [Indexed: 01/04/2023]
Abstract
PURPOSE To evaluate the influence of different scan parameters for single-energy CT and dual-energy CT, as well as the impact of different material used in a TKA prosthesis on image quality and the extent of metal artifacts. METHODS Eight pairs of TKA prostheses from different vendors were examined in a phantom set-up. Each pair consisted of a conventional CoCr prosthesis and the corresponding anti-allergic prosthesis (full titanium, ceramic, or ceramic-coated) from the same vendor. Nine different (seven dual-energy CT and two single-energy CT) scan protocols with different characteristics were used to determine the most suitable CT protocol for TKA imaging. Quantitative image analysis included assessment of blooming artifacts (metal implants appear thicker on CT than they are, given as virtual growth in mm in this paper) and streak artifacts (thick dark lines around metal). Qualitative image analysis was used to investigate the bone-prosthesis interface. RESULTS The full titanium prosthesis and full ceramic knee showed significantly fewer blooming artifacts compared to the standard CoCr prosthesis (mean virtual growth 0.6-2.2 mm compared to 2.9-4.6 mm, p < 0.001). Dual-energy CT protocols showed less blooming (range 3.3-3.8 mm) compared to single-energy protocols (4.6-5.5 mm). The full titanium and full ceramic prostheses showed significantly fewer streak artifacts (mean standard deviation 77-86 Hounsfield unit (HU)) compared to the standard CoCr prosthesis (277-334 HU, p < 0.001). All dual-energy CT protocols had fewer metal streak artifacts (215-296 HU compared to single-energy CT protocols (392-497 HU)). Full titanium and ceramic prostheses were ranked superior with regard to the image quality at the bone/prosthesis interface compared to a standard CoCr prosthesis, and all dual-energy CT protocols were ranked better than single-energy protocols. CONCLUSIONS Dual-energy CT and ceramic or titanium prostheses reduce CT artifacts and provide superior image quality of total knee arthroplasty at the bone/prosthesis interface. These findings support the use of dual-energy CT as a solid imaging base for clinical decision-making and the use of full-titanium or ceramic prostheses to allow for better CT visualization of the bone-prosthesis interface.
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Jaroma A, Suomalainen JS, Niemitukia L, Soininvaara T, Salo J, Kröger H. Imaging of symptomatic total knee arthroplasty with cone beam computed tomography. Acta Radiol 2018; 59:1500-1507. [PMID: 29493259 DOI: 10.1177/0284185118762247] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Computed tomography (CT) can be used to assess the rotational alignment of prosthesis components to identify possible underlying causes of symptomatic total knee arthroplasty (TKA). The use of cone beam computed tomography (CBCT) for the imaging of extremities is relatively new, although it has been widely used in dental imaging. PURPOSE To assess the intra- and inter-observer reproducibility of CBCT, as well as to validate CBCT for TKA component and periprosthetic bone diagnostics. MATERIAL AND METHODS CBCT scans were performed on 18 patients the day before a scheduled revision TKA, from which the intra- and inter-observer reproducibility were assessed. Component rotation and loosening were evaluated. Perioperative bone defects were classified. RESULTS The inter-observer intraclass coefficient correlation (ICC) for femoral component rotation was 0.41 (95% confidence interval [CI] = 0.12-0.69). For the tibial component, the ICC was 0.87 (95% CI = 0.74-0.94). Intra-observer reproducibilities were 0.70 (95% CI = 0.35-0.87) and 0.92 (95% CI = 0.80-0.97), respectively. The sensitivity for tibial component loosening was 97% and the specificity was 85%. The reliability of bone defect classification was only weak to moderate. CONCLUSION Two-dimensional (2D) CBCT scanning provides reliable and reproducible data for determining the rotation of femoral and tibial components, while showing minor overestimation of tibial component loosening. CBCT is a promising new tool for the evaluation of symptomatic knee arthroplasty patients, with a substantially lower radiation dose compared to conventional 2D multi-slice CT.
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Affiliation(s)
- Antti Jaroma
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
| | | | - Lea Niemitukia
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | | | - Jari Salo
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
| | - Heikki Kröger
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
- Department of Surgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
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Koff MF, Burge AJ, Koch KM, Potter HG. Imaging near orthopedic hardware. J Magn Reson Imaging 2017; 46:24-39. [PMID: 28152257 DOI: 10.1002/jmri.25577] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 11/18/2016] [Indexed: 12/12/2022] Open
Abstract
Over one million total joint replacement surgeries were performed in the US in 2013 alone, and this number is expected to more than double by 2030. Traditional imaging techniques for postoperative evaluation of implanted devices, such as radiography, computerized tomography, or ultrasound, utilize ionizing radiation, suffer from beam hardening artifact, or lack the inherent high contrast necessary to adequately evaluate soft tissues around the implants, respectively. Magnetic resonance imaging (MRI), due to its ability to generate multiplanar, high-contrast images without the use of ionizing radiation is ideal for evaluating periprosthetic soft tissues but has traditionally suffered from in-plane and through-plane data misregistration due to the magnetic susceptibility of implanted materials. A recent renaissance in the interest of imaging near arthroplasty and implanted orthopedic hardware has led to the development of new techniques that help to mitigate the effects of magnetic susceptibility. This article describes the challenges of performing imaging near implanted orthopedic hardware, how to generate clinically interpretable images when imaging near implanted devices, and how the images may be interpreted for clinical use. We will also describe current developments of utilizing MRI to evaluate implanted orthopedic hardware. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2017;46:24-39.
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Affiliation(s)
- Matthew F Koff
- MRI Laboratory, Hospital for Special Surgery, Department of Radiology and Imaging-MRI, New York, New York, USA
| | - Alissa J Burge
- MRI Laboratory, Hospital for Special Surgery, Department of Radiology and Imaging-MRI, New York, New York, USA
| | - Kevin M Koch
- Medical College of Wisconsin, Department of Radiology, Milwaukee, Wisconsin, USA
| | - Hollis G Potter
- MRI Laboratory, Hospital for Special Surgery, Department of Radiology and Imaging-MRI, New York, New York, USA
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Minoda Y, Yoshida T, Sugimoto K, Baba S, Ikebuchi M, Nakamura H. Detection of small periprosthetic bone defects after total knee arthroplasty. J Arthroplasty 2014; 29:2280-4. [PMID: 24961891 DOI: 10.1016/j.arth.2014.05.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 05/07/2014] [Accepted: 05/20/2014] [Indexed: 02/01/2023] Open
Abstract
Large bone defect around total knee prostheses is among the most critical challenges in revision surgery. However, it is difficult to detect bone defects around a prosthesis in early stage. We compared the efficacy of the detection of small bone defects between fluoroscopically guided plain radiography, CT, MRI, and a novel tomographic technique (tomosynthesis) using the six pig knee models. No bone defects were detected with plain radiography and MRI. The sensitivity and specificity of CT were 61.5% and 64.1%, respectively. The sensitivity and specificity of tomosynthesis were 85.4% and 87.2%, respectively. The radiation dose of tomosynthesis was 6% of that of CT. The cost of tomosynthesis was 28% of that of CT. Tomosynthesis was superior in terms of diagnosis, radiation dose, and cost.
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Affiliation(s)
- Yukihide Minoda
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Taku Yoshida
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | | | | | - Mitssuhiko Ikebuchi
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
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Liebl H, Heilmeier U, Lee S, Nardo L, Patsch J, Schuppert C, Han M, Rondak IC, Banerjee S, Koch K, Link TM, Krug R. In vitro assessment of knee MRI in the presence of metal implants comparing MAVRIC-SL and conventional fast spin echo sequences at 1.5 and 3 T field strength. J Magn Reson Imaging 2014; 41:1291-9. [PMID: 24912802 DOI: 10.1002/jmri.24668] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 05/02/2014] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To assess lesion detection and artifact size reduction of a multiacquisition variable-resonance image combination, slice encoding for metal artifact correction (MAVRIC-SEMAC) hybrid sequence (MAVRIC-SL) compared to standard sequences at 1.5T and 3T in porcine knee specimens with metal hardware. MATERIALS AND METHODS Artificial cartilage and bone lesions of defined size were created in the proximity of titanium and steel screws with 2.5 mm diameter in 12 porcine knee specimens and were imaged at 1.5T and 3T magnetic resonance imaging (MRI) with MAVRIC-SL PD and short T1 inversion recovery (STIR), standard fast spin echo (FSE) T2 PD, and STIR and fat-saturated T2 FSE sequences. Three radiologists blinded to the lesion locations assessed lesion detection rates on randomized images for each sequence using receiver operating characteristic (ROC). Artifact length and width were measured. RESULTS Metal artifact sizes were largest in the presence of steel screws at 3T (FSE T2 FS: 28.7 cm(2) ) and 1.5T (16.03 cm(2) ). MAVRIC-SL PD and STIR reduced artifact sizes at both 3T (1.43 cm(2) ; 2.46 cm(2) ) and 1.5T (1.16 cm(2) ; 1.59 cm(2) ) compared to FS T2 FSE sequences (27.57 cm(2) ; 13.20 cm(2) ). At 3T, ROC-derived AUC values using MAVRIC-SL sequences were significantly higher compared to standard sequences (MAVRIC-PD: 0.87, versus FSE-T2 -FS: 0.73 [P = 0.025]; MAVRIC-STIR: 0.9 vs. T2 -STIR: 0.78 [P = 0.001] and vs. FSE-T2 -FS: 0.73 [P = 0.026]). Similar values were observed at 1.5T. Comparison of 3T and 1.5T showed no significant differences (MAVRIC-SL PD: P = 0.382; MAVRIC-SL STIR: P = 0.071). CONCLUSION MAVRIC-SL sequences provided superior lesion detection and reduced metal artifact size at both 1.5T and 3T compared to conventionally used FSE sequences. No significant disadvantage was found comparing MAVRIC-SL at 3T and 1.5T, although metal artifacts at 3T were larger. J. Magn. Reson. Imaging 2015;41:1291-1299. © 2014 Wiley Periodicals, Inc.
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Affiliation(s)
- Hans Liebl
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA; Institut fuer diagnostische und interventionelle Radiologie, Technische Universitaet Muenchen, Munich, Germany
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Solomon LB, Stamenkov RB, MacDonald AJ, Yaikwavong N, Neale SD, Moss MJ, Howie DW. Imaging periprosthetic osteolysis around total knee arthroplasties using a human cadaver model. J Arthroplasty 2012; 27:1069-74. [PMID: 22085797 DOI: 10.1016/j.arth.2011.09.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Accepted: 09/16/2011] [Indexed: 02/01/2023] Open
Abstract
We examined the sensitivity and accuracy of measuring osteolysis around total knee arthroplasty (TKA) on radiographs, computed tomography (CT), and magnetic resonance imaging (MRI) in a cadaver model. Fifty-four simulated osteolytic defects ranging from 0.7 to 14 cm(3) were created in 6 cadaver knees implanted with either a cemented or an uncemented TKA. Three blinded investigators assessed the presence, location, and volume of defects on radiographs and CT and MRI scans with metal reduction protocols. Both CT and MRI had significantly higher sensitivities and specificities than did plain radiographs (P < .005). Overall, there was no difference in the accuracy of defect volume measurements between CT and MRI (P = .574). This study demonstrates the limitations of radiographs and the high sensitivity and specificity of both CT and MRI in assessing osteolysis around TKA.
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Affiliation(s)
- Lucian B Solomon
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, Australia
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Zotti MGT, Campbell DG, Woodman R. Detection of periprosthetic osteolysis around total knee arthroplasties an in vitro study. J Arthroplasty 2012; 27:317-22. [PMID: 21641179 DOI: 10.1016/j.arth.2011.03.047] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2010] [Accepted: 03/24/2011] [Indexed: 02/01/2023] Open
Abstract
Periprosthetic osteolysis is a common cause of revision of total knee arthroplasties (TKAs), with plain anteroposterior and lateral (APL) radiographs being the most common method for screening. The aim of this study was to examine the utility of lesion detection and volume appreciation with APL, paired oblique radiographs, and computed tomography. Defects of different sizes were created in 3 cadaveric knees with a cementless TKA in situ and imaged with APL, oblique, and computed tomography modalities. The resultant images were then shown to 3 arthroplasty surgeons, and the absence or presence of lesions, volume size, and confidence in assessment were recorded. The results suggest that the current practice of APL is inferior for the assessment of periprosthetic osteolysis around TKA.
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Affiliation(s)
- Mario G T Zotti
- Department of Orthopaedics, Flinders Medical Centre, Bedford Park and Repatriation General Hospital, Daw Park, South Australia
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