Metal Ion Concentrations in Body Fluids after Implantation of Hip Replacements with Metal-on-Metal Bearing – Systematic Review of Clinical and Epidemiological Studies
Identifieur interne : 000451 ( Pmc/Curation ); précédent : 000450; suivant : 000452Metal Ion Concentrations in Body Fluids after Implantation of Hip Replacements with Metal-on-Metal Bearing – Systematic Review of Clinical and Epidemiological Studies
Auteurs : Albrecht Hartmann [Allemagne] ; Franziska Hannemann [Allemagne] ; Jörg Lützner [Allemagne] ; Andreas Seidler [Allemagne] ; Hans Drexler [Allemagne] ; Klaus-Peter Günther [Allemagne] ; Jochen Schmitt [Allemagne]Source :
- PLoS ONE [ 1932-6203 ] ; 2013.
Abstract
The use of metal-on-metal (MoM) total hip arthroplasty (THA) increased in the last decades. A release of metal products (i.e. particles, ions, metallo-organic compounds) in these implants may cause local and/or systemic adverse reactions. Metal ion concentrations in body fluids are surrogate measures of metal exposure.
To systematically summarize and critically appraise published studies concerning metal ion concentrations after MoM THA.
Systematic review of clinical trials (RCTs) and epidemiological studies with assessment of metal ion levels (cobalt, chromium, titanium, nickel, molybdenum) in body fluids after implantation of metalliferous hip replacements. Systematic search in PubMed and Embase in January 2012 supplemented by hand search. Standardized abstraction of pre- and postoperative metal ion concentrations stratified by type of bearing (primary explanatory factor), patient characteristics as well as study quality characteristics (secondary explanatory factors).
Overall, 104 studies (11 RCTs, 93 epidemiological studies) totaling 9.957 patients with measurement of metal ions in body fluids were identified and analyzed. Consistently, median metal ion concentrations were persistently elevated after implantation of MoM-bearings in all investigated mediums (whole blood, serum, plasma, erythrocytes, urine) irrespective of patient characteristics and study characteristics. In several studies very high serum cobalt concentrations above 50 µg/L were measured (detection limit typically 0.3 µg/L). Highest metal ion concentrations were observed after treatment with stemmed large-head MoM-implants and hip resurfacing arthroplasty.
Due to the risk of local and systemic accumulation of metallic products after treatment with MoM-bearing, risk and benefits should be carefully balanced preoperatively. The authors support a proposed „time out“ for stemmed large-head MoM-THA and recommend a restricted indication for hip resurfacing arthroplasty. Patients with implanted MoM-bearing should receive regular and standardized monitoring of metal ion concentrations. Further research is indicated especially with regard to potential systemic reactions due to accumulation of metal products.
Url:
DOI: 10.1371/journal.pone.0070359
PubMed: 23950923
PubMed Central: 3737219
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Metal Ion Concentrations in Body Fluids after Implantation of Hip Replacements with Metal-on-Metal Bearing – Systematic Review of Clinical and Epidemiological Studies</title><author><name sortKey="Hartmann, Albrecht" sort="Hartmann, Albrecht" uniqKey="Hartmann A" first="Albrecht" last="Hartmann">Albrecht Hartmann</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>University Hospital Carl Gustav Carus Dresden, University Centre for Orthopaedics and Trauma Surgery, Dresden, Germany</addr-line></nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>University Hospital Carl Gustav Carus Dresden, University Centre for Orthopaedics and Trauma Surgery, Dresden</wicri:regionArea></affiliation></author><author><name sortKey="Hannemann, Franziska" sort="Hannemann, Franziska" uniqKey="Hannemann F" first="Franziska" last="Hannemann">Franziska Hannemann</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>University Hospital Carl Gustav Carus Dresden, University Centre for Orthopaedics and Trauma Surgery, Dresden, Germany</addr-line></nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>University Hospital Carl Gustav Carus Dresden, University Centre for Orthopaedics and Trauma Surgery, Dresden</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>University Hospital Carl Gustav Carus Dresden, Centre for Evidence-Based Health Care, Dresden, Germany</addr-line></nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>University Hospital Carl Gustav Carus Dresden, Centre for Evidence-Based Health Care, Dresden</wicri:regionArea></affiliation></author><author><name sortKey="Lutzner, Jorg" sort="Lutzner, Jorg" uniqKey="Lutzner J" first="Jörg" last="Lützner">Jörg Lützner</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>University Hospital Carl Gustav Carus Dresden, University Centre for Orthopaedics and Trauma Surgery, Dresden, Germany</addr-line></nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>University Hospital Carl Gustav Carus Dresden, University Centre for Orthopaedics and Trauma Surgery, Dresden</wicri:regionArea></affiliation></author><author><name sortKey="Seidler, Andreas" sort="Seidler, Andreas" uniqKey="Seidler A" first="Andreas" last="Seidler">Andreas Seidler</name><affiliation wicri:level="1"><nlm:aff id="aff3"><addr-line>Dresden University of Technology, Occupational and Social Medicine, Dresden, Germany</addr-line></nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Dresden University of Technology, Occupational and Social Medicine, Dresden</wicri:regionArea></affiliation></author><author><name sortKey="Drexler, Hans" sort="Drexler, Hans" uniqKey="Drexler H" first="Hans" last="Drexler">Hans Drexler</name><affiliation wicri:level="1"><nlm:aff id="aff4"><addr-line>University Erlangen-Nuremberg, Occupational, Social and Environmental Medicine, Erlangen, Germany</addr-line></nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>University Erlangen-Nuremberg, Occupational, Social and Environmental Medicine, Erlangen</wicri:regionArea></affiliation></author><author><name sortKey="Gunther, Klaus Peter" sort="Gunther, Klaus Peter" uniqKey="Gunther K" first="Klaus-Peter" last="Günther">Klaus-Peter Günther</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>University Hospital Carl Gustav Carus Dresden, University Centre for Orthopaedics and Trauma Surgery, Dresden, Germany</addr-line></nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>University Hospital Carl Gustav Carus Dresden, University Centre for Orthopaedics and Trauma Surgery, Dresden</wicri:regionArea></affiliation></author><author><name sortKey="Schmitt, Jochen" sort="Schmitt, Jochen" uniqKey="Schmitt J" first="Jochen" last="Schmitt">Jochen Schmitt</name><affiliation wicri:level="1"><nlm:aff 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type="wicri:Area/Pmc/Corpus">000452</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000452</idno><idno type="wicri:Area/Pmc/Curation">000451</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000451</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Metal Ion Concentrations in Body Fluids after Implantation of Hip Replacements with Metal-on-Metal Bearing – Systematic Review of Clinical and Epidemiological Studies</title><author><name sortKey="Hartmann, Albrecht" sort="Hartmann, Albrecht" uniqKey="Hartmann A" first="Albrecht" last="Hartmann">Albrecht Hartmann</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>University Hospital Carl Gustav Carus Dresden, University Centre for Orthopaedics and Trauma Surgery, Dresden, Germany</addr-line></nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>University Hospital Carl Gustav Carus Dresden, University Centre for Orthopaedics and Trauma Surgery, Dresden</wicri:regionArea></affiliation></author><author><name sortKey="Hannemann, Franziska" sort="Hannemann, Franziska" uniqKey="Hannemann F" first="Franziska" last="Hannemann">Franziska Hannemann</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>University Hospital Carl Gustav Carus Dresden, University Centre for Orthopaedics and Trauma Surgery, Dresden, Germany</addr-line></nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>University Hospital Carl Gustav Carus Dresden, University Centre for Orthopaedics and Trauma Surgery, Dresden</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>University Hospital Carl Gustav Carus Dresden, Centre for Evidence-Based Health Care, Dresden, Germany</addr-line></nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>University Hospital Carl Gustav Carus Dresden, Centre for Evidence-Based Health Care, Dresden</wicri:regionArea></affiliation></author><author><name sortKey="Lutzner, Jorg" sort="Lutzner, Jorg" uniqKey="Lutzner J" first="Jörg" last="Lützner">Jörg Lützner</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>University Hospital Carl Gustav Carus Dresden, University Centre for Orthopaedics and Trauma Surgery, Dresden, Germany</addr-line></nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>University Hospital Carl Gustav Carus Dresden, University Centre for Orthopaedics and Trauma Surgery, Dresden</wicri:regionArea></affiliation></author><author><name sortKey="Seidler, Andreas" sort="Seidler, Andreas" uniqKey="Seidler A" first="Andreas" last="Seidler">Andreas Seidler</name><affiliation wicri:level="1"><nlm:aff id="aff3"><addr-line>Dresden University of Technology, Occupational and Social Medicine, Dresden, Germany</addr-line></nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Dresden University of Technology, Occupational and Social Medicine, Dresden</wicri:regionArea></affiliation></author><author><name sortKey="Drexler, Hans" sort="Drexler, Hans" uniqKey="Drexler H" first="Hans" last="Drexler">Hans Drexler</name><affiliation wicri:level="1"><nlm:aff id="aff4"><addr-line>University Erlangen-Nuremberg, Occupational, Social and Environmental Medicine, Erlangen, Germany</addr-line></nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>University Erlangen-Nuremberg, Occupational, Social and Environmental Medicine, Erlangen</wicri:regionArea></affiliation></author><author><name sortKey="Gunther, Klaus Peter" sort="Gunther, Klaus Peter" uniqKey="Gunther K" first="Klaus-Peter" last="Günther">Klaus-Peter Günther</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>University Hospital Carl Gustav Carus Dresden, University Centre for Orthopaedics and Trauma Surgery, Dresden, Germany</addr-line></nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>University Hospital Carl Gustav Carus Dresden, University Centre for Orthopaedics and Trauma Surgery, Dresden</wicri:regionArea></affiliation></author><author><name sortKey="Schmitt, Jochen" sort="Schmitt, Jochen" uniqKey="Schmitt J" first="Jochen" last="Schmitt">Jochen Schmitt</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>University Hospital Carl Gustav Carus Dresden, Centre for Evidence-Based Health Care, Dresden, Germany</addr-line></nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>University Hospital Carl Gustav Carus Dresden, Centre for Evidence-Based Health Care, Dresden</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff3"><addr-line>Dresden University of Technology, Occupational and Social Medicine, Dresden, Germany</addr-line></nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Dresden University of Technology, Occupational and Social Medicine, Dresden</wicri:regionArea></affiliation></author></analytic><series><title level="j">PLoS ONE</title><idno type="eISSN">1932-6203</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Introduction</title><p>The use of metal-on-metal (MoM) total hip arthroplasty (THA) increased in the last decades. A release of metal products (i.e. particles, ions, metallo-organic compounds) in these implants may cause local and/or systemic adverse reactions. Metal ion concentrations in body fluids are surrogate measures of metal exposure.</p></sec><sec><title>Objective</title><p>To systematically summarize and critically appraise published studies concerning metal ion concentrations after MoM THA.</p></sec><sec><title>Methods</title><p>Systematic review of clinical trials (RCTs) and epidemiological studies with assessment of metal ion levels (cobalt, chromium, titanium, nickel, molybdenum) in body fluids after implantation of metalliferous hip replacements. Systematic search in PubMed and Embase in January 2012 supplemented by hand search. Standardized abstraction of pre- and postoperative metal ion concentrations stratified by type of bearing (primary explanatory factor), patient characteristics as well as study quality characteristics (secondary explanatory factors).</p></sec><sec><title>Results</title><p>Overall, 104 studies (11 RCTs, 93 epidemiological studies) totaling 9.957 patients with measurement of metal ions in body fluids were identified and analyzed. Consistently, median metal ion concentrations were persistently elevated after implantation of MoM-bearings in all investigated mediums (whole blood, serum, plasma, erythrocytes, urine) irrespective of patient characteristics and study characteristics. In several studies very high serum cobalt concentrations above 50 µg/L were measured (detection limit typically 0.3 µg/L). Highest metal ion concentrations were observed after treatment with stemmed large-head MoM-implants and hip resurfacing arthroplasty.</p></sec><sec><title>Discussion</title><p>Due to the risk of local and systemic accumulation of metallic products after treatment with MoM-bearing, risk and benefits should be carefully balanced preoperatively. The authors support a proposed „time out“ for stemmed large-head MoM-THA and recommend a restricted indication for hip resurfacing arthroplasty. Patients with implanted MoM-bearing should receive regular and standardized monitoring of metal ion concentrations. Further research is indicated especially with regard to potential systemic reactions due to accumulation of metal products.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Learmonth, Id" uniqKey="Learmonth I">ID Learmonth</name></author><author><name sortKey="Young, C" uniqKey="Young C">C Young</name></author><author><name sortKey="Rorabeck, C" uniqKey="Rorabeck C">C Rorabeck</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Brockett, C" uniqKey="Brockett C">C Brockett</name></author><author><name sortKey="Williams, S" uniqKey="Williams S">S Williams</name></author><author><name sortKey="Jin, Z" uniqKey="Jin Z">Z Jin</name></author><author><name sortKey="Isaac, G" uniqKey="Isaac G">G Isaac</name></author><author><name sortKey="Fisher, J" uniqKey="Fisher J">J Fisher</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ishida, T" uniqKey="Ishida T">T 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<front><journal-meta><journal-id journal-id-type="nlm-ta">PLoS One</journal-id><journal-id journal-id-type="iso-abbrev">PLoS ONE</journal-id><journal-id journal-id-type="publisher-id">plos</journal-id><journal-id journal-id-type="pmc">plosone</journal-id><journal-title-group><journal-title>PLoS ONE</journal-title></journal-title-group><issn pub-type="epub">1932-6203</issn><publisher><publisher-name>Public Library of Science</publisher-name><publisher-loc>San Francisco, USA</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">23950923</article-id><article-id pub-id-type="pmc">3737219</article-id><article-id pub-id-type="publisher-id">PONE-D-13-07137</article-id><article-id pub-id-type="doi">10.1371/journal.pone.0070359</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="Discipline-v2"><subject>Biology</subject><subj-group><subject>Biochemistry</subject><subj-group><subject>Blood Chemistry</subject></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v2"><subject>Medicine</subject><subj-group><subject>Clinical Research Design</subject><subj-group><subject>Systematic Reviews</subject></subj-group></subj-group><subj-group><subject>Non-Clinical Medicine</subject><subj-group><subject>Health Care Policy</subject><subj-group><subject>Health Risk Analysis</subject><subject>Health Statistics</subject><subject>Health Systems Strengthening</subject></subj-group></subj-group></subj-group><subj-group><subject>Surgery</subject><subj-group><subject>Orthopedic Surgery</subject><subj-group><subject>Joint Replacement Surgery</subject></subj-group></subj-group></subj-group></subj-group></article-categories><title-group><article-title>Metal Ion Concentrations in Body Fluids after Implantation of Hip Replacements with Metal-on-Metal Bearing – Systematic Review of Clinical and Epidemiological Studies</article-title><alt-title alt-title-type="running-head">Metal Ion Concentrations Following MoM THA/HRA</alt-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Hartmann</surname><given-names>Albrecht</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Hannemann</surname><given-names>Franziska</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Lützner</surname><given-names>Jörg</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Seidler</surname><given-names>Andreas</given-names></name><xref ref-type="aff" rid="aff3"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>Drexler</surname><given-names>Hans</given-names></name><xref ref-type="aff" rid="aff4"><sup>4</sup></xref></contrib><contrib contrib-type="author"><name><surname>Günther</surname><given-names>Klaus-Peter</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref ref-type="corresp" rid="cor1"><sup>*</sup></xref></contrib><contrib contrib-type="author"><name><surname>Schmitt</surname><given-names>Jochen</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref><xref ref-type="aff" rid="aff3"><sup>3</sup></xref></contrib></contrib-group><aff id="aff1"><label>1</label><addr-line>University Hospital Carl Gustav Carus Dresden, University Centre for Orthopaedics and Trauma Surgery, Dresden, Germany</addr-line></aff><aff id="aff2"><label>2</label><addr-line>University Hospital Carl Gustav Carus Dresden, Centre for Evidence-Based Health Care, Dresden, Germany</addr-line></aff><aff id="aff3"><label>3</label><addr-line>Dresden University of Technology, Occupational and Social Medicine, Dresden, Germany</addr-line></aff><aff id="aff4"><label>4</label><addr-line>University Erlangen-Nuremberg, Occupational, Social and Environmental Medicine, Erlangen, Germany</addr-line></aff><contrib-group><contrib contrib-type="editor"><name><surname>el Joseph</surname><given-names>Jo Gagnier</given-names></name><role>Editor</role><xref ref-type="aff" rid="edit1"></xref></contrib></contrib-group><aff id="edit1"><addr-line>University of Michigan, United States of America</addr-line></aff><author-notes><corresp id="cor1">* E-mail: <email>Klaus-Peter.Guenther@uniklinikum-dresden.de</email></corresp><fn fn-type="conflict"><p><bold>Competing Interests: </bold>AH: remuneration for lecture Aesculap, Zimmer; paid consultancy for this work by German Osteoarthritis Society. FH: Paid employment for this work by German Osteoarthritis Society. JL: Financial support for educational activities (Aesculap, Bayer, Mathys) and re-search funding (Aesculap, Mathys, Smith & Nephew, Stryker). AS: Paid consultancy for this work by German Osteoarthritis Society. HD: none. KPG: Financial support for educational activities (Aesculap, Link, Zimmer) and re-search funding (Aesculap, DePuy, Smith & Nephew, Zimmer). JS: Paid consultancy for this work by German Osteoarthritis Society. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials.</p></fn><fn fn-type="con"><p>Analyzed the data: AH FH JL AS HD KPG JS. Wrote the paper: AH FH JL AS HD KPG JS.</p></fn></author-notes><pub-date pub-type="collection"><year>2013</year></pub-date><pub-date pub-type="epub"><day>7</day><month>8</month><year>2013</year></pub-date><volume>8</volume><issue>8</issue><elocation-id>e70359</elocation-id><history><date date-type="received"><day>14</day><month>2</month><year>2013</year></date><date date-type="accepted"><day>16</day><month>6</month><year>2013</year></date></history><permissions><copyright-year>2013</copyright-year><copyright-holder>Hartmann et al</copyright-holder><license><license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</license-p></license></permissions><abstract><sec><title>Introduction</title><p>The use of metal-on-metal (MoM) total hip arthroplasty (THA) increased in the last decades. A release of metal products (i.e. particles, ions, metallo-organic compounds) in these implants may cause local and/or systemic adverse reactions. Metal ion concentrations in body fluids are surrogate measures of metal exposure.</p></sec><sec><title>Objective</title><p>To systematically summarize and critically appraise published studies concerning metal ion concentrations after MoM THA.</p></sec><sec><title>Methods</title><p>Systematic review of clinical trials (RCTs) and epidemiological studies with assessment of metal ion levels (cobalt, chromium, titanium, nickel, molybdenum) in body fluids after implantation of metalliferous hip replacements. Systematic search in PubMed and Embase in January 2012 supplemented by hand search. Standardized abstraction of pre- and postoperative metal ion concentrations stratified by type of bearing (primary explanatory factor), patient characteristics as well as study quality characteristics (secondary explanatory factors).</p></sec><sec><title>Results</title><p>Overall, 104 studies (11 RCTs, 93 epidemiological studies) totaling 9.957 patients with measurement of metal ions in body fluids were identified and analyzed. Consistently, median metal ion concentrations were persistently elevated after implantation of MoM-bearings in all investigated mediums (whole blood, serum, plasma, erythrocytes, urine) irrespective of patient characteristics and study characteristics. In several studies very high serum cobalt concentrations above 50 µg/L were measured (detection limit typically 0.3 µg/L). Highest metal ion concentrations were observed after treatment with stemmed large-head MoM-implants and hip resurfacing arthroplasty.</p></sec><sec><title>Discussion</title><p>Due to the risk of local and systemic accumulation of metallic products after treatment with MoM-bearing, risk and benefits should be carefully balanced preoperatively. The authors support a proposed „time out“ for stemmed large-head MoM-THA and recommend a restricted indication for hip resurfacing arthroplasty. Patients with implanted MoM-bearing should receive regular and standardized monitoring of metal ion concentrations. Further research is indicated especially with regard to potential systemic reactions due to accumulation of metal products.</p></sec></abstract><funding-group><funding-statement>The project was funded by the German Osteoarthritis Society (<ext-link ext-link-type="uri" xlink:href="http://www.arthrose.de/">http://www.arthrose.de/</ext-link>). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.</funding-statement></funding-group><counts><page-count count="25"></page-count></counts></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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