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Femoroacetabular impingement surgery leads to early pain relief but minimal functional gains past 6 months: experience from the FIRST trial

  • HIP
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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To understand the early outcomes after hip arthroscopy and better define the trajectory of improvement in a prospective cohort of patients who have undergone hip arthroscopic osteochondroplasty for femoroacetabular impingement (FAI) syndrome.

Methods

Data were analyzed from the Femoroacetabular Impingement RandomiSed controlled Trial (FIRST) on the 108 study patients who underwent osteochondroplasty, with or without labral repair. Study outcomes included patient-reported pain (using a 100-point Visual Analogue Scale (VAS)), hip function (using the Hip Outcome Score (HOS) and International Hip Outcome Tool (iHOT-12)), and health-related quality of life (using the EuroQol 5 Dimensions (EQ-5D)) measured at baseline, 2 weeks, 3 months, 6 months, and 12 months post-operatively.

Results

There was a decrease in mean post-operative pain VAS scores from baseline. The first 2 weeks post-operative yielded the greatest reduction in pain with a mean (SD) VAS score of 37.8 (23.4), with score stabilization between 6 months (26.9 (26.9)) and 12 months (25.3 (27.6)). Mean HOS (activities of daily living) scores improved from baseline (59.7 (16.2)) starting at 6 weeks post-operative (64.1 (19.1)). The HOS (Sports) showed no improvement from baseline (41.2 (20.4)) until 3 months (49.1 (27.9)), and continued to improve at 6 months (64.1 (28.7)) and 12 months (68.6 (30.5)). The iHOT-12 scores showed functional improvement from baseline (31.3 (18.8)), as early as 6 weeks (44.9 (22.4)) up to and including 12 months (67.1 (29.7)). EQ-5D index scores showed modest steady improvement from 6 weeks to 12 months post-operative, while the EQ-5D VAS component similarly showed modest and steady improvements from 3 months onward.

Conclusion

Results from this study highlight that hip arthroscopic osteochondroplasty with or without labral repair for FAI leads to early pain relief. While all scores improved from baseline, functional gains appear to plateau from 6 months onwards. These data can be used to inform decision-making about timelines for rehabilitation and return to sport, a knowledge gap in the current FAI literature.

Level of evidence

II.

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Abbreviations

FAI:

Femoroacetabular impingement

FIRST:

Femoroacetabular Impingement RandomiSed controlled Trial

RCT:

Randomized controlled trial

VAS:

Visual analogue scale

HOS-ADL:

Hip outcome score-activities of daily living

HOS-Sports:

Hip outcome score-sports subscale

iHOT-12:

International hip outcome tool-12

MCID:

Minimum clinically important difference

EQ-5D:

Euro-Qol 5 dimensions

References

  1. Ayeni OR, Karlsson J, Heels-Ansdell D, Thabane L, Musahl V, Simunovic N, Duong A, Bhandari M, Bedi A, Järvinen T, Naudie D, Seppänen M, Slobogean G, Skelly M, Shanmugaraj A, Crouch S, Sprague S, Buckingham L, Ramsay T, Lee J, Kousa P, Carsen S, Choudur H, Sim Y, Johnston K, Sprague S, Wong I, Murphy R, Sparavalo S, Whelan D, Khan R, Wood GCA, Howells F, Grant H, Naudie D, Zomar B, Pollock M, Willits K, Firth A, Wanlin S, Remtulla A, Kaniki N, Belzile EL, Turmel S, Jørgensen U, Gam-Pedersen A, Hatanpää T, Sihvonen R, Raivio M, Toivonen P, Routapohja MP (2020) Osteochondroplasty and labral repair for the treatment of young adults with femoroacetabular impingement: a randomized controlled trial. Am J Sports Med. https://doi.org/10.1177/0363546520952804

    Article  PubMed  PubMed Central  Google Scholar 

  2. Bayley G, Poitras S, Parker G, Beaulé PE (2016) Hip arthroscopy in patients less than 25 years of age in the treatment of labral tears: aetiology and clinical outcomes. HIP Int 27:436–442

    Article  Google Scholar 

  3. Bennett AN, Nixon J, Roberts A, Barker-Davies R, Villar R, Houghton JM (2016) Prospective 12-month functional and vocational outcomes of hip arthroscopy for femoroacetabular impingement as part of an evidence-based hip pain rehabilitation pathway in an active military population. BMJ Open Sport Exerc Med 2:e000144

    Article  CAS  Google Scholar 

  4. Bosch BL, Hunink MGM (2000) (2000) Comparison of the Health Utilities Index Mark 3 (HUI3) and the EuroQol EQ-5D in patients treated for intermittent claudication. Qual Life Res 9:591–601

    Article  CAS  Google Scholar 

  5. Bozic KJ, Chan V, Valone FH, Feeley BT, Vail TP (2013) Trends in hip arthroscopy utilization in the United States. J Arthroplasty 28:140–143

    Article  Google Scholar 

  6. Chahal J, Thiel GS Van, Mather RC, Lee S, Salata MJ, Nho SJ. (2014) The Minimal Clinical Important Difference (MCID) And Patient Acceptable Symptomatic State (PASS) For The Modified Harris Hip Score And Hip Outcome Score Among Patients Undergoing Surgical Treatment For Femoroacetabular Impingement. Orthop J Sport Med. 2:2325967114S00105

  7. Chahal J, Van TGS, Mather RC, Lee S, Song SH, Davis AM, Salata M, Nho SJ (2015) The patient acceptable symptomatic state for the modified harris hip score and hip outcome score among patients undergoing surgical treatment for femoroacetabular impingement. Am J Sports Med 43:1844–1849

    Article  Google Scholar 

  8. Collins SL, Moore RA, McQuay HJ (1997) The visual analogue pain intensity scale: what is moderate pain in millimetres? Pain 72:95–97

    Article  CAS  Google Scholar 

  9. Dippmann C, Thorborg K, Kraemer O, Winge S, Palm H, Hölmich P (2014) Hip arthroscopy with labral repair for femoroacetabular impingement: short-term outcomes. Knee Surgery Sport Traumatol Arthrosc 22:744–749

    Article  Google Scholar 

  10. Fabricant PD, Heyworth BE, Kelly BT (2012) Hip arthroscopy improves symptoms associated with FAI in selected adolescent athletes. Clin Orthop Relat Res 470:261–269

    Article  Google Scholar 

  11. Glaws KR, Ellis TJ, Hewett TE, Di SS (2019) Return to sport rates in physically active individuals 6 months after arthroscopy for femoroacetabular impingement syndrome. J Sport Rehabil 28:570–575

    Article  Google Scholar 

  12. Griffin DR, Dickenson EJ, Wall PDH, Achana F, Donovan JL, Griffin J, Hobson R, Hutchinson CE, Jepson M, Parsons NR, Petrou S, Realpe A, Smith J, Foster NE; FASHIoN Study Group. (2018) Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN): a multicentre randomised controlled trial. Lancet. 2;391(10136):2225–2235.

  13. Griffin DR, Parsons N, Mohtadi NGH, Safran MR (2012) A short version of the international hip outcome tool (iHOT-12) for use in routine clinical practice. Arthroscopy 28(5):611–616

    Article  Google Scholar 

  14. Ho K, Spence J, Murphy MF (1996) Review of pain-measurement tools. Ann Emerg Med 27:427–432

    Article  CAS  Google Scholar 

  15. Hurst NP, Kind P, Ruta D, Hunter M, Stubbings A (1997) Health-related quality of life in rheumatoid arthritis: validity, responsiveness and reliability of EuroQol (EQ-5D). Br J Rheumatol 36:551–559

    Article  CAS  Google Scholar 

  16. Investigators FIRST (2015) A multi-centre randomized controlled trial comparing arthroscopic osteochondroplasty and lavage with arthroscopic lavage alone on patient important outcomes and quality of life in the treatment of young adult (18–50) Femoroacetabular impingement. BMC Musculoskelet Disord 16:64

    Article  Google Scholar 

  17. Ishøi L, Thorborg K, Kraemer O, Hölmich P (2018) Return to sport and performance after hip arthroscopy for femoroacetabular impingement in 18- to 30-year-old athletes: a cross-sectional cohort study of 189 athletes. Am J Sports Med 46:2578–2587

    Article  Google Scholar 

  18. Jensen MP, Karoly P, Braver S (1986) The measurement of clinical pain intensity: a comparison of six methods. Pain 27(1):117–126

    Article  Google Scholar 

  19. Kemp JL, Collins NJ, Makdissi M, Schache AG, Machotka Z, Crossley K (2012) Hip arthroscopy for intra-articular pathology: a systematic review of outcomes with and without femoral osteoplasty. Br J Sports Med 46:632

    Article  Google Scholar 

  20. Khan M, Ayeni OR, Madden K, Bedi A, Ranawat A, Kelly BT, Sancheti P, Ejnisman L, Tsiridis E, Bhandari M (2016) Femoroacetabular impingement: have we hit a global tipping point in diagnosis and treatment? results from the international femoroacetabular impingement optimal care update survey (IN FOCUS). Arthroscopy 32:779-787.e4

    Article  Google Scholar 

  21. Ko SJ, Terry MA, Tjong VK (2020) Return to sport after hip arthroscopy for femoroacetabular impingement syndrome: a comprehensive review of qualitative considerations. Curr Rev Musculoskelet Med 13:435–441

    Article  Google Scholar 

  22. Kowalczuk M, Yeung M, Simunovic N, Ayeni OR (2015) Does femoroacetabular impingement contribute to the development of hip osteoarthritis? Syst Rev Sports Med Arthrosc 23:174–179

    Article  Google Scholar 

  23. Maempel JF, Ting JZ, Gaston P (2018) Assessing the outcome of hip arthroscopy for labral tears in femoroacetabular impingement using the minimum dataset of the british non-arthroplasty hip register: a single-surgeon experience. Arthroscopy 34:2131–2139

    Article  Google Scholar 

  24. Mansell NS, Rhon DI, Meyer J, Slevin JM, Marchant BG (2018) arthroscopic surgery or physical therapy for patients with femoroacetabular impingement syndrome: a randomized controlled trial with 2-year follow-up. Am J Sports Med 46:1306–1314

    Article  Google Scholar 

  25. Martin RL, Kivlan BR, Christoforetti JJ, Wolff AB, Nho SJ, Salvo JP, Ellis TJ, Van TG, Matsuda DK, Carreira DS (2019) Minimal clinically important difference and substantial clinical benefit values for the 12-item international hip outcome tool. Arthroscopy 35:411–416

    Article  Google Scholar 

  26. Martin RL, Kivlan BR, Christoforetti JJ, Wolff AB, Nho SJ, Salvo JP, Ellis TJ, Van TG, Matsuda D, Carreira DS (2019) Minimal clinically important difference and substantial clinical benefit values for a pain visual analog scale after hip arthroscopy. Arthroscopy 35:2064–2069

    Article  Google Scholar 

  27. Martin RL, Kivlan BR, Christoforetti JJ, Wolff AB, Nho SJ, Salvo JP, Van TG, Matsuda D, Carreira DS (2020) Defining variations in outcomes of hip arthroscopy for femoroacetabular impingement using the 12-Item international hip outcome tool (iHOT-12). Am J Sports Med 48:1175–1180

    Article  Google Scholar 

  28. Mather RC, Nho SJ, Federer A, Demiralp B, Nguyen J, Saavoss A, Salata MJ, Philippon MJ, Bedi A, Larson CM, Byrd JWT, Koenig L (2018) Effects of arthroscopy for femoroacetabular impingement syndrome on quality of life and economic outcomes. Am J Sports Med 46:1205–1213

    Article  Google Scholar 

  29. Memon M, Kay J, Hache P, Simunovic N, Harris JD, O’Donnell J, Ayeni OR (2019) Athletes experience a high rate of return to sport following hip arthroscopy. Knee Surg Sports Traumatol Arthrosc 27:3066–3104

    Article  Google Scholar 

  30. Minkara AA, Westermann RW, Rosneck J, Lynch TS (2019) Systematic Review and meta-analysis of outcomes after hip arthroscopy in femoroacetabular impingement. Am J Sports Med 47:488–500

    Article  Google Scholar 

  31. Mohan R, Johnson NR, Hevesi M, Gibbs CM, Levy BA, Krych AJ (2017) Return to sport and clinical outcomes after hip arthroscopic labral repair in young amateur athletes: minimum 2-year follow-up. Arthroscopy 33:1679–1684

    Article  Google Scholar 

  32. Nwachukwu BU, Beck EC, Kunze KN, Chahla J, Rasio J, Nho SJ (2019) Defining the clinically meaningful outcomes for arthroscopic treatment of femoroacetabular impingement syndrome at minimum 5-year follow-up. Am J Sports Med 48:901–907

    Article  Google Scholar 

  33. O’Connor M, Minkara AA, Westermann RW, Rosneck J, Lynch TS (2018) Return to play after hip arthroscopy: a systematic review and meta-analysis. Am J Sports Med 46:2780–2788

    Article  Google Scholar 

  34. Palmer AJR, Gupta VA, Fernquest S, Rombach I, Dutton SJ, Mansour R, Wood S, Khanduja V, Pollard TCB, McCaskie AW, Barker KL, Andrade TJMD, Carr AJ, Beard DJ, Glyn-Jones S, Group FS (2019) Arthroscopic hip surgery compared with physiotherapy and activity modification for the treatment of symptomatic femoroacetabular impingement: multicentre randomised controlled trial. BMJ 364:l185

  35. Perets I, Craig MJ, Mu BH, Maldonado DR, Litrenta JM, Domb BG (2018) Midterm outcomes and return to sports among athletes undergoing hip arthroscopy. Am J Sports Med 46:1661–1667

    Article  Google Scholar 

  36. Philippon MJ, Yen Y-M, Briggs KK, Kuppersmith DA, Maxwell RB (2008) Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient. J Pediatr Orthop 28:705–710

    Article  Google Scholar 

  37. Schenker ML, Martin RR, Weiland DE, Philippon MJ (2005) Current trends in hip arthroscopy: a review of injury diagnosis, techniques, and outcome scoring. Curr Opin Orthop 16(2):89–94

    Article  Google Scholar 

  38. Simunovic N, Heels-Ansdell D, Thabane L, Ayeni OR, Bhandari M, Bedi A, Järvinen T, Musahl V, Naudie D, Seppänen M, Slobogean G, Thabane L, Simunovic N, Duong A, Skelly M, Sprague S, Heels-Ansdell D, Buckingham L, Ramsay T, Lee J, Kousa P, Carsen S, Choudur H, Sim Y, Johnston K, Wong I, Paquet N, Den HJ, Whelan D, Khan R, Wood GCA, Howells F, Grant H, Zomar B, Pollock M, Willits K, Firth A, Wanlin S, Remtulla A, Kaniki N, Belzile EL, Turmel S, Routapohja MP, Jørgensen U, Gam-Pedersen A, Sihvoenen R, Raivio M, Toivonen P (2018) Femoroacetabular Impingement Randomised controlled Trial (FIRST) - a multi-centre randomized controlled trial comparing arthroscopic lavage and arthroscopic osteochondroplasty on patient important outcomes and quality of life in the treatment of young adult (18–50 years) femoroacetabular impingement: a statistical analysis plan. Trials 19(1):588

    Article  Google Scholar 

  39. Thorborg K, Kraemer O, Madsen A-D, Hölmich P (2018) Patient-reported outcomes within the first year after hip arthroscopy and rehabilitation for femoroacetabular impingement and/or labral injury: the difference between getting better and getting back to normal. Am J Sports Med 46:2607–2614

    Article  Google Scholar 

  40. Tijssen M, van Cingel R, de Visser E, der Sanden MN (2016) A clinical observational study on patient-reported outcomes, hip functional performance and return to sports activities in hip arthroscopy patients. Phys Ther Sport 20:45–55

    Article  Google Scholar 

  41. Tjong VK, Cogan CJ, Riederman BD, Terry MA (2016) A qualitative assessment of return to sport after hip arthroscopy for femoroacetabular impingement. Orthop J Sport Med 4:2325967116671940

    Article  Google Scholar 

  42. Walters SJ, Brazier JE (2005) Comparison of the minimally important difference for two health state utility measures: EQ-5D and SF-6D. Qual Life Res 14:1523–1532

    Article  Google Scholar 

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Acknow̄ledgements

Writing Committee: Olufemi R. Ayeni MD, MSc, PhD, FRCSC (Chair, McMaster University), Jon Karlsson MD, PhD (University of Gothenburg), Diane Heels-Ansdell MSc (McMaster University), Lehana Thabane PhD (McMaster University), Volker Musahl MD (University of Pittsburgh), Nicole Simunovic MSc (McMaster University), Andrew Duong MSc (McMaster University), and Mohit Bhandari MD, PhD, FRCSC (McMaster University) .

Steering Committee: Olufemi R. Ayeni (Chair, McMaster University), Mohit Bhandari (Co-Chair, McMaster University), Asheesh Bedi (University of Michigan), Teppo Järvinen (University of Helsinki), Volker Musahl (University of Pittsburgh), Douglas Naudie (University of Western Ontario), Matti Seppänen MD (Turku University), Gerard Slobogean (University of Maryland, Baltimore), Lehana Thabane (McMaster University) .

Methods Centre: Olufemi R. Ayeni (Principal Investigator); Nicole Simunovic (Research Manager); Andrew Duong, Matthew Skelly, Ajay Shanmugaraj, Sarah Crouch (Project Management); Sheila Sprague (Research Methodologist); Diane Heels-Ansdell, (Statistical Analysis); Lisa Buckingham (Data Management) (McMaster University) .

Data and Safety Monitoring Committee: Tim Ramsay (Chair, Ottawa Hospital Research Institute), John Lee (University of Toronto), Petteri Kousa (Sports Clinic Hospital Dextra) .

Adjudication Committee: Sasha Carsen (Chair, University of Ottawa), Hema Choudur (Hamilton Health Sciences), Yan Sim (McMaster University), Kelly Johnston (University of Calgary) .

Participating Clinical Sites Canada: McMaster University Medical Centre (Hamilton, ON) – Olufemi R. Ayeni MD, PhD, FRCSC; Sarah Crouch BSc (Pharm); Andrew Duong MSc; Ajay Shanmugaraj BSc; Nicole Simunovic MSc; Matthew Skelly BSc; Sheila Sprague PhD. Dalhousie University (Halifax, NS) – Ivan Wong MD, FRCSC, Dip. Sports Medicine, MACM; Ryland Murphy BSc; Sara Sparavalo MASc. St. Michael’s Hospital (Toronto, ON) – Daniel Whelan MD, MSc, FRCSC; Ryan Khan BA, CCRP. Kingston Health Sciences Centre (Kingston, ON) – Gavin CA Wood MBChB, FRCS; Fiona Howells BPharm; Heather Grant MSc. London Health Sciences Centre (London, ON) – Douglas Naudie MD, MSc, FRCSC; Bryn Zomar MSc; Michael Pollock MSc. Fowler Kennedy Sport Medicine Clinic (London, ON) – Kevin Willits MD, FRCSC; Andrew Firth MSc; Stacey Wanlin; Alliya Remtulla MSc; Nicole Kaniki PhD. CHU de Québec-Université Laval (Quebec City, QC) – Etienne L. Belzile MD; Sylvie Turmel RN.

International: Odense University Hospital (Odense, Denmark) – Uffe Jørgensen MD, Dr. Med Sci; Annie Gam-Pedersen RN. Tays Hatanpää (Tampere University Hospital, Tampere, Finland) – Raine Sihvonen MD, PhD; Marko Raivio MD; Pirjo Toivonen PT. Turku University Hospital (Turku, Finland) - Matti Seppänen MD; Mari Pirjetta Routapohja RN.

Post-Trial Statement: The Methods Centre at McMaster University coordinated the trial. The Methods Centre was responsible for programming trial randomization, the maintenance of the database, data validation, data analyses, and study-centre coordination. The Steering Committee designed the trial, some members assisted with developing the statistical analysis plan, and vouch for the completeness and accuracy of the data and analyses. OR Ayeni, the first author and chair of the writing committee, wrote the first draft of the manuscript; the writing committee made revisions.

Funding

Research grants for the FIRST trial were received from the Canadian Institutes of Health Research (CIHR) (PI: ORA, MB), American Orthopaedic Society for Sports Medicine (PI: ORA), Canadian Orthopaedic Foundation (PI: ORA, MB), McMaster Surgical Associates (PI: ORA, MB), and Hamilton Health Sciences Department of Surgery (PI: ORA).

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Authors and Affiliations

  1. Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 1200 Main St. W. 4E15, HamiltonHamilton, ON, L8N 3Z5, Canada

    Mahmoud Almasri, Nicole Simunovic & Olufemi R. Ayeni

  2. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada

    Diane Heels-Ansdell & Olufemi R. Ayeni

  3. Mercy Health - Cincinnati Sports Medicine and Orthopaedic Center, Cincinnati, OH, USA

    Mahmoud Almasri

Authors
  1. Mahmoud Almasri
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  2. Nicole Simunovic
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  3. Diane Heels-Ansdell
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Consortia

The FIRST Investigators

  • Olufemi R. Ayeni
  • , Jon Karlsson
  • , Diane Heels-Ansdell
  • , Lehana Thabane
  • , Volker Musahl
  • , Nicole Simunovic
  • , Andrew Duong
  • , Mohit Bhandari
  • , Asheesh Bedi
  • , Teppo Järvinen
  • , Douglas Naudie
  • , Matti Seppänen
  • , Gerard Slobogean
  • , Matthew Skelly
  • , Ajay Shanmugaraj
  • , Sarah Crouch
  • , Sheila Sprague
  • , Lisa Buckingham
  • , Tim Ramsay
  • , John Lee
  • , Petteri Kousa
  • , Sasha Carsen
  • , Hema Choudur
  • , Yan Sim
  • , Kelly Johnston
  • , Ivan Wong
  • , Ryland Murphy
  • , Sara Sparavalo
  • , Daniel Whelan
  • , Ryan Khan
  • , Gavin CA
  • , Fiona Howells
  • , Bryn Zomar
  • , Michael Pollock
  • , Kevin Willits
  • , Andrew Firth
  • , Stacey Wanlin
  • , Alliya Remtulla
  • , Nicole Kaniki
  • , Etienne L. Belzile
  • , Sylvie Turmel
  • , Uffe Jørgensen
  • , Annie Gam-Pedersen
  • , Raine Sihvonen
  • , Marko Raivio
  • , Pirjo Toivonen
  •  & Mari Pirjetta Routapohja

Contributions

MA participated in data interpretation, statistical analysis, and drafted the manuscript. NS was involved in study design, data acquisition, data analysis, and revising the manuscript. DHA was involved in data acquisition and statistical analysis. OA conceived the study and participated in revision of the manuscript.

Corresponding author

Correspondence to Olufemi R. Ayeni.

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Conflict of interest

Dr. Ayeni serves on the speakers bureau for ConMed and Stryker, and sits on the editorial boards for The American Journal of Sports Medicine, and BMC Musculoskeletal Disorders.

Ethical approval

The FIRST trial was approved by the Hamilton Integrated Research Ethics Board (12-396) before it started. All participating centres obtained their own site-specific ethics approval before starting the trial. All participants provided written informed consent.

Informed consent

Written informed consent was obtained by study personnel from all patients enrolled in the FIRST trial.

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Almasri, M., Simunovic, N., Heels-Ansdell, D. et al. Femoroacetabular impingement surgery leads to early pain relief but minimal functional gains past 6 months: experience from the FIRST trial. Knee Surg Sports Traumatol Arthrosc 29, 1362–1369 (2021). https://doi.org/10.1007/s00167-020-06401-x

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