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Functional alignment in robotic-assisted total knee arthroplasty: a systematic review

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Purpose

The present study systematically reviewed current evidence on functional alignment (FA) in robotic total knee arthroplasty (TKA), discussing advantages and limitations, possible pitfalls, and prospects.

Methods

This study was conducted according to the 2020 PRISMA statement. In August 2023, the following databases were accessed: PubMed, Web of Science, Google Scholar, and Embase with no additional filters or time constraints. All the clinical studies investigating functional alignment in robotic TKA were accessed. Only studies published in peer-reviewed journals were considered. The risk of bias was evaluated following the guidelines in the Cochrane Handbook for Systematic Reviews of Interventions. Non-randomized controlled trials (non-RCTs) were evaluated using the Risk of Bias in Nonrandomised Studies of Interventions (NRSI) (ROBINS-I) tool.

Results

Data from 1198 patients (seven studies) were retrieved. The mean length of the follow-up was 17.1 ± 6.4 months. The mean age was 67.2 ± 5.4 years, and the mean BMI was 30.9 ± 2.7 kg/m2.

Conclusion

FA might improve resection accuracy, implant alignment, and gap balancing in TKA, and additional high-quality clinical trials are necessary to properly establish the superiority of FA to other alignment techniques in TKA. Long-term clinical trials are needed to investigate the impact of FA on implant survivorship.

Level of evidence

Level IV, systematic review and meta-analysis.

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Availability of data and materials

The datasets generated during and/or analyzed during the current study are available throughout the manuscript.

Registration and protocol

The present review was not registered.

References

  1. Bhatia A, Bhatia S (2023) The short-to-midterm outcomes of geniculate artery embolization for mild-to-moderate osteoarthritis of the knee: a systematic review. J Orthop 39:30–41. https://doi.org/10.1016/j.jor.2023.03.009

    Article  PubMed  Google Scholar 

  2. Via GG, Brueggeman DA, Lyons JG, Frommeyer TC, Froehle AW, Krishnamurthy AB (2023) Funding has no effect on studies evaluating viscosupplementation for knee osteoarthritis: a systematic review of bibliometrics and conflicts of interest. J Orthop 39:18–29. https://doi.org/10.1016/j.jor.2023.03.015

    Article  PubMed  Google Scholar 

  3. Saraf A, Hussain A, Bishnoi S, Habib H, Garg A (2023) Serial intraarticular injections of growth factor concentrate in knee osteoarthritis: a placebo controlled randomized study. J Orthop 37:46–52. https://doi.org/10.1016/j.jor.2023.02.006

    Article  PubMed  PubMed Central  Google Scholar 

  4. Voskuilen R, Boonen B, Tilman P, Schotanus M, Most J (2023) Demographics are no clinically relevant predictors of patient-reported knee osteoarthritis symptoms - comprehensive multivariate analysis. J Orthop 35:85–92. https://doi.org/10.1016/j.jor.2022.11.002

    Article  PubMed  Google Scholar 

  5. Migliorini F, Eschweiler J, Tingart M, B. R, (2019) Posterior-stabilized versus cruciate-retained implants for total knee arthroplasty: a meta-analysis of clinical trials. Eur J Orthop Surg Traumatol 29(4):937–946. https://doi.org/10.1007/s00590-019-02370-1

    Article  PubMed  Google Scholar 

  6. Migliorini F, Aretini P, Driessen A, El Mansy Y, Quack V, Tingart M, Eschweiler J (2021) Correction to: Better outcomes after mini-subvastus approach for primary total knee arthroplasty: a Bayesian network meta-analysis. Eur J Orthop Surg Traumatol 31(6):1259. https://doi.org/10.1007/s00590-021-03026-9

    Article  PubMed  PubMed Central  Google Scholar 

  7. Migliorini F, Eschweiler J, Baroncini A, Tingart M, Maffulli N (2021) Better outcomes after minimally invasive surgeries compared to the standard invasive medial parapatellar approach for total knee arthroplasty: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 29(11):3608–3620. https://doi.org/10.1007/s00167-020-06306-9

    Article  PubMed  Google Scholar 

  8. Shavazipour B, Afsar B, Multanen J, Miettinen K, Kujala UM (2022) Interactive multiobjective optimization for finding the most preferred exercise therapy modality in knee osteoarthritis. Ann Med 54(1):181–194. https://doi.org/10.1080/07853890.2021.2024876

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Migliorini F, Eschweiler J, Tingart M, Rath B (2019) Posterior-stabilized versus cruciate-retained implants for total knee arthroplasty: a meta-analysis of clinical trials. Eur J Orthop Surg Traumatol 29(4):937–946. https://doi.org/10.1007/s00590-019-02370-1

    Article  PubMed  Google Scholar 

  10. Migliorini F, Maffulli N, Aretini P, Trivellas A, Tingart M, Eschweiler J, Baroncini A (2021) Correction to: Impact of tourniquet during knee arthroplasty: a bayesian network metaanalysis of perioperative outcomes. Arch Orthop Trauma Surg 141(6):1025–1026. https://doi.org/10.1007/s00402-021-03844-w

    Article  PubMed  PubMed Central  Google Scholar 

  11. Migliorini F, Maffulli N, Aretini P, Trivellas A, Tingart M, Eschweiler J, Baroncini A (2021) Impact of tourniquet during knee arthroplasty: a bayesian network meta-analysis of peri-operative outcomes. Arch Orthop Trauma Surg 141(6):1007–1023. https://doi.org/10.1007/s00402-020-03725-8

    Article  PubMed  PubMed Central  Google Scholar 

  12. Migliorini F, Maffulli N, Cuozzo F, Pilone M, Elsner K, Eschweiler J (2022) No difference between mobile and fixed bearing in primary total knee arthroplasty: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 30(9):3138–3154. https://doi.org/10.1007/s00167-022-07065-5

    Article  PubMed  PubMed Central  Google Scholar 

  13. Grimberg A, Jansson VWD, Lützner J, Melsheimer O, Morlock M, Steinbrück A (2020) Endoprothesenregister Deutschland, Jahresbericht 2020

  14. Migliorini F, Weber CD, Bell A, Betsch M, Maffulli N, Poth V, Hofmann UK, Hildebrand F, Driessen A (2023) Bacterial pathogens and in-hospital mortality in revision surgery for periprosthetic joint infection of the hip and knee: analysis of 346 patients. Eur J Med Res 28(1):177. https://doi.org/10.1186/s40001-023-01138-y

    Article  PubMed  PubMed Central  Google Scholar 

  15. Makela KT, Peltola M, Sund R, Malmivaara A, Hakkinen U, Remes V (2011) Regional and hospital variance in performance of total hip and knee replacements: a national population-based study. Ann Med 43(Suppl 1):S31-38. https://doi.org/10.3109/07853890.2011.586362

    Article  PubMed  Google Scholar 

  16. Stefanac S, Oppenauer C, Zauner M, Durechova M, Dioso D, Aletaha D, Hobusch G, Windhager R, Stamm T (2022) From individualised treatment goals to personalised rehabilitation in osteoarthritis: a longitudinal prospective mapping study using the WHO international classification for functioning, disability and health. Ann Med 54(1):2816–2827. https://doi.org/10.1080/07853890.2022.2131326

    Article  PubMed  PubMed Central  Google Scholar 

  17. Cao Z, Wu Y, Li Q, Li Y, Wu J (2022) A causal relationship between childhood obesity and risk of osteoarthritis: results from a two-sample Mendelian randomization analysis. Ann Med 54(1):1636–1645. https://doi.org/10.1080/07853890.2022.2085883

    Article  PubMed  PubMed Central  Google Scholar 

  18. Statistisches Bundesamt (2020) Fallpauschalenbezogene Krankenhausstatistik (DRG-Statistik) Operationen und Prozeduren der vollstationären Patientinnen und Patienten in Krankenhäusern (4-Steller) für das Jahr 2019.1–62

  19. Statistisches Bundesamt (2017) Fallpauschalenbezogene Krankenhausstatistik (DRG-Statistik) Operationen und Prozeduren der vollstationären Patientinnen und Patienten in Krankenhäusern (4-Steller) für das Jahr 2016.

  20. Bell SW, Young P, Drury C, Smith J, Anthony I, Jones B, Blyth M, McLean A (2014) Component rotational alignment in unexplained painful primary total knee arthroplasty. Knee 21(1):272–277. https://doi.org/10.1016/j.knee.2012.09.011

    Article  PubMed  Google Scholar 

  21. Calvisi V, Lupparelli S, Padua R (2006) Do bisphosphonates reduce early micromotion and Periprosthetic bone loss in total knee arthroplasty? a review of the evidence. J Orthop Traumatol 7:201–206

    Article  PubMed Central  Google Scholar 

  22. Rodriguez-Merchan EC (2021) Patient satisfaction following primary total knee arthroplasty: contributing factors. Arch Bone Jt Surg 9(4):379–386. https://doi.org/10.22038/abjs.2020.46395.2274

    Article  PubMed  PubMed Central  Google Scholar 

  23. Brivio A, Al-Jabri T, Martin J, Barrett D, Maffulli N (2023) Debridement, antibiotics and implant retention (DAIR) is successful in the management of acutely infected unicompartmental knee arthroplasty: a case series. Ann Med 55(1):680–688. https://doi.org/10.1080/07853890.2023.2179105

    Article  PubMed  PubMed Central  Google Scholar 

  24. Hernandez-Hermoso JA, Nescolarde L, Yanez-Siller F, Calle-Garcia J, Garcia-Perdomo D, Perez-Andres R (2023) Combined femoral and tibial component total knee arthroplasty device rotation measurement is reliable and predicts clinical outcome. J Orthop Traumatol 24(1):40. https://doi.org/10.1186/s10195-023-00718-2

    Article  PubMed  PubMed Central  Google Scholar 

  25. Migliorini F, Eschweiler J, Mansy YE, Quack V, Schenker H, Tingart M, Driessen A (2020) Gap balancing versus measured resection for primary total knee arthroplasty: a meta-analysis study. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-020-03478-4

    Article  PubMed  PubMed Central  Google Scholar 

  26. Matassi F, Pettinari F, Frascona F, Innocenti M, Civinini R (2023) Coronal alignment in total knee arthroplasty: a review. J Orthop Traumatol 24(1):24. https://doi.org/10.1186/s10195-023-00702-w

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Lee SC, Gondalia V, Hwang BY, Ahn HS, Lee CK, Hunter DJ, Jung KA (2016) Is end-stage lateral osteoarthritic knee always valgus? Mechanical alignment analysis and radiographic severity assessment. J Orthop Traumatol 17(1):35–40. https://doi.org/10.1007/s10195-015-0356-9

    Article  PubMed  Google Scholar 

  28. Liu B, Feng C, Tu C (2022) Kinematic alignment versus mechanical alignment in primary total knee arthroplasty: an updated meta-analysis of randomized controlled trials. J Orthop Surg Res 17(1):201. https://doi.org/10.1186/s13018-022-03097-2

    Article  PubMed  PubMed Central  Google Scholar 

  29. Parente A, Medetti M, Raineri D, Parente F, Ventura A, Legnani C (2023) Patellofemoral knee pain following total knee arthroplasty. comparison between adjusted mechanical and inverse restricted kinematic alignment. J Orthop 43:121–124. https://doi.org/10.1016/j.jor.2023.07.027

    Article  PubMed  Google Scholar 

  30. Bhor P, Pawar S, Kutumbe D, Vatkar A, Kale S, Jagtap R (2023) Does preoperative 3D CT planning helps in predicting the component size determination and alignment in automatic robotic total knee arthroplasty (RA-TKA). J Orthop 43:25–29. https://doi.org/10.1016/j.jor.2023.07.011

    Article  PubMed  Google Scholar 

  31. Shang G, Hu M, Guo J, Hao X, Xiang S (2022) Using short knee radiographs to predict the coronal alignment after TKA: is it an accurate proxy for HKA on full-length images? J Orthop Surg Res 17(1):340. https://doi.org/10.1186/s13018-022-03235-w

    Article  PubMed  PubMed Central  Google Scholar 

  32. Wang R, Wang Z, Gu Y, Zhang J, Wang P, Tong P, Lv S (2022) Total knee arthroplasty in patients with haemophilic arthropathy is effective and safe according to the outcomes at a mid-term follow-up. J Orthop Traumatol 23(1):31. https://doi.org/10.1186/s10195-022-00648-5

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Xi G, Wang HH, Li H, Zhang M (2022) Short-term outcomes of Oxford unicompartmental knee arthroplasty with coronal subluxation of the knee: a retrospective case-control study. J Orthop Traumatol 23(1):6. https://doi.org/10.1186/s10195-022-00626-x

    Article  PubMed  PubMed Central  Google Scholar 

  34. Kayani B, Konan S, Ayuob A, Onochie E, Al-Jabri T, Haddad FS (2019) Robotic technology in total knee arthroplasty: a systematic review. EFORT Open Rev 4(10):611–617. https://doi.org/10.1302/2058-5241.4.190022

    Article  PubMed  PubMed Central  Google Scholar 

  35. MacDessi SJ, Griffiths-Jones W, Harris IA, Bellemans J, Chen DB (2021) Coronal plane alignment of the knee (CPAK) classification. Bone Joint J 103-B(2):329–337. https://doi.org/10.1302/0301-620X.103B2.BJJ-2020-1050.R1

    Article  PubMed  PubMed Central  Google Scholar 

  36. Choi BS, Kim SE, Yang M, Ro DH, Han HS (2023) Functional alignment with robotic-arm assisted total knee arthroplasty demonstrated better patient-reported outcomes than mechanical alignment with manual total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 31(3):1072–1080. https://doi.org/10.1007/s00167-022-07227-5

    Article  PubMed  Google Scholar 

  37. Clark G, Steer R, Wood D (2023) Functional alignment achieves a more balanced total knee arthroplasty than either mechanical alignment or kinematic alignment prior to soft tissue releases. Knee Surg Sports Traumatol Arthrosc 31(4):1420–1426. https://doi.org/10.1007/s00167-022-07156-3

    Article  PubMed  Google Scholar 

  38. Hazratwala K, Gouk C, Wilkinson MPR, O’Callaghan WB (2023) Navigated functional alignment total knee arthroplasty achieves reliable, reproducible and accurate results with high patient satisfaction. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-023-07327-w

    Article  PubMed  PubMed Central  Google Scholar 

  39. Murphy GT, Shatrov J, Duong J, Fritsch BA (2023) How does the use of quantified gap-balancing affect component positioning and limb alignment in robotic total knee arthroplasty using functional alignment philosophy? a comparison of two robotic platforms. Int Orthop 47(5):1221–1232. https://doi.org/10.1007/s00264-022-05681-x

    Article  PubMed  Google Scholar 

  40. Parratte S, Van Overschelde P, Bandi M, Ozturk BY, Batailler C (2023) An anatomo-functional implant positioning technique with robotic assistance for primary TKA allows the restoration of the native knee alignment and a natural functional ligament pattern, with a faster recovery at 6 months compared to an adjusted mechanical technique. Knee Surg Sports Traumatol Arthrosc 31(4):1334–1346. https://doi.org/10.1007/s00167-022-06995-4

    Article  PubMed  Google Scholar 

  41. Shatrov J, Batailler C, Sappey-Marinier E, Gunst S, Servien E, Lustig S (2022) Kinematic alignment fails to achieve balancing in 50% of varus knees and resects more bone compared to functional alignment. Knee Surg Sports Traumatol Arthrosc 30(9):2991–2999. https://doi.org/10.1007/s00167-022-07073-5

    Article  PubMed  Google Scholar 

  42. Tuecking LR, Savov P, Zander M, Jeremic D, Windhagen H, Ettinger M (2023) Comparable accuracy of femoral joint line reconstruction in different kinematic and functional alignment techniques. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-023-07360-9

    Article  PubMed  Google Scholar 

  43. Howick J CI, Glasziou P, Greenhalgh T, Carl Heneghan, Liberati A, Moschetti I, Phillips B, Thornton H, Goddard O, Hodgkinson M (2011) The 2011 Oxford CEBM Levels of Evidence. Oxford Centre for Evidence-Based Medicine Available at https://www.cebmnet/indexaspx?o=5653

  44. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R, Glanville J, Grimshaw JM, Hrobjartsson A, Lalu MM, Li T, Loder EW, Mayo-Wilson E, McDonald S, McGuinness LA, Stewart LA, Thomas J, Tricco AC, Welch VA, Whiting P, Moher D (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372:n71. https://doi.org/10.1136/bmj.n71

    Article  PubMed  PubMed Central  Google Scholar 

  45. Cumpston M, Li T, Page MJ, Chandler J, Welch VA, Higgins JP, Thomas J (2019) Updated guidance for trusted systematic reviews: a new edition of the cochrane handbook for systematic reviews of interventions. Cochrane Database Syst Rev 10:000142. https://doi.org/10.1002/14651858.ED000142

    Article  Google Scholar 

  46. Sterne JA, Hernan MA, Reeves BC, Savovic J, Berkman ND, Viswanathan M, Henry D, Altman DG, Ansari MT, Boutron I, Carpenter JR, Chan AW, Churchill R, Deeks JJ, Hrobjartsson A, Kirkham J, Juni P, Loke YK, Pigott TD, Ramsay CR, Regidor D, Rothstein HR, Sandhu L, Santaguida PL, Schunemann HJ, Shea B, Shrier I, Tugwell P, Turner L, Valentine JC, Waddington H, Waters E, Wells GA, Whiting PF, Higgins JP (2016) ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 355:i4919. https://doi.org/10.1136/bmj.i4919

    Article  PubMed  PubMed Central  Google Scholar 

  47. McGuinness LA, Higgins JPT (2020) Risk-of-bias VISualization (robvis): an R package and Shiny web app for visualizing risk-of-bias assessments. Res Synth Methods. https://doi.org/10.1002/jrsm.1411

    Article  PubMed  Google Scholar 

  48. Higgins JPT TJ, Chandler J, Cumpston M, Li T, Page MJ, Welch VA . Cochrane Handbook for Systematic Reviews of Interventions version 6.2. Cochrane 2021. Available from www.training.cochrane.org/handbook. Accessed on February 2022.

  49. Hirschmann MT, Moser LB, Amsler F, Behrend H, Leclerq V, Hess S (2019) Functional knee phenotypes: a novel classification for phenotyping the coronal lower limb alignment based on the native alignment in young non-osteoarthritic patients. Knee Surg Sports Traumatol Arthrosc 27(5):1394–1402. https://doi.org/10.1007/s00167-019-05509-z

    Article  PubMed  Google Scholar 

  50. Oussedik S, Abdel MP, Victor J, Pagnano MW, Haddad FS (2020) Alignment in total knee arthroplasty. Bone Joint J 102-B(3):276–279. https://doi.org/10.1302/0301-620X.102B3.BJJ-2019-1729

    Article  PubMed  Google Scholar 

  51. Lustig S, Sappey-Marinier E, Fary C, Servien E, Parratte S, Batailler C (2021) Personalized alignment in total knee arthroplasty: current concepts. SICOT J 7:19. https://doi.org/10.1051/sicotj/2021021

    Article  PubMed  PubMed Central  Google Scholar 

  52. Vaidya NV, Deshpande AN, Panjwani T, Patil R, Jaysingani T, Patil P (2022) Robotic-assisted TKA leads to a better prosthesis alignment and a better joint line restoration as compared to conventional TKA: a prospective randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 30(2):621–626. https://doi.org/10.1007/s00167-020-06353-2

    Article  PubMed  Google Scholar 

  53. Nedopil AJ, Singh AK, Howell SM, Hull ML (2018) Does calipered kinematically aligned TKA restore native left to right symmetry of the lower limb and improve function? J Arthroplasty 33(2):398–406. https://doi.org/10.1016/j.arth.2017.09.039

    Article  PubMed  Google Scholar 

  54. Aflatooni JO, Wininger AE, Park KJ, Incavo SJ (2023) Alignment options and robotics in total knee arthroplasty. Front Surg 10:1106608. https://doi.org/10.3389/fsurg.2023.1106608

    Article  PubMed  PubMed Central  Google Scholar 

  55. Graichen H, Luderer V, Strauch M, Hirschmann MT, Scior W (2023) Navigated, gap-balanced, adjusted mechanical alignment achieves alignment and balancing goals in a very high percentage but with partially non-anatomical resections. Knee Surg Sports Traumatol Arthrosc 31(3):768–776. https://doi.org/10.1007/s00167-022-07014-2

    Article  PubMed  Google Scholar 

  56. Roth JD, Howell SM, Hull ML (2015) Native knee laxities at 0 degrees, 45 degrees, and 90 degrees of flexion and their relationship to the goal of the gap-balancing alignment method of total knee arthroplasty. J Bone Joint Surg Am 97(20):1678–1684. https://doi.org/10.2106/JBJS.N.01256

    Article  PubMed  Google Scholar 

  57. McEwen P, Balendra G, Doma K (2019) Medial and lateral gap laxity differential in computer-assisted kinematic total knee arthroplasty. Bone Joint J 101-B(3):331–339. https://doi.org/10.1302/0301-620X.101B3.BJJ-2018-0544.R1

    Article  CAS  PubMed  Google Scholar 

  58. Chang JS, Kayani B, Wallace C, Haddad FS (2021) Functional alignment achieves soft-tissue balance in total knee arthroplasty as measured with quantitative sensor-guided technology. Bone Joint J 103-B(3):507–514. https://doi.org/10.1302/0301-620X.103B.BJJ-2020-0940.R1

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Medical Centre, Pauwelsstraße 30, 52074, Aachen, Germany

    Filippo Migliorini & Luise Schäfer

  2. Department of Orthopedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical University, 39100, Bolzano, Italy

    Filippo Migliorini & Francesco Simeone

  3. Residency Program in Orthopedics and Traumatology, University of Milan, Milan, Italy

    Marco Pilone

  4. Department of Medicine and Psychology, University of Rome “La Sapienza”, Rome, Italy

    Nicola Maffulli

  5. Department of Orthopedics, Eifelklinik St. Brigida, Simmerath, Germany

    Andreas Bell

  6. School of Pharmacy and Bioengineering, Faculty of Medicine, Keele University, Stoke On Trent, ST4 7QB, UK

    Nicola Maffulli

  7. Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Mile End Hospital, Queen Mary University of London, London, E1 4DG, UK

    Nicola Maffulli

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Contributions

FM: conception, writing; MP: writing; LS: literature search, risk of bias assessment; FS: literature search, risk of bias assessment; AB: supervision; NM: revision. All authors have agreed to the final version to be published and agree to be accountable for all aspects of the work.

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Migliorini, F., Pilone, M., Schäfer, L. et al. Functional alignment in robotic-assisted total knee arthroplasty: a systematic review. Arch Orthop Trauma Surg 144, 1741–1749 (2024). https://doi.org/10.1007/s00402-023-05195-0

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