Journal of Arthroplasty




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Editorial Board

doi : 10.1016/S0883-5403(23)00294-2

Volume 38, Issue 5, May 2023, Pages A1-A2

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Masthead

doi : 10.1016/S0883-5403(23)00295-4

Volume 38, Issue 5, May 2023, Page A4

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Table of Contents

doi : 10.1016/S0883-5403(23)00296-6

Volume 38, Issue 5, May 2023, Pages A5-A8

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The Education Committee of the American Association of Hip and Knee Surgeons

Kimberly K. Tucker, MD* Jeffrey B. Stambough, MD Sigita Wolfe, MA Matthew S. Austin, MD Ugo N. Ihekweazu, MD Michael P. Ast, MD Timothy S. Brown, MD Nathanael D. Heckmann, MD Jeffrey K. Lange, MD

doi : 10.1016/j.arth.2023.03.062

Volume 38, Issue 5, May 2023, Page 777

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The American Association of Hip and Knee Surgeons Publications Committee

Kimberly K. Tucker, MD* Samuel S. Wellman, MD Christopher E. Pelt, MD Gregory J. Golladay, MD John W. Barrington, MD Cambize Shahdar Jr., MD Ashok Rajgopal, MD

doi : 10.1016/j.arth.2023.03.063

Volume 38, Issue 5, May 2023, Page 778

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Orthopedic Surgery and Anesthesiology Surgical Improvement Strategies Project – Phase III Outcomes

Alexis K. Matrka, MD a, 1 , Hugh M. Smith, MD, PhD b, 1 , Adam W. Amundson, MD b , Christopher M. Duncan, MD b , Matthew J. Rueter, MAOL c , Sasa Andrijasevic, BS c , Charles P. Hannon, MD a , Cory G. Couch, MD a , Joaquin Sanchez-Sotelo, MD, PhD a , Robert T. Trousdale, MD a , Matthew P. Abdel, MD

doi : 10.1016/j.arth.2022.11.002

Volume 38, Issue 5, May 2023, Pages 779-784

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A Validated Pre-operative Risk Prediction Tool for Extended Inpatient Length of Stay Following Primary Total Hip or Knee Arthroplasty

Daniel E. Goltz, MD, MBA a, *, Chelsea S. Sicat, MS b , Jay M. Levin, MD, MBA a , Joshua K. Helmkamp, MD a , Claire B. Howell, MMCi c , Daniel Waren, MPH b , Cynthia L. Green, PhD d , David Attarian, MD a , William A. Jiranek, MD a , Michael P. Bolognesi, MD a , Ran Schwarzkopf, MD b , Thorsten M. Seyler, MD, PhD

doi : 10.1016/j.arth.2022.11.006

Volume 38, Issue 5, May 2023, Pages 785-793

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Accuracy of ICD-10 Coding for Femoral Head Bearing Surfaces in Hip Arthroplasty

Vinaya Rajahraman, BS, Safa C. Fassihi, MD, Vaidehi Patel, BA, Caleigh A. Pope, BA, Joshua C. Rozell, MD, Ran Schwarzkopf, MD, MSc

doi : 10.1016/j.arth.2022.12.002

Volume 38, Issue 5, May 2023, Pages 794-797

The International Classification of Diseases-10 Procedure Code System (ICD-10-PCS) introduced oxidized zirconium (OxZi) and niobium procedural codes to the types of femoral head bearing surfaces in 2017. These codes aimed to increase procedural specificity in coding and improve data collection through administrative claims databases. This study aimed to assess the accuracy of ICD-10-PCS coding for femoral head bearing surfaces (cobalt chrome/metal, ceramic, and OxZi) in hip procedures.

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Early Total Hip Arthroplasty is a Cost-Effective Treatment for Severe Radiographic Slipped Capital Femoral Epiphysis Over an Individual's Lifetime

Olivia B. de Araujo, BS a, *, Chinmay S. Paranjape, MD, MHS a, b , Daniel N. Bracey, MD, PhD a, b , Anna D. Vergun, MD

doi : 10.1016/j.arth.2022.11.017

Volume 38, Issue 5, May 2023, Pages 798-805

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Participation in Sports and Physical Activities After Total Joint Arthroplasty

Armin Arshi, MD a, *, Irfan A. Khan, ATC b , Kerri-Anne Ciesielka, MPH b , Nicholas F. Cozzarelli, BS b , Yale A. Fillingham, MD

doi : 10.1016/j.arth.2022.11.008

Volume 38, Issue 5, May 2023, Pages 806-814.e5

Quality data on physical activity participation following total joint arthroplasty (TJA) are limited. The purpose of this study was to explore patient participation, outcomes, and limitations in sports/physical activities following TJA.

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Risk of Periprosthetic Joint Infection After Intra-Articular Corticosteroid Injection Following Unicompartmental Knee Arthroplasty

Hugo C. Rodriguez, DO, MBS a, b , Kevin L. Mekkawy, DO a , Adam Watkins, BS c , Martin W. Roche, MD a, d , W. Vincent Burke, MD a , Raul G. Gosthe, MD

doi : 10.1016/j.arth.2022.12.005

Volume 38, Issue 5, May 2023, Pages 815-819

Perioperative intra-articular joint injection is a known risk factor for developing prosthetic joint infection (PJI) in the immediate preoperative and postoperative periods for total knee arthroplasty, but is less defined in unicompartmental knee arthroplasty (UKA). The goal of this study was to elucidate the risk of developing PJI after intra-articular corticosteroid injection (IACI) into a post UKA knee.

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Survivorship of 500 Cementless Total Knee Arthroplasties in Patients Under 55 Years of Age

Gerard A. Sheridan, MD *, Roslyn S. Cassidy, PhD, Christopher McKee, MD, Ioan Hughes, MD, Janet C. Hill, PhD, David E. Beverland, MD

doi : 10.1016/j.arth.2022.10.035

Volume 38, Issue 5, May 2023, Pages 820-823

With respect to survivorship following total knee arthroplasty (TKA), joint registries consistently demonstrate higher revision rates for both genders in those aged less than 55 years. The present study analyzed the survivorship of 500 cementless TKAs performed in this age group in a high-volume primary joint unit where cementless TKA has traditionally been used for the majority of patients.

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Comparison of Femoral Nerve Catheter, Adductor Canal Catheter, and Periarticular Liposomal Bupivacaine Infiltration for Postoperative Analgesia After Primary Total Knee Arthroplasty

Sean W. Dobson, MD, PhD a, *, Nathan D. Stouffer, MD a , Robert S. Weller, MD a , John S. Shields, MD b , Christopher J. Edwards, MD a , Daryl S. Henshaw, MD

doi : 10.1016/j.arth.2022.11.015

Volume 38, Issue 5, May 2023, Pages 824-830

Peripheral nerve catheters are used to provide analgesia after total knee arthroplasty (TKA) and have been shown to decrease pain and opioid use, to facilitate participation with physical therapy (PT), and to hasten discharge. More recently, pericapsular infiltration using liposomal bupivacaine (LB) has been employed as an alternative analgesic approach.

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Liposomal Bupivacaine Versus Continuous Nerve Block: Liposomal Bupivacaine May be Non-inferior and More Cost Effective

Geordie C. Lonza, MD a , Frank Yuan, MD a , Felix M. Pham, PharmD b , Christine T. Wright, MSN RN b , Anthony Arellano-Kruse, MD c , John Andrawis, MD MBA

doi : 10.1016/j.arth.2022.12.014

Volume 38, Issue 5, May 2023, Pages 831-835

Regional anesthesia with adductor canal block has become the standard of care for pain management after total knee arthroplasty (TKA). We hypothesized that liposomal bupivacaine (LB) may be noninferior to continuous nerve block with a pain pump in terms of average pain scores, 30- and 90-day readmissions, and emergency department (ED) visits while reducing cost.

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Tumors Constitute a Majority of Total Knee Arthroplasty in Patients <21 Years Old: A United States Nationwide Analysis

J. Alex B. Gibbons, BA a , Cynthia A. Kahlenberg, MD, MPH a , Deanna P. Jannat-Khah, DrPH, MSPH a, b , Alexander B. Christ, MD c , Susan M. Goodman, MD a, b , Peter K. Sculco, MD a, b , Mark P. Figgie, MD a, b , Bella Y. Mehta, MBBS, MS

doi : 10.1016/j.arth.2022.11.018

Volume 38, Issue 5, May 2023, Pages 836-842

Total knee arthroplasty (TKA) is rarely performed in patients under 21 years old, but the frequency of utilization of TKA in this population in the United States is not known. The purpose of this study was to evaluate trends in the use of TKA in patients <21 in the United States.

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Mortality and Complications Following Early Conversion Arthroplasty for Failed Hip Fracture Surgery

Justin A. Magnuson, MD a , Sean A. Griffin, BS a, b , John Hobbs, MS a , Taylor D’Amore, MD a , Andrew J. Hughes, MB BCh BAO, MCh a , Matthew B. Sherman, BS a , Armin Arshi, MD a, c , Chad A. Krueger, MD

doi : 10.1016/j.arth.2022.12.003

Volume 38, Issue 5, May 2023, Pages 843-848

Hip fracture in older patients leads to high morbidity and mortality. Patients who are treated surgically but fail acutely face a more complex operation with conversion total hip arthroplasty (THA). This study investigated mortalities and complications in patients who experienced failure within one year following hip fracture surgery requiring conversion THA.

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Hip Arthroplasty Femoral Stem Designs and Their Association With Early Postoperative Periprosthetic Femoral Fractures

Tyler E. Calkins, MD a , Devon D. Goetz, MD b , Jacob T. Zalewski, MD a , Caleb A. Jones, MD a , Peyton R. Gaumer, BS c , Marcus C. Ford, MD a , Patrick C. Toy, MD a , John R. Crockarell, MD a , James W. Harkess, MD a , William M. Mihalko, MD, PhD a , James L. Guyton, MD a, *

doi : 10.1016/j.arth.2022.12.020

Volume 38, Issue 5, May 2023, Pages 849-854

Periprosthetic femoral fractures (PFFs) in total hip arthroplasty (THA), especially those in contact with the diaphyseal stem, carry high morbidity. This study evaluated how stem design influences the risk of early Vancouver B PFF or other PFF requiring operative intervention after THA.

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Single Wedge Femoral Stem Designs are Associated With a Higher Risk for Revision After Cementless Primary Total Hip Arthroplasty

Nithin C. Reddy, MD a, *, Richard N. Chang, MPH b , Heather A. Prentice, PhD b , Elizabeth W. Paxton, PhD b , Matthew P. Kelly, MD c , Monti Khatod, MD

doi : 10.1016/j.arth.2022.12.019

Volume 38, Issue 5, May 2023, Pages 855-861.e1

Cementless total hip arthroplasty (THA) femoral stems are the most commonly selected prostheses in the United States. Optimal stem geometry remains controversial with excellent survivorship reported for many designs. We compared cause-specific stem revision of single-wedge versus double-wedge designs from a multicenter US cohort.

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Total Hip Arthroplasty Imageless Navigation Does Not Reduce 90-Day Adverse Events or Five-Year Revisions in a Large National Cohort

Rahul H. Jayaram a , Stephen M. Gillinov a , Dennis L. Caruana a , Alexander J. Kammien a , Peter Y. Joo, MD, MPH a , Lee E. Rubin, MD b , Jonathan N. Grauer, MD

doi : 10.1016/j.arth.2022.12.012

Volume 38, Issue 5, May 2023, Pages 862-867

Computer navigation is an increasingly utilized technology that is considered with total hip arthroplasty (THA). However, the evidence to support this practice is mixed. The current study leveraged a large national administrative database to compare 90-day adverse events as well as 5-year all-cause revision and dislocation rates following THA performed with and without imageless navigation.

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Heart Failure is Associated with Early Medical and Surgery-Related Complications Following Total Hip Arthroplasty: A Propensity-Scored Analysis

Sean B. Sequeira, MD *, Henry R. Boucher, MD

doi : 10.1016/j.arth.2022.11.009

Volume 38, Issue 5, May 2023, Pages 868-872.e4

There is a paucity of literature that examines how heart failure (HF) impacts surgery-related complications following total hip arthroplasty (THA). We hypothesized that patients who had HF will be at increased risk of early medical- and surgery-related complications following THA.

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Minimum 30-Year Results of Bilaterally Implanted Cemented and Cementless Total Hip Arthroplasty in Patients Younger Than 50 Years

Young-Hoo Kim, MD a, *, Jang-Won Park, MD b , Young-Soo Jang, MD a , Eun-Jung Kim, MD

doi : 10.1016/j.arth.2022.11.003

Volume 38, Issue 5, May 2023, Pages 873-879

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Survival and Clinical Outcomes at 30 to 35 Years Following Primary Total Hip Arthroplasty With a Cementless Femoral Stem Fully Coated With Hydroxyapatite

Laurent Jacquot, MD a, b , Alain Machenaud, MD a, b , Michel P. Bonnin, MD, PhD a, c , Julien Chouteau, MD, PhD a, b , ReSurg d, 1 , Jean-Pierre Vidalain, MD

doi : 10.1016/j.arth.2022.11.016

Volume 38, Issue 5, May 2023, Pages 880-885

The purpose of the present study was to update and report clinical outcomes and survival of primary total hip arthroplasty using a cementless double-tapered titanium fully hydroxyapatite-coated stem at a follow-up > 30 years.

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Tantalum Cones for Severe Bone Defects in Revision Knee Arthroplasty: A Minimum 10-Year Follow-Up

Ivan De Martino, MD a, b, *, Fabio Mancino, MD a, b , Vincenzo Di Matteo, MD a, b , Alessandro Singlitico, MD a, b , Giulio Maccauro, MD a, b , Giorgio Gasparini, MD

doi : 10.1016/j.arth.2022.11.013

Volume 38, Issue 5, May 2023, Pages 886-892

Two-to 6-year results of reconstruction of severe bone defects in revision total knee arthroplasty (TKA) with highly porous tantalum cones have been encouraging, but 10-year follow-up is lacking. The purpose of this study was to determine the minimum 10-year results of tantalum cones in revision TKA.

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Isolated Liner Exchange in Total Hip Arthroplasty at a Mean of 13 Years of Follow-up: Does Fixation Technique Matter?

Wai Kiu Thomas Liu, MBBS (HK) a , Amy Cheung, MBBS (HK) a, *, Henry Fu, MBBS, MMedSc (HK) b , Man Hong Cheung, MBBS, MRCSEd b , Ping Keung Chan, MBBS, MRCSEd b , Kwong Yuen Chiu, MBBS (HK)

doi : 10.1016/j.arth.2022.11.012

Volume 38, Issue 5, May 2023, Pages 893-898

Isolated liner exchange is an option to address polyethylene wear after total hip arthroplasty (THA). The liner can be fixed with either the original locking mechanism or cemented into the acetabular cup. Whether the method used for liner fixation has any bearing on the outcomes in the first and second decade after surgery is still unclear.

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A Multicenter Prospective Investigation on Patient Physical and Mental Health After Girdlestone Resection Arthroplasty

Colleen M. Wixted, MBA a, *, Breanna A. Polascik, BS a , Niall H. Cochrane, MD b , Brielle Antonelli, BS c , Nishanth Muthusamy, BS d , Sean P. Ryan, MD b , Antonia F. Chen, MD, MBA c , Ran Schwarzkopf, MD, MSc d , Thorsten M. Seyler, MD, PhD

doi : 10.1016/j.arth.2022.12.016

Volume 38, Issue 5, May 2023, Pages 899-902

Girdlestone resection arthroplasty is a salvage procedure for hip periprosthetic joint infection (PJI) that controls infection and reduces chronic pain, but may result in limited postoperative joint function. The aim of this study was to assess physical function and mental health after Girdlestone.

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Revision Hip Arthroplasty Using a Modular, Cementless Femoral Stem: Long-Term Follow-Up

Rosa S. Valtanen, MD, Katherine L. Hwang, MPH, MS, Derek F. Amanatullah, MD, PhD, James I. Huddleston III, MD, William J. Maloney, MD, Stuart B. Goodman, MD, PhD

doi : 10.1016/j.arth.2022.12.018

Volume 38, Issue 5, May 2023, Pages 903-908

As the number of primary total hip arthroplasty (THA) cases increase, so does the demand for revision operations. However, long-term follow-up data for revision THA is lacking.

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Short Course of Oral Antibiotic Treatment After Two-Stage Exchange Arthroplasty Appears to Decrease Early Reinfection

Sean P. Ryan, MD a , Christopher N. Warne, MD a , Douglas R. Osmon, MD b , Aaron J. Tande, MD b , Cameron K. Ledford, MD a , Meredith Hyun, MS c , Daniel J. Berry, MD a , Matthew P. Abdel, MD

doi : 10.1016/j.arth.2022.12.006

Volume 38, Issue 5, May 2023, Pages 909-913

Recent evidence has suggested a benefit to extended postoperative prophylactic oral antibiotics after two-stage exchange arthroplasty for treatment of periprosthetic joint infections. We sought to determine reinfection rates with and without a short course of oral antibiotics after two-stage exchange procedures.

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D-Dimer, Erythrocyte Sedimentation Rate, and C-Reactive Protein Sensitivities for Periprosthetic Joint Infection Diagnosis

Colleen M. Wixted, MBA a, *, Lefko T. Charalambous, MD, MBA a , Billy I. Kim, BA a , Ayden Case, BS a , Edward F. Hendershot, MD b , Jessica L. Seidelman, MD, MPH b , Thorsten M. Seyler, MD, PhD b , William A. Jiranek, MD

doi : 10.1016/j.arth.2022.12.010

Volume 38, Issue 5, May 2023, Pages 914-917

There is contradicting evidence on the diagnostic value of inflammatory biomarkers for periprosthetic joint infection (PJI). We sought to quantify the sensitivity of D-dimer for acute and chronic PJI diagnosis and evaluate D-dimer lab values in the 90-day postoperative window in a control cohort of primary joint arthroplasty patients for comparison.

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The Diagnostic Accuracy of Neutrophils to Lymphocytes Ratio, Platelets to Lymphocytes Ratio, Monocytes to Lymphocytes Ratio, and Platelets to Mean Platelet Volume Ratio in Diagnosing Periprosthetic Knee Infections. Are Gender-Specific Cutoff Values Needed?

Giovanni Balato, MD, PhD a, *, Tiziana Ascione, MD b , Enrico Festa, MD a , Donato Di Gennaro, MD a , Giuseppe Pandolfo, PhD c , Pasquale Pagliano, MD

doi : 10.1016/j.arth.2022.11.014

Volume 38, Issue 5, May 2023, Pages 918-924

This study aimed to assess the most appropriate thresholds for neutrophils to lymphocytes ratio (NLR), platelets to lymphocytes ratio, monocytes to lymphocytes ratio (MLR), and platelets to mean platelet volume ratio in patients who had a suspected prosthetic knee infection. Furthermore, we evaluated the diagnostic accuracy of our proposed thresholds by men and women.

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Prior Septic Arthritis Within One Year of Knee Arthroplasty is Associated With a High Risk for Infection

Daniel Hameed, MD, Sandeep S. Bains, MD, DC, Zhongming Chen, MD, Jeremy A. Dubin, BA, Ronald E. Delanois, MD, Michael A. Mont, MD, James Nace, DO, MPT

doi : 10.1016/j.arth.2022.11.020

Volume 38, Issue 5, May 2023, Pages 925-929.e1

A prior history of a septic knee may predispose patients to a periprosthetic joint infection (PJI) after total knee arthroplasty (TKA). We performed multivariate analyses of known risk factors that portend a periprosthetic infection for patients who have a history of septic arthritis (SA).

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Less Than 1-Year Quiescent Period After Septic Arthritis of the Hip is Associated With High Risk of Periprosthetic Joint Infection Following Total Hip Arthroplasty

Jeremy A. Dubin, BA, Zhongming Chen, MD, Sandeep S. Bains, MD, Daniel Hameed, MD, Michael A. Mont, MD, Ronald E. Delanois, MD, James Nace, DO

doi : 10.1016/j.arth.2022.11.004

Volume 38, Issue 5, May 2023, Pages 930-934.e1

Approximately 20,000 patients are diagnosed with septic arthritis annually, with 15% specifically affecting the hip joint. These cases exacerbate arthritic changes, often warranting a total hip arthroplasty (THA).

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Role of Operating Room Size on Air Quality in Primary Total Hip Arthroplasty

Kendall H. Derry, BE, Chelsea S. Sicat, MS, Michelle Shen, MD, MBA, Roy I. Davidovitch, MD, Ran Schwarzkopf, MD, MSc, Joshua C. Rozell, MD *

doi : 10.1016/j.arth.2022.12.011

Volume 38, Issue 5, May 2023, Pages 935-938

Airborne biologic particles (ABPs) can be measured intraoperatively to evaluate operating room (OR) sterility. Our study examines the role of OR size on air quality and ABP count in primary total hip arthroplasty (THA).

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Short-Term Surface Damage Mechanisms of Retrieved Highly Cross-Linked Polyethylene Patellar Components

Tabitha Derr a, *, Daniel W. MacDonald, MS a , Gregg R. Klein, MD b , Michael A. Mont, MD c , Nicolas S. Piuzzi, MD d , Steven M. Kurtz, PhD

doi : 10.1016/j.arth.2022.11.005

Volume 38, Issue 5, May 2023, Pages 939-944.e1

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High Prevalence of Causal Language and Inferences in Observational Hip and Knee Arthroplasty Database Studies: A Review of Papers Published Across Four Orthopaedic Journals

Nadim Barakat, BA a , Wendy M. Novicoff, PhD b , Brian C. Werner, MD c , James A. Browne, MD

doi : 10.1016/j.arth.2022.12.008

Volume 38, Issue 5, May 2023, Pages 945-949

The use of administrative databases and clinical registries in lower extremity arthroplasty research is growing. Such observational studies are unable to fully control for confounders and cannot establish causality.

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The Role of Cryotherapy After Total Knee Arthroplasty: A Systematic Review

Phillip B. Wyatt, DPT a , Chase T. Nelson, BS a , John W. Cyrus, MSIL a , Ashton H. Goldman, MD b, c , Nirav K. Patel, MD, FRCS

doi : 10.1016/j.arth.2022.12.004

Volume 38, Issue 5, May 2023, Pages 950-956

Previous research shows conflicting evidence regarding the postoperative role of cryotherapy after total knee arthroplasty (TKA). This systematic review aims to further investigate the effect of various methods of cryotherapy on the following: (1) pain; (2) swelling; (3) postoperative opioid use; and (4) range of motion (ROM).

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A Meta-Analysis of the Incidence and Temporal Trends of Postoperative Dislocation in Revision Total Hip Arthroplasty Utilizing Constrained Acetabular Components or Dual Mobility Implants

Richard L. Donovan, MBBS, MRCS, MSc a, b, *, Harvey Johnson, BSc (hons) b , Sherwin Fernando, BSc (hons), MBBS b , Michael Foxall-Smith, BSc, MBBS b , Michael R. Whitehouse, MBChB, PhD, FRCS (Tr&Orth) a, b, c , Ashley W. Blom, MBChB, PhD, FRCS (Tr&Orth) a, b, c , Setor K. Kunutsor, MBChB, MPhil, PhD

doi : 10.1016/j.arth.2022.11.007

Volume 38, Issue 5, May 2023, Pages 957-969.e1

The incidence of dislocation after revision total hip arthroplasty (rTHA) is reported to be up to 25% and remains a common source of failure. Constrained acetabular components and dual mobility implants are two implant classes being utilized to alleviate this burden in patients who have recurrent instability or major intraoperative instability.

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In Vivo Performance of Vitamin E Stabilized Polyethylene Implants for Total Hip Arthroplasty: A Review

Hannah Spece, PhD a, b, *, Ronald V. Yarbrough c , Steven M. Kurtz, PhD

doi : 10.1016/j.arth.2022.11.010

Volume 38, Issue 5, May 2023, Pages 970-979

Vitamin E stabilization was introduced to improve the oxidative stability, wear resistance, and mechanical properties of highly crosslinked polyethylene (HXLPE).

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Erratum to ‘What are the Causes, Costs and Risk-Factors for Emergency Department Visits Following Primary Total Hip Arthroplasty? An Analysis of 1,018,772 Patients’

Mitchell K. Ng, MD a , Aaron Lam, MD a , Keith Diamond, MD a , Nicolas S. Piuzzi, MD b , Martin Roche, MD c , Orry Erez, MD a , Che Hang Jason Wong, MD a , Michael A. Mont, MD

doi : 10.1016/j.arth.2023.02.038

Volume 38, Issue 5, May 2023, Page 980

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Letter to the Editor: Regarding “High Prevalence of Spino-pelvic Risk Factors in Patients With Postoperative Hip Dislocations�

Kerim Sariyilmaz, MD* Goksel Dikmen, MD

doi : 10.1016/j.arth.2023.01.033

Volume 38, Issue 5, May 2023, Page e11

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Conflict of Interest Statement

doi : 10.1016/S0883-5403(23)00297-8

Volume 38, Issue 5, May 2023, Page A11

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