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Brodt S, Schulze M, Jacob B, Wassilew G, Nowack D, Rohe S, Matziolis G. Validity of leg length measurement in the supine and standing position compared with pelvic survey X-ray after total hip arthroplasty. Arch Orthop Trauma Surg 2024; 144:433-438. [PMID: 37530843 PMCID: PMC10774217 DOI: 10.1007/s00402-023-05014-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 07/23/2023] [Indexed: 08/03/2023]
Abstract
INTRODUCTION The correct adjustment of leg length is a major goal in the implantation of total hip replacements (THRs). Differences in leg length can lead to functional impairment and patient dissatisfaction. By determining leg length at an early stage, before the patient is discharged from hospital, compensatory measures such as the production of special insoles or orthopaedic footwear can be initiated promptly if there is a difference in leg length. Due to shortening of the period of time spent in hospital, the traditional measurement of leg length in a standing position may be increasingly subject to error. A protective posture immediately after surgery or the presence of a twisted pelvis, for example, due to scoliotic spinal misalignments, falsifies the measurement result in the standing position. Here, the measurement of leg length in the supine position may prove to be accurate immediately postoperatively, regardless of potential sources of error, and is to be compared with measurement in the standing position versus radiological measurement on the AP pelvic survey. MATERIAL AND METHODS The present retrospective study included 190 patients who had undergone primary total hip arthroplasty. The leg length difference (LLD) of the patients was determined pre- and postoperatively both in the supine and standing position and compared with the postoperative radiological pelvic survey image. RESULTS Postoperatively, it was shown that the mean length measured was 0.35 mm too long in the supine position and 0.68 mm too short in the standing position (p value < 0.001). Determination of the average absolute measurement error produces a deviation of 4.06 mm in the standing and 4.51 mm in the supine position (p value 0.126). CONCLUSIONS It is shown that the postoperative measurement of LLD in the supine and standing position is equally valid and sufficiently accurate, compared with the gold standard of measurement on a radiograph.
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Affiliation(s)
- Steffen Brodt
- Department of Orthopedics, Jena University Hospital, Campus Eisenberg, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany.
| | - Marcel Schulze
- Department of Orthopedics, Jena University Hospital, Campus Eisenberg, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany
| | - Benjamin Jacob
- Department of Orthopedics, Jena University Hospital, Campus Eisenberg, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany
| | - Georgi Wassilew
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Dimitri Nowack
- Department of Orthopedics, Jena University Hospital, Campus Eisenberg, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany
| | - Sebastian Rohe
- Department of Orthopedics, Jena University Hospital, Campus Eisenberg, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany
| | - Georg Matziolis
- Department of Orthopedics, Jena University Hospital, Campus Eisenberg, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany
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Al-Ashqar M, Aslam N, Azhar MS, Grayston J, Hahnel J. KingMark's dual-marker versus a conventional single-marker templating system: is there a difference in accuracy of predicting final implant sizes and leg lengths? Eur J Orthop Surg Traumatol 2023; 33:167-175. [PMID: 34842990 DOI: 10.1007/s00590-021-03174-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 11/19/2021] [Indexed: 01/07/2023]
Abstract
AIMS Pre-operative templating for total hip replacement (THR) surgery leads to more accurate implant sizing and positioning. This study aimed to compare the KingMark™ dual-marker system for magnification calibration to the current gold standard single-marker system in accuracy of predicting implant size and restoration of leg length post-operatively. METHODS This is a retrospective analysis of patients who had primary THR surgery from 2013 to 2019 by a single surgeon. Patients were in two cohorts whose operations were completed at separate healthcare facilities. Patients in the first cohort had pre-operative templating using the KingMark system; patients in the second cohort had templating using a single-marker. For all patients, pre-operative radiographs were reviewed; predicted implants noted; and leg length discrepancies calculated. These were compared to post-operative data. We then tested the null hypothesis that there was no difference between the templating methods for prediction accuracy of implant size and achieving restoration of leg length. RESULTS A total of 121 patients were included in the KingMark cohort, and 104 were included in the single-marker cohort. In the KingMark cohort, 83.5% of patients had implantation of a cup within one size of that predicted, compared to 71.2% of the single-marker cohort. This superiority was statistically significant. There was a greater proportion of exact cup size predictions in the KingMark cohort, but this was not statistically significant. We did not find any significant difference between the cohorts for stem size, or stem placement, or reduction of leg length discrepancy. CONCLUSION We have demonstrated statistically significant superiority of the KingMark over a single-marker templating system for predicting cup size in primary THR surgery. For post-operative restoration of leg length, our study did not show any advantage of KingMark templating compared to single-marker templating.
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Affiliation(s)
- Mohammad Al-Ashqar
- Bradford Royal Infirmary, Bradford, UK.
- Leeds Teaching Hospitals, Leeds, UK.
| | - Nayef Aslam
- Bradford Royal Infirmary, Bradford, UK
- Leeds Teaching Hospitals, Leeds, UK
| | | | - James Grayston
- Bradford Royal Infirmary, Bradford, UK
- Leeds Teaching Hospitals, Leeds, UK
| | - James Hahnel
- Bradford Royal Infirmary, Bradford, UK
- Leeds Teaching Hospitals, Leeds, UK
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Luger M, Feldler S, Klasan A, Gotterbarm T, Schopper C. The morphology of the proximal femur in cementless short-stem total hip arthroplasty: No negative effect on offset reconstruction, leg length difference and implant positioning. J Orthop Surg Res 2021; 16:730. [PMID: 34930358 DOI: 10.1186/s13018-021-02876-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/05/2021] [Indexed: 11/10/2022] Open
Abstract
Background Correct reconstruction of hip offset (HO) and leg length are important for clinical–functional outcome and patient satisfaction in total hip arthroplasty (THA). The morphology of the proximal femur can pose a risk for increased leg length difference (LLD) in cementless straight-stem THA. We therefore wanted to evaluate, if this is also applicable in THA with a cementless meta-diaphyseal short stem. Methods In a retrospective study, 106 patients (index surgery 2014–2019) with unilateral THA and a morphologically healthy hip as a reference (Kellgren–Lawrence ≤ 1) were included. The same cementless short stem with meta-diaphyseal fixation and cementless press-fit cup was implanted. The proximal femur was rated by Dorr’s classification, and subgroups were formed afterward. Measurements were carried out on preoperative and 3 months postoperative anterior–posterior radiographs of the pelvis. Kruskal–Wallis test, Fisher’s exact test and binary logistic regression were performed to evaluate the influence of the anatomical shape on postoperative leg length difference and offset reconstruction. Results The Dorr type did not show any significance influence on LLD (p = 0.532), or postoperative difference in femoral offset (p = 0.243), acetabular offset (p = 0.106) and hip offset (p = 0.698). Stem alignment (p = 0.705) and canal fill indices (CFI I: p = 0.321; CFI II: p = 0.411; CFI III: p = 0.478) were also without significant differences. Logistic regression did not show any significant increased risk for a LLD ≥ 5 mm or ≥ 10 mm as well as HO ≥ 5 mm or ≥ 10 mm. Conclusion Reconstruction of hip offset and postoperative leg length difference is not negatively influenced by Dorr type, canal flare index, cortical index and canal-to-calcar ratio in cementless short-stem THA. Implant positioning and canal fill are also not negatively affected by the anatomical shape of the proximal femur. Level of evidence: Level IV.
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Tolk JJ, Merchant R, Eastwood DM, Buddhdev P, Hashemi-Nejad A. The Development of Leg Length Difference and Influence on Persistent Dysplasia in Patients with Developmental Dysplasia of the Hip. Indian J Orthop 2021; 55:1568-1575. [PMID: 35003543 PMCID: PMC8688656 DOI: 10.1007/s43465-021-00492-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/13/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Leg-length difference (LLD) is common in patients with developmental dysplasia of the hip (DDH). LLD of > 1 cm at skeletal maturity is reported in > 40% of patients, with the majority related to ipsilateral overgrowth. A longer DDH leg might lead to excessive mechanical loading at the acetabular margin, resulting in compromised acetabular development. We hypothesised that the LLD would negatively influence acetabular development. If so, it would be advantageous to identify such patients early in the course of follow-up, and address this if necessary. METHODS A retrospective study was conducted on a consecutive series of DDH patients managed surgically at the Royal National Orthopaedic Hospital, Stanmore, United Kingdom. We included patients with adequate long-leg radiographs at the age of 4-8 years (early-FU) and skeletal maturity (final-FU). Bilateral cases and those who underwent surgical procedures for hip dysplasia during the follow-up period were excluded. Measurements including leg length and centre-edge-angle (CE-angle) were obtained at the 2 time points. RESULTS Twenty-seven patients were included, mean age at early-FU 5.7 (± 0.9) years, and 13.9 (± 1.0) years at final-FU. Mean LLD at early-FU was 9.5 (± 7.6) mm and 10.9 (± 9.4) mm at final-FU, p = 0.337. Correlation between early- and final-FU LLD was 0.68 (p < 0.001). The mean CE-angle at early follow-up was 14.6° (± 9.8), this improved to 23.2° (± 8.2) at skeletal maturity (p = 0.003, paired samples t-test). Linear regression analysis showed a non-significant trend towards less CE-angle improvement in patients with more initial residual dysplasia and more initial LLD. CONCLUSION Most leg-length differences can be identified early in the follow-up period, nevertheless, considerable individual changes in LLD are observed on continued follow-up. Furthermore, a trend was observed towards impaired acetabular improvement in patients with more LLD. These findings justify careful clinical and radiological monitoring of LLD from an early stage in the follow-up period. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s43465-021-00492-5.
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Affiliation(s)
- Jaap J. Tolk
- Catterall Unit, Royal National Orthopaedic Hospital, Stanmore, UK
- Department of Orthopaedic Surgery, Erasmus MC - Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Rajiv Merchant
- Catterall Unit, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Deborah M. Eastwood
- Catterall Unit, Royal National Orthopaedic Hospital, Stanmore, UK
- Department of Orthopaedics, Great Ormond Street Hospital for Children, London, UK
| | - Pranai Buddhdev
- Department of Orthopaedic Surgery, Mid and South Essex NHS Trust, Chelmsford, Essex, UK
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Schmidt S, Wölfle N, Schultz C, Sielmann D, Huber R, Walach H. Assessment of a taping method combined with manual therapy as a treatment of non-specific chronic low back pain - a randomized controlled trial. BMC Musculoskelet Disord 2021; 22:410. [PMID: 33947367 PMCID: PMC8094483 DOI: 10.1186/s12891-021-04236-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 04/09/2021] [Indexed: 12/29/2022] Open
Abstract
Background Chronic low back pain is the most frequent medical problem and the condition with the most years lived with disability in Western countries. The objective of this study was to assess a new treatment, Medi-Taping, which aims at reducing complaints by treating pelvic obliquity with a combination of manual treatment of trigger points and kinesio taping in a pragmatic RCT with pilot character. Methods One hundred ten patients were randomized at two study centers either to Medi-Taping or to a standard treatment consisting of patient education and physiotherapy as control. Treatment duration was 3 weeks. Measures were taken at baseline, end of treatment and at follow-up after 2 months. Main outcome criteria were low back pain measured with VAS, the Chronic Pain Grade Scale (CPGS) and the Oswestry Low Back Pain Disability Questionnaire (ODQ). Results Patients of both groups benefited from the treatment by medium to large effect sizes. All effects were pointing towards the intended direction. While Medi-Taping showed slightly better improvement rates, there were no significant differences for the primary endpoints between groups at the end of treatment (VAS: mean difference in change 0.38, 95-CI [− 0.45; 1.21] p = 0.10; ODQ 2.35 [− 0.77; 5.48] p = 0.14; CPGS − 0.19 [− 0.46; 0.08] p = 0.64) and at follow-up. Health-related quality of life was significantly higher (p = .004) in patients receiving Medi-Taping compared to controls. Conclusions Medi-Taping, a purported way of correcting pelvic obliquity and chronic tension resulting from it, is a treatment modality similar in effectiveness to complex physiotherapy and patient education. Trial registration This trial was registered retrospectively on July 24th, 2019 as Number DRKS00017051 in the German Register of Clinical Trials (Deutsches Register Klinischer Studien). URL of trial registry record: https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00017051.
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Affiliation(s)
- Stefan Schmidt
- Department for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Medical Center - University of Freiburg, Hauptstr. 8, 79104, Freiburg, Germany. .,Institute for Frontier Areas of Psychology and Mental Health, Freiburg, Germany.
| | - Nicolas Wölfle
- Department for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Medical Center - University of Freiburg, Hauptstr. 8, 79104, Freiburg, Germany.,University Centre for Complementary Medicine, Medical Faculty, Medical Center - University of Freiburg, Freiburg, Germany
| | - Claudia Schultz
- University Centre for Complementary Medicine, Medical Faculty, Medical Center - University of Freiburg, Freiburg, Germany.,GP Practice B80, Gundelfingen, Germany
| | | | - Roman Huber
- University Centre for Complementary Medicine, Medical Faculty, Medical Center - University of Freiburg, Freiburg, Germany
| | - Harald Walach
- Institute for Frontier Areas of Psychology and Mental Health, Freiburg, Germany.,Pediatric Clinic, Medical University Poznan, Poznan, Poland.,Department of Psychology and Psychotherapy, University Witten-Herdecke, Witten, Germany.,CHS Institute, Berlin, Germany
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Goyal T, Choudhury AK, Paul S, Gupta T, Das L. Acetabular and Femoral Component Positioning Using Direct Anterior Approach Versus Posterior Approach in Total Hip Arthroplasty. Indian J Orthop 2021; 55:1215-1224. [PMID: 34824723 PMCID: PMC8586307 DOI: 10.1007/s43465-020-00343-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/30/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Direct anterior approach (DAA) has recently become popular in total hip arthroplasty (THA). However, irrespective of the surgical approach used, component malposition is an important factor affecting function and complications after THA. This study aims to compare component positioning on the femoral and acetabular side between DAA and posterior approach (PA) to the hip joint. We hypothesized that the two approaches are similar in terms of component positioning. METHODS We prospectively studied 50 patients, matched according to age, sex, and body mass index, undergoing THA, divided non-randomly into 2 groups. Group 1 comprised 25 patients (35 hips) undergoing THA using DAA and group 2 comprised 25 patients (25 hips) undergoing THA using PA. Ten patients from group 1 had simultaneous bilateral THA. Radiological parameters studied were acetabular inclination (AI), coronal femoral stem alignment (CFA), leg length difference (LLD), acetabular cup version (AV), and femoral stem version (FV). RESULTS There was no significant difference in AI, CFA, LLD, AV, and FV between the two groups. Excellent to good inter and intra-observer reliability expressed in terms of intraclass correlation coefficient (ICC) was noted for all the radiographic measurements. CONCLUSION Both DAA and PA for THA achieve comparable radiological component positioning. DAA may not provide any advantage over PA in terms of positioning of the prosthesis. LEVEL OF EVIDENCE Level II, non-randomized comparative study.
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Affiliation(s)
- Tarun Goyal
- Department of Orthopaedics, All India Institute of Medical Sciences, Bathinda, 151001 Punjab India
| | | | - Souvik Paul
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Tushar Gupta
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Lakshmana Das
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
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Siebers HL, Eschweiler J, Quack VM, Tingart M, Betsch M. Inertial measurement units for the detection of the effects of simulated leg length inequalities. J Orthop Surg Res 2021; 16:142. [PMID: 33596939 PMCID: PMC7888156 DOI: 10.1186/s13018-021-02212-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 01/06/2021] [Indexed: 11/11/2022] Open
Abstract
Background Leg length inequalities (LLI) are a common condition that can be associated with detrimental effects like low back pain and osteoarthritis. Inertial measurement units (IMUs) offer the chance to analyze daily activities outside a laboratory. Analyzing the kinematic effects of (simulated) LLI on the musculoskeletal apparatus using IMUs will show their potentiality to improve the comprehension of LLI. Methods Twenty healthy participants with simulated LLI of 0-4 cm were analyzed while walking with an inertial sensor system (MyoMotion). Statistical evaluation of the peak anatomical angles of the spine and legs were performed using repeated measurement (RM) ANOVA or their non-parametric test versions (Friedman test). Results Lumbar lateral flexion and pelvic obliquity increased during the stance phase of the elongated leg and decreased during its swing phase. The longer limb was functionally shortened by higher hip and knee flexion, higher hip adduction, dorsiflexion, and lower ankle adduction. Finally, the shorter leg was lengthened by higher hip and knee extension, hip abduction, ankle plantarflexion, and decreased hip adduction. Conclusion We found differing compensation strategies between the different joints, movement planes, gait phases, and amounts of inequality. Overall the shorter leg is lengthened and the longer leg is shortened during walking, to retain the upright posture of the trunk. IMUs were helpful and precise in the detection of anatomical joint angles and for the analysis of the effects of LLI.
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Affiliation(s)
- Hannah Lena Siebers
- Department of Orthopaedic Surgery, University Hospital RWTH Aachen, Pauwelsstr 30, 52074, Aachen, Germany.
| | - Jörg Eschweiler
- Department of Orthopaedic Surgery, University Hospital RWTH Aachen, Pauwelsstr 30, 52074, Aachen, Germany
| | - Valentin M Quack
- Department of Orthopaedic Surgery, University Hospital RWTH Aachen, Pauwelsstr 30, 52074, Aachen, Germany
| | - Markus Tingart
- Department of Orthopaedic Surgery, University Hospital RWTH Aachen, Pauwelsstr 30, 52074, Aachen, Germany
| | - Marcel Betsch
- University of Toronto Orthopaedic Sports Medicine Program (UTOSM), Women's College Hospital, Toronto, Ontario, Canada.,Department of Orthopaedics and Trauma Surgery, University Medical Center Mannheim of the University Heidelberg, Mannheim, Germany
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Mufty S, Vandenneucker H, Bellemans J. The influence of leg length difference on clinical outcome after revision TKA. Knee 2014; 21:424-7. [PMID: 23092888 DOI: 10.1016/j.knee.2012.09.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Revised: 08/25/2012] [Accepted: 09/06/2012] [Indexed: 02/02/2023]
Abstract
BACKGROUND The purpose of this paper was to document the incidence of leg length changes after revision total knee arthroplasty (TKA) and its effect on clinical outcome. METHODS Leg length difference (LLD) was prospectively measured in 85 patients using digital standing full leg radiography before and after revision TKA. Additionally the patient's subjective perception of LLD was assessed postoperatively. Linear regression models were used to study the correlation between each of these parameters and the clinical outcome after 1 year. Clinical outcome was evaluated by means of the Knee Society Score (KSS). RESULTS Revision TKA resulted on average in an increased leg length of 5.3 mm. Sixty-five legs (76%) were lengthened with the procedure, 17 (20%) were shortened and three (4%) remained of identical length. Increased leg length after revision was positively correlated with clinical outcome at 3 months (Spearman r=0.22, p=0.044) and 1 year (Spearman r=0.26, p=0.027). The evidence for this correlation remained after correction for age, gender and diagnosis (p=0.012). The most important contributors to improved clinical outcome scores were improved pain score (Spearman r=0.19, p=0.09) and increased stability (Spearman r=0.13, p=0.24), rather than range of motion (Spearman r=-0.02, p=0.85). CONCLUSIONS The results from our work indicate that revision TKA tends to lengthen the leg by approximately 5mm. Contrary to what might be expected, leg lengthening after revision TKA is correlated with improved clinical outcome. LEVEL OF EVIDENCE Level 2b.
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Affiliation(s)
- S Mufty
- Department of Orthopaedic Surgery, University Hospitals Leuven, Weligerveld 1, 3012 Pellenberg, Belgium.
| | - H Vandenneucker
- Department of Orthopaedic Surgery, University Hospitals Leuven, Weligerveld 1, 3012 Pellenberg, Belgium
| | - J Bellemans
- Department of Orthopaedic Surgery, University Hospitals Leuven, Weligerveld 1, 3012 Pellenberg, Belgium
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