Attach a new needle to the syringe and remove the needle guard. There are no available data on the presence of triamcinolone acetonide in either human or animal milk, the effects on the breastfed infant, or the effects on milk production. Importantly, analysis of the X-ray data showed no impact on cartilage or any other negative structural impact at one-year follow-up.. Dosage form: extended-release injectable suspension kit The last injection (in a prior course) was given at least six (6) months ago. Inspect the Zilretta powder vial to ensure no clumped powder is visible and a uniform suspension has been achieved. While my relief has been excellent; I am concerned on the cost $$$$$$$$$$$$$$$! The majority of published literature with corticosteroid exposure during pregnancy includes the oral, topical and inhaled dosage formulations; therefore, the applicability of these findings to a single intra-articular injection of triamcinolone acetonide is limited. When the pain returns, I just get my Zilretta injections and I feel like new agin. Monitor patients with elevated intraocular pressure for potential treatment adjustment. I participated in the 2nd phase study for consecutive shots in my left knee. Big mistake. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. A total of 424 patients received Zilretta and 262 received placebo. The chemical name for triamcinolone acetonide is 9-fluoro-11,16,17,21-tetrahydroxypregna-1,4-diene- 3,20-dione cyclic 16,17-acetal with acetone. The usual technique for intra-articular injection should be followed. Intra-articularly injected corticosteroids are systemically absorbed. (Opens in a new browser tab). For additional information, visit www.Zilretta.com or call Pacira Pharmaceuticals, Inc. at 1-844-353-9466. (Arroll B, et al. Studies in animals to evaluate the impairment of fertility of Zilretta have not been conducted. Of a total of 208 patients who received a first injection of Zilretta, a second injection was administered to 179 patients (median time to second injection was 16.6 weeks). Visit Website, More information please phone: Attach the syringe onto the vial adapter by pushing down and turning clockwise until you feel resistance (Fig. Ideally, it would spur the knee to begin generating more natural hyaluronic acid. Medicare.Org Is Privately Owned And Operated By Health Network Group, LLC. The data from this study are insufficient to fully characterize the safety of repeat administration of Zilretta. This is a magic bullet and absolutely relieves all okay pain for just about three months. Special consideration should be given to patients with previous or current emotional instability or psychiatric illness before initiating corticosteroid therapy. Anaphylactic reactions: Anaphylaxis including death, angioedema [see Warnings and Precautions (5.3)]. Applicable Procedure Codes J3304 Injection, triamcinolone acetonide, preservative-free, extended-release, microsphere formulation, 1 mg Applicable Diagnosis Codes The full study has been published in the journal Rheumatology and Therapy. Gently swirl the vial to resuspend any of the settled microspheres prior to preparing the syringe for injection. Leftover Zilretta in the vial must never be reused for another injection. Instruct patients to contact their health care provider immediately if they are exposed [see Warnings and Precautions (5.5)]. (triamcinolone acetonide Examine any joint fluid present to exclude a septic process. Overall, the incidence and nature of adverse reactions was similar to that observed with placebo. 866-316-7263 These effects are less likely to occur with synthetic derivatives. Now patients like me can get durable long term pain relief. Contact program for details. Many people who use Zilretta have relief from pain and stiffness that osteoarthritis has caused. A repeat series of injections may be allowed when: The indications continue to be met; and. Triamcinolone acetonide occurs as a white to almost white, crystalline powder having not more than a slight odor and is practically insoluble in water and very soluble in alcohol. Zilretta offers may be in the form of a printable coupon, rebate, savings or copay card, trial offer, or free samples. You are responsible for paying 20 percent of that approved amount, and you may be responsible for a copayment if the drug is administered in a hospital outpatient setting. I am very pleased with Zilretta. Osteoarthritis, the most common joint disorder in the United States, affects the knee joints of 10 percent of all men, and 13 percent of all women over the age of 60. Use a separate alcohol pad for each vial. As shown in Figure 3, the vial on the left, with the X, requires additional tapping because the powder is not properly dislodged. Intra-articular injection may result in damage to joint tissues. 7). Zilretta demonstrated a statistically significant reduction in pain intensity at the primary endpoint vs placebo. A total of 484 patients (Zilretta 32 mg, N=161; placebo [saline], N=162; active control [a crystalline suspension, immediate-release formulation of triamcinolone acetonide 40 mg], N=161) were treated and followed for up to 24 weeks. Hold the syringe in a completely vertical position, per the illustration on the right, in Figure 12. Close more info about Repeat Zilretta Administration Safe, Effective for Osteoarthritis Knee Pain, Says Study, Court Rules That States Medical Malpractice Act Can Apply to Nonpatients, Interview With Dr Tobias Janowitz on Conducting Fully Remote Trials, Interview with Dr Preeti N. Malani, Chief Health Officer at the University of Michigan, Clinical Challenge: Hair Loss After COVID-19, Clinical Challenge: White Papular Rash on 4-Year-Old Child, Clinical Challenge: Red Nodule on Abdomen, Long-Term Opioid Use With OA Varies Across States, Tanezumab Beneficial in Second Phase 3 Osteoarthritis Pain Trial, TriVisc Now Available in the US to Treat Osteoarthritis Knee Pain. In this study, all participants will receive an intra-articular glenohumeral injection of ZILRETTA and will be followed up with at four time points over 1 year to observe pain, function and range of motion following the injection. Zilretta No notable maternal toxicity was observed in rodents. Extended Release; Injectable Suspension; Intra-Articular, Medically Necessary as determined by a Doctor. However, knee injections are typically administered by a physician in a medical office or clinic. Pregnant primates dosed with triamcinolone acetonide via intramuscular injection for 4 days during organogenesis at doses equivalent to 3 times the MRHD or higher caused severe craniofacial CNS and skeletal/visceral malformation and higher prenatal death. Medicare and supplement insurance paid for it in full. I have been living with almost constant bilateral knee pain. For intra-articular injection only. Osteoarthritis is mostly an age-related condition that breaks down the cartilage that would normally function as a cushion to prevent bones from chafing. Triamcinolone acetonide is a corticosteroid with anti-inflammatory and immunomodulating properties. The exposure margins listed below are based on body surface area comparisons (mg/m2) to the highest daily triamcinolone acetonide exposure at the MRHD of 32 mg triamcinolone acetonide via Zilretta. The second type of injection is hyaluronic acid (HA). The following adverse reactions, presented alphabetically by body system, are from voluntary reports or clinical studies of corticosteroids. The tenth week a lot worse and by week 11 back to original bad pain and as bad as it ever was. Treatment emergent adverse reactions reported by greater than or equal to 1% of patients in the Zilretta arms are summarized below (Table 1 and 2). The following adverse reactions, presented alphabetically by body system, have been identified during post-approval use of Zilretta. I have moderate osteo arthritis in both knees. 2). Also encouraged is losing excess weight that may be placing a strain on the knees. To maintain expiry period, refrigerate the Zilretta single-dose kit (36-46F; 2-8C) before use. I don? Read More Read Less. Invert the syringe several times to ensure a properly mixed suspension. ZILRETTA (triamcinolone acetonide extended-release injectable suspension), for intra-articular use Initial U.S. Approval: 1957 _____ _____ INDICATIONS AND USAGE. It's very short lived and very expensive. It is a corticosteroid that your doctor injects into your knee joints. The orthopedic Dr. who did them said that Zilretta can take up to a month to even work, and you need the injections repeated every 6 to 8 months. The estimated background risk of major birth defects and miscarriage for the indicated population is unknown. (1) Limitation of Use Zilretta is not intended for epidural, intrathecal, intravenous, intraocular, intramuscular, intradermal, or subcutaneous use. Avoid injection of a corticosteroid into an infected site. discounted medicines and copay programs to low income or uninsured and under-insured people who meet specific guidelines. So one month to even work, then repeat in as little as 6 months. Table 3 contains drug interactions associated with systemic corticosteroids. The physician who prescribes the drug, as well as the pharmacy where you get it, must accept Medicare assignment. Speak with a Licensed Medicare Sales Agent 877-388-0596 - TTY 711. Think twice before doing this. No drug-drug interaction studies have been conducted with Zilretta. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. The purpose of this study is to examine the pre-post effects of a single ZILRETTA knee injection on physiological measures of self-reported pain and disability, physical performance, and physical activity in individuals with knee osteoarthritis (OA). Zilretta is a savior !! 5 mL single-dose vial to deliver 32 mg of triamcinolone acetonide supplied as a sterile, white to off-white powder in a cerium glass (clear) vial with a rubber stopper and an aluminum seal with a gray plastic cap. All rights reserved. 4). Much worse than mine. In 2017, Zilretta was approved by the Food and Drug Administration for the management of pain associated with osteoarthritis (OA) of the knee, but was not intended for repeat administration. is a member of the glucocorticoids drug class and is commonly used for Contact your bank to set up an online bill payment from your checking or savings . Then turn the syringe gently, 180 degrees, until the plunger is pointing straight up. There have been cases reported in which concomitant use of amphotericin B and hydrocortisone was followed by cardiac enlargement and congestive heart failure. Infection and discomfort at the site of the infection are possible side effects. Convulsions have been reported with this concurrent use. Note: All new enrollment is now done electronically or over the phone. In most cases, osteoarthritis develops slowly, but continues to worsen over time. Drugs like Zilretta work by blocking the substances within the body that can cause inflammation. Patient pays (average) $null Ambulatory surgical centers This includes facility and doctor fees. 5). (triamcinolone acetonide) Monitor patients with renal insufficiency for signs of edema, weight gain, and imbalance in serum electrolytes. And its allowed me to play tennis multiple times each week and to defer my eventual knee replacement. The efficacy and safety of Zilretta for management of osteoarthritis pain of shoulder and hip have not been evaluated. To assess potential effects of the systemic levels of triamcinolone acetonide associated with a single intra-articular (IA) administration of Zilretta on hypothalamic pituitary adrenal (HPA) axis function, serum and urine cortisol levels were monitored over 6 weeks post injection. I gave 2 stars on ease of use since the injections were painful to get. prednisone, aspirin, ibuprofen, meloxicam, naproxen, Cymbalta. Zilretta is supplied as a single-dose kit containing a vial of Zilretta microsphere powder, a vial of sterile diluent, and a sterile vial adapter. Available for Android and iOS devices. Had severe reaction with severe inflammatory response in the injected. Looking to reduce costs at the pharmacy counter? Aspiration of synovial fluid may be performed based on clinical judgment prior to administration of Zilretta. Had Ziretta injection for flare of OA. A marked increase in pain accompanied by local swelling, further restriction of joint motion, fever, and malaise are suggestive of septic arthritis. We do not offer every plan available in your area. First my heart and swelling of my kneesthen I though I had the flu but I had a flu shot and didnt have the flusore throat, sinus issues, rash, headache. A properly mixed suspension will be milky white, contain no clumps, and move freely down the vial wall. Adrenal suppression with Zilretta occurred within 12-24 hours and then gradually returned to normal, within 30-42 days. These infections may be mild to severe. Works very well for 9 weeks. Zilretta (triamcinolone) is a member of the glucocorticoids drug class and is commonly used for Osteoarthritis. Preparation of Zilretta requires close attention to the Instructions for Use to ensure successful administration. Zilretta must be prepared using the diluent supplied in the kit. Promptly inject Zilretta after preparation to avoid settling of the suspension. It is administered as a one-time injection into the affected knee(s); the safety and efficacy of repeat injections have not been demonstrated. No peri- and post-natal development studies of triamcinolone acetonide in animals have been conducted. "Zilretta is a non-opioid medicine that employs Flexion's proprietary microsphere technology to provide proven pain relief over 12 weeks," the company said in a news release. Peel off the paper cover from the vial adapter package (Fig. Zilretta is supplied as a single-dose kit and administered as a suspension containing microspheres. Medicare Part B benefits may apply to certain drugs obtained in a doctors office or hospital outpatient facility. [see Dosage and Administration (2.1)]. Zilretta has not been evaluated and should not be administered by the following routes: Serious neurologic events, some resulting in death, have been reported with epidural injection of corticosteroids. TRICARE covers medications that are approved by the U.S. Food and Drug Administration. In particular, the formulation of Zilretta should not be considered safe to use for epidural or intrathecal administration. 1), Medical-grade gloves (not shown in Fig. They decided against doing a total knee replacement due to my age. Version: 5, 03/2022, Zilretta View generic Zilretta availability for more details. General and administration site conditions, Figure 1: Weekly Change from Baseline to Week 12 in Average Daily Pain. My Doctor did an MRI of of knee which showed mild arthritis and partial meniscus tear. Tap the vial until excess powder is dislodged from the vial and stopper (Fig. The syringe must remain on the vial adapter while the suspension remains in the vial. Avoid corticosteroids in these patients because signs of peritoneal irritation following gastrointestinal perforation may be minimal or absent. Aerobics followed by stretching after exercise lessens the impact of aging because these activities support the flow of fluid around the joints and promote full range of motion. I cannot afford to pay for it as it is very expensive. Pharmacologic agents are often used as adjuncts to physical therapy, and include nonsteroidal anti-inflammatory . Twenty-five percent (25%) of patients had received at least one prior corticosteroid intra-articular injection more than 3 months prior to treatment. Neurologic/Psychiatric: Convulsions, depression, emotional instability, euphoria, headache, increased intracranial pressure with papilledema (pseudotumor cerebri) usually following discontinuation of treatment, insomnia, mood swings, neuritis, neuropathy, paresthesia, personality changes, psychiatric disorders [see Warnings and Precautions (5.12)], vertigo. After 1 week,of getting a shot in both knees, I felt like Superman. Drugs like Zilretta work by blocking the substances within the body that can cause inflammation. Package insert / product label In situations of stress during that period (as in trauma, surgery, or illness), institute corticosteroid replacement therapy. If an aspiration and an injection procedure are performed at the same session, bill only one unit for CPT code 20610 or 20611 (if applicable). extended-release injectable suspension). The efficacy and safety of repeat administration of Zilretta have not been demonstrated. ii. ?s even a candidate for total knee replacement. 12). They need to change this and pay for it when it is needed again. Medically reviewed by Drugs.com. Note: Discard all used components in an appropriate medical waste container according to local regulations. A total of 179 patients received a repeat injection on or after Week 12 (median 16.6 weeks) and were followed for 52 weeks from the initial injection. ZILRETTA is an extended-release synthetic corticosteroid indicated as an intra-articular injection for the management of osteoarthritis pain of the knee. Corticosteroid use may be associated with new or aggravated adverse psychiatric reactions ranging from euphoria, insomnia, mood swings, and personality changes to severe depression and frank psychotic manifestations. Musculoskeletal: Arthralgia, joint swelling or effusion, muscle spasms. To ensure proper dosing, it is important that you follow the preparation and administration steps outlined in these instructions. I treated both knees at the same time. I gave 2 stars on ease of use since the injections were painful to get. If bubbles are observed, gently tap the syringe with your finger until the bubbles rise to the top. The efficacy and safety of repeat administration of Zilretta have not been demonstrated. or obtaining a sample from the doctor's office. One 32 mg vial of Zilretta microsphere powder, Three sterile needles, 21-gauge, 1" length, One sterile Luer Lock compatible syringe, 5 mL, Paper towels or pad to cushion vial tapping (not shown in Fig. Approval of Zilretta was based on the results of a double-blind, 24-week trial in 484 patients 40-85 years old with moderate to severe knee OA pain who were randomized to receive triamcinolone acetonide ER 32 mg, saline placebo, or a standard crystalline suspension of triamcinolone acetonide 40 mg (active control). Zilretta also demonstrated a reduction in pain intensity scores each week from Weeks 1 through 12 (Figure 1). The usual technique for intra-articular injection should be followed. As assessed by adverse event rates for the periods of baseline to second dose and second dose to the comparable period after the second dose, there were higher rates of reported mild to moderate arthralgia after the second dose (16%) than after the first dose (6%). Call for most recent medications as the list is subject to change and the medication for which you are seeking assistance must treat the disease directly. (triamcinolone acetonide extended-release You may need more than one doctor and additional costs may apply. Please contactMedicare.govor 1-800-MEDICARE (TTY users should call1-877-486-2048) 24 hours a day/7 days a week to get information on all of your options. 1). Please contactMedicare.govor 1-800-MEDICARE (TTY users should call1-877-486-2048) 24 hours a day/7 days a week to get information on all of your options. Zilretta must be prepared using only the diluent supplied in the kit. So one month to even work, then repeat in as. It lasted almost 4 months. Nonsteroidal anti-inflammatory drugs (NSAIDs). Zilretta is proven and medically necessary for the treatment ofOsteoarthritis pain of the knee when all of the following criteria are met: Diagnosis of osteoarthritis pain of the knee; and Steady Pain Relief. I hope it helps you and your friends. Hoping for the same great experience I had with the first shots. Had to go to physical therapy for several weeks & use pain medicine for several weeks. No notable maternal toxicity was observed. I got my first Zilretta shot almost 8 weeks ago. User-generated content areas are not reviewed by a WebMD physician or any member of the WebMD editorial staff for accuracy, balance, objectivity, or any other reason except for compliance with our Terms and Conditions. First my heart and swelling of my kneesthen I though I had the flu but I had a flu shot and didnt have the flusore throat, sinus issues, rash, headache. Commenting on the study results, Andrew Spitzer, MD, Co-Director, Joint Replacement Program, Cedars-Sinai Orthopaedic Center and lead investigator said, This valuable study suggests that repeat administration of Zilretta can provide patients suffering from knee OA consistent, substantial, and durable pain relief, and is generally well-tolerated. Grip the top of the Zilretta powder vial and tap firmly and repeatedly on the padded surface. Single and repeat administrations (one injection every three months for a total of three injections) of Zilretta in non-arthritic knee joints of healthy dogs have been studied at ~1.9 times the maximum recommended human dose (MRHD) of 32 mg (based on estimated drug concentrations within the knee joints). Zilretta microspheres were degraded by approximately 4-and 6-months post dosing in single and repeat dose studies, respectively. Problem is Medicare will not pay except every 3 months for the injection and the Dr. will not even give an appointment for it until after the 3 months has passed. Increased activity of both cyclosporine and corticosteroids may occur when the two are used concurrently. Immediately depress the plunger fully and then invert the syringe so the vial is directly on top of the syringe (Fig. This program is intended for US HEALTHCARE PROFESSIONALS and/or Professionals involved in Healthcare Reimbursement ONLY. Infection with any pathogen (viral, bacterial, fungal, protozoan, or helminthic) in any location of the body may be associated with the use of corticosteroids alone or in combination with other immunosuppressive agents. One vial of Zilretta white to off-white microsphere powder, Serious Neurologic Adverse Reactions with Epidural and Intrathecal Administration. I have tried laser treatments, 3 different types of injections which includes Zilretta and I have had no relief. Available for Android and iOS devices. Gently swirl the vial to resuspend any of the settled microspheres prior to preparing the syringe for injection. Because some of these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. Without Part B Medicare benefits, your out-of-pocket costs for one dose of Zilretta is over $600.00. Use proper aseptic technique throughout the dose preparation and administration procedure. I can? After Zilretta, I can focus on enjoying activities like walking and fishing. After 4 months discomfort began to come back, after another 2 weeks, a big decline and then back to the total discomfort I had before the shot. Corticosteroid injection into unstable joints is generally not recommended. (Opens in a new browser tab), Will Medicare Cover Emergency Room Visits? Tap the bottom edge of the vial firmly and repeatedly, in a circular motion, on the padded surface. Zilretta is the answer for me ! In the U.S. general population, the estimated risk of major birth defects and miscarriage in clinically recognized pregnancies is 2% to 4% and 15% to 20%, respectively. Concomitant use of aspirin (or other nonsteroidal anti-inflammatory drugs) and corticosteroids increases the risk of gastrointestinal side effects. Dietary salt restriction and potassium supplementation may be necessary. Side effects include inflammation. 3 months and going strong. Now patients like me can get durable long term pain relief. 2015). In addition, more than two-thirds of patients experienced a 50% analgesic response, measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)-A (pain) score, 4 weeks after the first and second injections. For Medicare recipients, drugs typically fall under Part D, and Medicare recipients have the option of enrolling for prescription drug insurance when they become eligible for Medicare. You are a woman. In a vertical orientation, gently push the adapter down onto the Zilretta powder vial until the spike on the adapter penetrates the rubber stopper on the Zilretta powder vial. No effect on the animals according to observations related to gait/walking, pain/discomfort in the injected knee, local swelling, local redness or local tenderness were noted. The orthopedic Dr. who did them said that Zilretta can take up to a month to even work, and you need the injections repeated every 6 to 8 months. Drug class: Glucocorticoids. Patients who are on corticosteroids are more susceptible to infections than are healthy individuals. Thanks for a reply! Covered Indications Duane Reade and 65,000 pharmacies nationwide. My right knee still has some pain, but it has decreased, and it has been one month since the injections. Remove the plastic holder from the vial adapter (Fig. injectable suspension). Inform patients that corticosteroid use may be associated with adverse psychiatric reactions. Monitor patients with congestive heart failure or hypertension for signs of edema, weight gain, and imbalance in serum electrolytes. Zilretta is an injectable suspension that delivers 32 mg of triamcinolone acetonide. Withdraw the full contents from the Zilretta vial into the syringe. If you are living with constant pain and stiffness, your health care provider may suggest that you try Zilretta. Walking, hiking, mountain climbing, working on and off my knees. No more living with pain. Corticosteroids can produce reversible hypothalamic-pituitary-adrenal axis suppression, with the potential for adrenal insufficiency after withdrawal of treatment, which may persist for months. Corticosteroid injections improve function and provide short-term pain relief, but do not improve overall quality of life, according to systematic reviews. Some of the symptoms of osteoarthritis include: Pain in the affected joint during movement or at rest after movement. All she talks about is how great Zilretta isso I asked my doctor what is opinion is. These effects are less likely to occur with synthetic derivatives. I would not do injections again and would opt instead for laparoscopy surgery if available. Grating of the bones against each other. Intra-articular injection of corticosteroid may be complicated by joint infection. Advise patients and/or caregivers to immediately report any new or worsening behavioral or mood disturbances to their health care provider [see Warnings and Precautions (5.12)]. The free Drugs.com Discount Card works like a coupon and can save you up to After about 4 or 5 months, the pain relief fades and your original knee pain returns. Last updated on Dec 1, 2022. I am on my 2nd injection! However, don??t expect miracles and then bad mouth the drug. . Newberry et al 4 conducted a systematic review for effectiveness of hyaluronic acid in the treatment of severe degenerative joint disease (DJD) of the knee. Osteoarthritis occurs as the result of the wearing down of the protective cartilage between the joints. I was worse and can barely walk sometimesmy knees lock up so I have to get up and then sit constantly. These opinions do not represent the opinions of WebMD. If you have Part B, your Medicare benefits will likely pay 80 percent of the Medicare-approved amount of these prescription drugs. You have previous joint injuries, such as sports injuries. All pregnancies have a background risk of birth defect, loss, or other adverse outcomes. Corticosteroids can cause elevations of blood pressure, salt and water retention, and increased excretion of potassium. My itb is now so inflamed it's affecting by back and ability to walk. Arachnoiditis, meningitis, paraparesis/paraplegia, and sensory disturbances have occurred after intrathecal administration. Osteoarthritis is the most common type of arthritis and it most commonly affects the knees, hips, hands, and the spine. Since osteo arthritis is degenerative, I'm sure a total knee replacement is in my future. The data below reflect exposure to a single 32 mg intra-articular injection of Zilretta in clinical studies in patients with moderate to severe pain due to osteoarthritis of the knee. I have been suffering from itb pain following a hip revision. Copyright 2023 Haymarket Media, Inc. All Rights Reserved Remove the flip-off caps from the Zilretta powder and diluent vials (Fig. Repeat administration of Zilretta (triamcinolone acetonide extended-release; Flexion Therapeutics) appears to be safe and well-tolerated in patients with osteoarthritis knee pain, according to results from a Phase 3b study. Fluid and electrolyte disturbances: Congestive heart failure in susceptible patients [see Warnings and Precautions (5.7)], fluid retention, sodium retention. 2 DOSAGE AND ADMINISTRATION Since osteo arthritis is degenerative, I'm sure a total knee replacement is in my future. The adapter will snap into place. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. There are a number of medicines that can interact with corticosteroids such as triamcinolone acetonide. What is Osteoarthritis? Up to 52weeks of radiographic data collected in this study revealed no adverse effects, including no evidence of osteonecrosis, clinically significant subchondral bone changes, insufficiency fracture, or accelerated joint space narrowing suggestive of chondrolysis, the study authors reported.
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