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Perioperative Considerations for Hip Arthroplasty in Patients with Rheumatoid Arthritis. 类风湿关节炎患者髋关节置换术围手术期的注意事项。
Pub Date : 2024-12-01 DOI: 10.5371/hp.2024.36.4.250
Seung-Chan Kim, Hyung Chul Park, Kyung-Hag Lee

Due to its distinct features, rheumatoid arthritis (RA), an inflammatory autoimmune disorder, poses challenges in planning for surgical interventions. This review includes available evidence regarding perioperative considerations in management of RA patients, with a focus on hip surgery. RA can affect multiple joints, with development of extra-articular manifestations; therefore, preoperatively, comprehensive medical assessments, including cardiovascular or pulmonary evaluation must be considered in addition to surgical considerations. Modification of medications capable of controlling RA-related disease activity is critical, and requires collaboration with rheumatologists. Surgical considerations include the choice of surgical approach, implant selection, and problems related to weakened soft tissues, fragile bone density, and bony deformity such as protrusio acetabuli. Careful monitoring and more active rehabilitation are recommended for RA patients due to higher risk of postoperative complications. For achievement of optimal outcomes, use of a multidisciplinary perioperative approach is required for patients with RA.

类风湿关节炎(RA)是一种炎症性自身免疫性疾病,由于其独特的特征,在手术干预计划中提出了挑战。本综述包括有关RA患者围手术期治疗注意事项的现有证据,重点是髋关节手术。RA可累及多个关节,并发关节外表现;因此,术前除手术考虑外,还必须考虑全面的医学评估,包括心血管或肺部评估。调整药物以控制ra相关疾病活动是至关重要的,需要与风湿病学家合作。手术方面的考虑包括手术入路的选择,植入物的选择,以及与软弱的软组织、脆弱的骨密度和骨畸形(如髋臼突)相关的问题。由于RA术后并发症的风险较高,建议对RA患者进行仔细的监测和更积极的康复。为了获得最佳结果,RA患者需要采用多学科围手术期方法。
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引用次数: 0
Biological Agent and Total Hip Arthroplasty in Rheumatoid Arthritis. 类风湿性关节炎生物制剂与全髋关节置换术。
Pub Date : 2024-12-01 DOI: 10.5371/hp.2024.36.4.273
Yuya Takakubo, Kan Sasaki, Juji Ito, Hiroharu Oki, Masaji Ishii, Michiaki Takagi

Purpose: Therapies for treatment of rheumatoid arthritis (RA) have shown significant improvement since the introduction of biological agents (BIO) in 2003 and Janus kinase inhibitors (JAKi) in 2013 in Japan. The rate of orthopedic surgery, including total hip arthroplasties (THA), may reflect trends in disease severity, management, and health outcomes.

Materials and methods: An analysis of data on THAs performed at our institutes for treatment of RA with BIO or non-BIO therapy from 2004 to 2021 was conducted.

Results: A total of 40,328 orthopedic surgeries, including 5,938 primary THAs and 204 RA-THAs, were performed between 2004 and 2021. An increase in the annual rate of THA performed for patients undergoing orthopedic surgery was observed. The rates of THA decreased annually for patients with RA when compared to the total number of orthopedic surgeries and primary THAs performed.

Conclusion: The number of THAs performed for patients with RA may show an annual decrease resulting from early and aggressive drug therapy for management of RA in the era of BIO and JAKi. However, patients with RA undergoing THA have several unmet needs, including secondary osteoarthritis, dislocation, periprosthetic joint infection, and periprosthetic fracture with osteoporosis.

目的:自2003年生物制剂(BIO)和2013年Janus激酶抑制剂(JAKi)在日本引入以来,治疗类风湿性关节炎(RA)的疗法显示出显着的改善。包括全髋关节置换术(THA)在内的骨科手术率可能反映疾病严重程度、管理和健康结果的趋势。材料和方法:对2004年至2021年在我们研究所进行的生物或非生物治疗类风湿性关节炎的tha数据进行分析。结果:2004 - 2021年共实施骨科手术40328例,其中原发性tha手术5938例,ra - tha手术204例。观察到接受骨科手术的患者每年进行全髋关节置换术的比率增加。与骨科手术和原发性THA的总数相比,RA患者THA的发生率每年都在下降。结论:在BIO和JAKi时代,由于早期和积极的药物治疗RA, RA患者的tha数量可能呈逐年减少的趋势。然而,接受THA的RA患者有几个未满足的需求,包括继发性骨关节炎、脱位、假体周围关节感染和假体周围骨折伴骨质疏松症。
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引用次数: 0
Comparison of Analgesic Efficacy between Ultrasound-guided Supra-inguinal Fascia Iliaca Block and Pericapsular Nerve Group Block following Total Hip Arthroplasty: A Randomized Controlled Trial. 超声引导下腹股沟上髂筋膜阻滞与囊周神经阻滞对全髋关节置换术后镇痛效果的比较:一项随机对照试验。
Pub Date : 2024-12-01 DOI: 10.5371/hp.2024.36.4.290
Chutikant Vichainarong, Wirinaree Kampitak, Srihatach Ngarmukos, Aree Tanavalee, Chotetawan Tanavalee, Pongkwan Jinaworn

Purpose: The effectiveness of pericapsular nerve group (PENG) block versus suprainguinal fascia iliaca block (SFIB) for pain relief after hip arthroplasty is a topic of ongoing debate. This study aimed to examine the association of PENG block with lower consumption of opioids during the first 24 hours following surgery compared to SFIB.

Materials and methods: In this single-center, double-blind, randomized controlled trial, 60 patients scheduled for an elective posterior approach to total hip arthroplasty (THA) were randomized according to two groups: ultrasound-guided PENG block (PENG group) or SFIB (SFIB group). The 24-hour consumption of intravenous fentanyl was the primary outcome. Secondary outcomes included perioperative consumption of intravenous fentanyl, pain scores, sensorimotor function, and functional measures.

Results: No significant intergroup difference was observed in 24-hour total fentanyl consumption (SFIB group: 117.4±99.8 μg, PENG group: 145.9±122.7 μg; mean difference: 22.6 μg [95% confidence interval -36.6 to 81.8]; P=0.45). No statistically significant difference in terms of fentanyl consumption in intraoperative, post-anesthetic care unit, at 6-hour and 48-hour postoperatively was observed between the two groups. No statistically significant differences in scores for rest and dynamic pain for all aspects of hip joint and surgical incision were observed between the groups (P>0.05). Better cutaneous sensory perception in the hip region and 12-hour postoperative quadriceps muscle strength at 90° were observed in the PENG group compared with the SFIB group (P<0.05).

Conclusion: Compared to SFIB, the addition of PENG block to multimodal analgesia did not reduce fentanyl consumption or pain scores after posterior approach THA.

目的:髋关节置换术后囊周神经群(PENG)阻滞与腹股沟上髂筋膜阻滞(SFIB)缓解疼痛的有效性是一个持续争论的话题。本研究旨在研究与SFIB相比,术后24小时内PENG阻滞与阿片类药物消耗减少的关系。材料和方法:在这项单中心、双盲、随机对照试验中,60例计划择期后路全髋关节置换术(THA)的患者被随机分为两组:超声引导的PENG阻滞(PENG组)或SFIB (SFIB组)。24小时静脉注射芬太尼是主要结局。次要结果包括围手术期静脉注射芬太尼用量、疼痛评分、感觉运动功能和功能测量。结果:24小时芬太尼总消耗量组间差异无统计学意义(SFIB组:117.4±99.8 μg, PENG组:145.9±122.7 μg;平均差值:22.6 μg[95%置信区间-36.6 ~ 81.8];P = 0.45)。两组术中、麻醉后护理单元、术后6小时和48小时芬太尼用量差异无统计学意义。两组患者髋关节各方面及手术切口的静息、动态疼痛评分比较,差异均无统计学意义(P < 0.05)。与SFIB组相比,PENG组髋关节区域的皮肤感觉更好,术后12小时90°四头肌肌力更好(结论:与SFIB相比,在多模式镇痛中添加PENG阻滞并没有减少后路THA后芬太尼的消耗或疼痛评分。
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引用次数: 0
The Surge of Artificial Intelligence (AI) in Scientific Writing: Who Will Hold the Rudder, You or AI? 科技写作中人工智能(AI)的兴起:谁来掌舵,你还是AI?
Pub Date : 2024-12-01 DOI: 10.5371/hp.2024.36.4.231
Kee Hyung Rhyu
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引用次数: 0
Hemiarthroplasty for Hip Fracture in Down Syndrome: A Retrospective Series of Five Cases. 唐氏综合征髋部骨折的半关节置换术:回顾性分析5例。
Pub Date : 2024-12-01 DOI: 10.5371/hp.2024.36.4.281
Ahmed Nageeb Mahmoud, John Paul Prodoehl, Maria F Echeverry-Martinez, Daniel S Horwitz

Purpose: There is limited evidence regarding the outcomes of hip hemiarthroplasty (HA) following trauma in individuals living with Down syndrome (DS). This study aims to summarize the outcomes of hip HA in a series of individuals living with DS following femoral neck fractures.

Materials and methods: This retrospective study includes five cases of hip HA in four individuals with DS and displaced femoral neck fractures. Subjects (four males) had a mean age of 49.3 years (range, 26.1-59.7 years) at the time of surgery. All subjects presented with hip pain, loss of weight-bearing ability, and decreased activity level as reported by the subject caregivers. In all cases, the precise time of injury was not known.

Results: After a mean follow-up of 15.2 months, all subjects had returned to the pre-injury activity level without any recorded complications. One individual died 32 months after surgery for unrelated causes; the remaining subjects are alive and ambulating without pain at a mean of 24.2 months since the surgery.

Conclusion: When treating femoral neck fractures in those living with DS, careful history taking should be performed as regards the timing of trauma and the individual's functional status. Hip HA seems a viable treatment option for those living with DS if a proper surgical procedure is utilized.

目的:关于唐氏综合征(DS)患者创伤后髋关节置换术(HA)的结果的证据有限。本研究旨在总结一系列股骨颈骨折后退行性椎体滑移患者的髋关节HA治疗结果。材料和方法:本回顾性研究包括4例退行性椎体滑移伴移位性股骨颈骨折的5例髋关节HA。受试者(4名男性)手术时平均年龄49.3岁(范围26.1-59.7岁)。根据受试者护理人员的报告,所有受试者均表现为髋关节疼痛、负重能力丧失和活动水平下降。在所有病例中,受伤的确切时间都不清楚。结果:平均随访15.2个月后,所有受试者均恢复到损伤前活动水平,无任何并发症记录。一例患者在手术后32个月因无关原因死亡;其余受试者存活,术后平均24.2个月无疼痛行走。结论:在治疗退行性椎体滑移患者股骨颈骨折时,应根据创伤时间和个体功能状态仔细记录病史。如果采用适当的外科手术,髋部HA似乎是退行性椎体滑移患者可行的治疗选择。
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引用次数: 0
Revision Total Hip Arthroplasty for Spongy Metal Lübeck Hip Prosthesis with Repeated Stem Fracture and Periprosthetic Femur Fractures: A Case Report. 改良全髋关节置换术治疗海绵状金属<s:1>贝克髋关节假体伴重复股骨柄骨折及假体周围骨折1例。
Pub Date : 2024-12-01 DOI: 10.5371/hp.2024.36.4.320
Takuya Nakai, Shigeo Fukunishi

The fully porous structure of the Lübeck prosthesis is designed to closely resemble cancellous bone. Several studies have reported 'good' to 'excellent' mid- to long-term results for use of the Lübeck, but stem fractures have been reported as a complication. We report on the case of an 85-year-old patient who underwent total hip arthroplasty (THA) using the Lübeck more than 25 years ago who underwent revision surgery for management of two periprosthetic femoral fractures and a stem fracture. A subtrochanteric fracture and a fracture of the stem were observed on radiographs, and a radiolucent line was observed in the proximal portion of the stem and a well-fixed distal portion was observed. Revision THA using a proximal femoral replacement stem and resection of the proximal femur has been proven as an effective procedure for treatment of an elderly patient with a fractured Lübeck stem with a well-fixed distal stem.

l贝克假体的全多孔结构被设计成与松质骨非常相似。有几项研究报道了使用l柄的中长期效果为“好”到“优”,但有报道称柄骨折是一种并发症。我们报告了一例85岁的患者,25年前使用l beck行全髋关节置换术(THA),并接受翻修手术治疗两例假体周围骨折和一例股骨骨干骨折。在x线片上观察到转子下骨折和柄骨折,在柄近端观察到一条透光线,远端观察到固定良好。采用股骨近端置换术和股骨近端切除翻修THA已被证明是治疗老年患者远端固定良好的腰椎椎弓根骨折的有效方法。
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引用次数: 0
Current Concepts and Medical Management for Patients with Radiographic Axial Spondyloarthritis. 影像学诊断中轴性脊柱炎的当前观念与医疗管理。
Pub Date : 2024-12-01 DOI: 10.5371/hp.2024.36.4.234
Seung-Hoon Baek, Seungbae Oh, Bum-Jin Shim, Jeong Joon Yoo, Jung-Mo Hwang, Tae-Young Kim, Seung-Cheol Shim

Radiographic axial spondyloarthritis (r-axSpA), a chronic inflammatory disease, can cause significant radiographic damage to the axial skeleton. Regarding the pathogenic mechanism, association of r-axSpA with tumor necrosis factor (TNF) and the interleukin-23/17 (IL23/ IL17) pathway has been reported. Development of extraarticular manifestations, including uveitis, inflammatory bowel disease, and psoriasis, has been reported in some patients. The pivotal role of human leukocyte antigen-B27 in the pathogenesis of r-axSpA remains to be clarified. Symptoms usually start in late adolescence or early adulthood, and disease progression can vary in each patient, with clinical manifestations ranging from mild joint stiffness without radiographic changes to advanced manifestations including complete fusion of the spine, and severe arthritis of the hip, and could include peripheral arthritis and extraarticular manifestations. The modified New York criteria was used previously in diagnosis of r-axSpA. However, early diagnosis of the disease prior to development of bone deformity was required due to development of biological agents. As a result of Assessment of SpondyloArthritis international Society (ASAS), the classification was improved in part for diagnosis of spondyloarthritis prior to development of bone deformity. The diagnosis is based on comprehensive laboratory findings, physical examinations, and radiologic findings. Medical treatment for r-axSpA involves the use of a stepwise strategy, starting with administration of nonsteroidal anti-inflammatory drugs and physiotherapy, and progressing to sulfasalazine or methotrexate and biologics including TNF-α inhibitors or IL-17 inhibitors as needed. Use of Janus kinase inhibitors has been recently reported.

影像学中轴性脊柱炎(r-axSpA)是一种慢性炎症性疾病,可对中轴骨骼造成严重的影像学损伤。关于其致病机制,已有报道r-axSpA与肿瘤坏死因子(TNF)和白细胞介素-23/17 (IL23/ IL17)通路相关。一些患者出现关节外表现,包括葡萄膜炎、炎症性肠病和牛皮癣。人白细胞抗原b27在r-axSpA发病机制中的关键作用尚不清楚。症状通常始于青春期晚期或成年早期,每个患者的病情进展各不相同,临床表现从无影像学改变的轻度关节僵硬到晚期表现,包括脊柱完全融合和严重的髋关节关节炎,并可能包括外周关节炎和关节外表现。修订后的纽约标准以前用于r-axSpA的诊断。然而,由于生物制剂的发展,需要在骨骼畸形发展之前对疾病进行早期诊断。由于国际脊椎关节炎评估协会(ASAS)的结果,该分类得到了改进,部分是为了在骨骼畸形发展之前诊断脊椎关节炎。诊断是基于综合实验室结果、体格检查和放射学结果。r-axSpA的医学治疗包括使用循序渐进的策略,从非甾体抗炎药和物理治疗开始,根据需要进展到磺胺氮嗪或甲氨蝶呤和包括TNF-α抑制剂或IL-17抑制剂的生物制剂。最近报道了Janus激酶抑制剂的使用。
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引用次数: 0
Greater Trochanter Tip as an Anatomical Reference to Minimize Leg Length Discrepancy following Hip Arthroplasty. 大转子尖端作为髋关节置换术后减少腿长差异的解剖学参考。
Pub Date : 2024-12-01 DOI: 10.5371/hp.2024.36.4.302
John Christian Parsaoran Butarbutar, Gian Ivander, Albert Riantho, Kevin Fidiasrianto, Joshua Edward, Earlene Tasya

Purpose: The objective of the current study is to introduce a proposed method and evaluate its efficacy using the greater trochanter (GT) tip rather than the lesser trochanter (LT) as an anatomical landmark to reduce leg length discrepancy (LLD) during performance of hip arthroplasty.

Materials and methods: Thirty-two patients who underwent hip arthroplasty were divided according to the GT group (n=17) and the LT control group (n=11); four patients were excluded. LLD was determined by assessing the vertical lengths parallel to the line connecting the lower margin of the teardrop to the most prominent part of the LT on a standing anteroposterior pelvic X-ray taken 30 days after the procedure. The mean and median LLD of the two groups were compared. Analysis of planning for femoral stem depth insertion and postoperative results was also performed.

Results: No significant differences in characteristics including age, sex, or body mass index were observed between the two groups. However, the type of arthroplasty differed significantly between groups (P=0.016). The mean postoperative LLD was significantly smaller in the GT group compared with the control group (P=0.004). The results of linear regression of femoral stem depth showed a significant association between intraoperative planning and postoperative measurement (t=2.705, r2=0.672, P=0.016).

Conclusion: Preoperative measurement in determining femoral stem depth insertion using the GT tip as an anatomical reference can effectively minimize LLD in patients who underwent hip arthroplasty.

目的:本研究的目的是介绍一种拟议的方法,并评估其有效性,使用大转子(GT)尖端而不是小转子(LT)作为解剖学标志,以减少髋关节置换术中腿长差异(LLD)。材料与方法:32例髋关节置换术患者分为GT组(n=17)和LT对照组(n=11);4例患者被排除在外。LLD的确定是通过在术后30天站立骨盆正位x光片上评估泪滴下缘与LT最突出部分连接线平行的垂直长度。比较两组患者LLD的平均值和中位数。分析股骨干深度插入计划及术后结果。结果:两组患者在年龄、性别、体重指数等方面均无显著差异。但两组间关节置换类型差异有统计学意义(P=0.016)。GT组术后平均LLD明显小于对照组(P=0.004)。股骨干深度线性回归结果显示术中计划与术后测量有显著相关性(t=2.705, r2=0.672, P=0.016)。结论:术前以GT尖端为解剖学参考测量股干插入深度可有效减少髋关节置换术患者的LLD。
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引用次数: 0
Difference of Neck Shortening in Femoral Neck Fracture between Femoral Neck System and Multiple Cannulated Cancellous Screws: Single Center, Prospective Randomized Controlled Trial. 股骨颈系统与多个空心松质螺钉在股骨颈骨折中缩短颈的差异:单中心、前瞻性随机对照试验。
Pub Date : 2024-12-01 DOI: 10.5371/hp.2024.36.4.310
Saurabh Gupta, Abhay Elhence, Sumit Banerjee, Sandeep Yadav, Prabodh Kantiwal, Rajesh Kumar Rajnish, Pushpinder Khera, Rajesh Malhotra

Purpose: Fracture union after osteosynthesis of a fracture neck femur (FNF) occurs by compression of the fracture ends and potential neck shortening. Selection of an implant for fixation of a femoral fracture of the neck can be challenging when making management decisions. Femoral neck shortening after internal fixation of FNFs using a femoral neck system (FNS) or multiple cannulated cancellous screws (MCS) was compared.

Materials and methods: This prospective interventional single-blinded randomized controlled trial was conducted at a university teaching hospital. Sixty patients undergoing internal fixation for management of sub-capital or trans-cervical FNFs were randomized and assigned, to one of the two groups-the test group (FNS group) and the control group (MCS group). Primary outcome was determined by measuring the difference in 1-year shortening of the femoral neck on radiographs between FNS and MCS. The secondary objective was to determine the correlation between neck shortening with patient reported outcome measures (PROMs) at the end of the final follow-up.

Results: At the final follow-up, shortening of the femoral neck was 3.77±1.87 mm in the FNS group, significantly lower compared with the MCS group, 6.53±1.59 mm.

Conclusion: Significantly less shortening of the femoral neck was observed in the FNS group compared with the MCS group. No statistically significant difference in PROMs was observed at 1-year follow-up. The findings of the study suggest that FNS can be regarded as a suitable alternative for internal fixation in young adults (<60 years) with trans-cervical and subcapital FNFs.

目的:骨折颈股骨(FNF)植骨后的骨折愈合是通过压迫骨折端和潜在的颈部缩短来实现的。在做出治疗决定时,选择股骨颈骨折的内固定物是具有挑战性的。比较使用股骨颈系统(FNS)或多个空心松质螺钉(MCS)内固定FNFs后股骨颈缩短。材料与方法:本前瞻性介入单盲随机对照试验在某大学附属教学医院进行。60例接受内固定治疗亚资本或经颈椎fnf的患者随机分为两组:试验组(FNS组)和对照组(MCS组)。主要结局是通过测量FNS和MCS在1年股骨颈缩短的x线片上的差异来确定的。次要目的是确定在最后随访结束时颈部缩短与患者报告的结果测量(PROMs)之间的相关性。结果:末次随访时,FNS组股骨颈缩短量为3.77±1.87 mm,明显低于MCS组(6.53±1.59 mm)。结论:FNS组股骨颈缩短量明显低于MCS组。随访1年,两组间PROMs差异无统计学意义。研究结果表明,FNS可被视为年轻成人内固定的合适选择(
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引用次数: 0
Total Hip Arthroplasty in Patients with Hip Osteoporosis: A Narrative Review. 髋关节骨质疏松患者的全髋关节置换术:综述。
Pub Date : 2024-12-01 DOI: 10.5371/hp.2024.36.4.260
Mohammad Daher, Elio Mekhael, Mouhanad M El-Othmani

Osteoporosis and osteopenia can affect patients undergoing arthroplasty of the hip, which is typically recommended for patients with severe osteoarthritis or elderly patients with a femoral neck fracture. Preoperative screening for this type of bone loss could be helpful to patients and prevent poor outcomes due to the rate of underdiagnosis of osteoporosis, which can reach 73% in patients undergoing hip arthroplasty. Complications associated with low bone mineral density include periprosthetic fractures as well as an increased revision rate. Although the benefit of antiresorptive medications postoperatively has been demonstrated, when administered preoperatively, worse outcomes were reported compared to its non-usage. Surgical management is as important as pre-medication. According to general recommendations, cemented implants provide greater benefit in osteoporotic patients. However, when using cementless implants, ribbed stems, straight tapered stems, stems with medial calcar contact, and titanium-composed stems can be used to prevent periprosthetic loss of bone mineral density; however, they should not be placed in a varus position. These stems can also be coated with zoledronate and other products.

骨质疏松和骨质减少可影响髋关节置换术患者,这通常推荐给患有严重骨关节炎的患者或老年股骨颈骨折患者。术前筛查这种类型的骨质流失可能有助于患者,并防止因骨质疏松症的漏诊率而导致的不良结果,在接受髋关节置换术的患者中,骨质疏松症的漏诊率可达73%。与低骨密度相关的并发症包括假体周围骨折以及翻修率增加。虽然术后抗吸收药物的益处已被证实,但术前给予抗吸收药物的结果比未使用更差。手术治疗和药物治疗同样重要。根据一般建议,骨水泥种植体对骨质疏松患者有更大的益处。然而,当使用无骨水泥种植体时,肋状茎、直锥形茎、与内侧跟骨接触的茎和钛成分茎可用于防止假体周围骨矿物质密度的损失;然而,它们不应该被放置在内翻的位置。这些茎也可以涂上唑来膦酸盐和其他产品。
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引用次数: 0
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Hip & pelvis
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