Skip to main content
SpringerLink
Log in
SpringerLink
Log in

Revision Shoulder Arthroplasty

  • Chapter
  • First Online:
Textbook of Shoulder Surgery

  • 887 Accesses

Abstract

Described in 1983, Dr. Jules-Emile Pean performed the first glenohumeral joint arthroplasty to replace a shoulder damaged by tuberculosis [1, 2]. Since then, the indications for shoulder arthroplasty have expanded, including primary osteoarthritis, rotator cuff arthropathy, acute trauma, post-traumatic arthritis, inflammatory disease, osteonecrosis and tumors. In their epidemiological study of shoulder arthroplasty in the United States (US), Jain et al. found that primary shoulder arthroplasties increased from ~52,000 in 2009 to ~67,000 in 2011. In 2011, anatomic shoulder arthroplasties accounted for ~29,000 (44%), reverse shoulder arthroplasties comprised ~22,000 (32%), and hemiarthroplasties comprised ~16,000 (23%) [3]. Westermann et al. found similar numbers in the US in 2011 [4]. As the number of shoulder replacements continues to grow, so do the complications and need for subsequent revision surgeries. Unfortunately, complications after shoulder arthroplasty are not uncommon and oftentimes require revision surgery. Bohsali et al. found 404 complications in their analysis of 2540 shoulder arthroplasties (15.9%) [2]. Others have reported similar complication rates [5, 6]. Jain found that the number of revision cases increased from 5070 in 2009 to 6028 in 2011 in the US, accounting for ~8% of all cases. Labek found revision rates of 8% in Norway and 6% in New Zealand [7]. Slightly higher numbers were seen in Farvard’s study in France, with a 11.2% revision rate in anatomic arthroplasties and 13.4% in reverse implants [8]. With an increase in the numbers of shoulder arthroplasties performed each year, it is important that shoulder surgeons recognize the common modes of failure and have strategies to address this failure with revision shoulder arthroplasty. This chapter outlines the different modes of failure for shoulder arthroplasty, including patient presentation and necessary investigations. Furthermore, this chapter discusses strategies and surgical techniques for revision shoulder arthroplasty and associated results.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Lugli T. Artificial shoulder joint by Péan (1893): the facts of an exceptional intervention and the prosthetic method. Clin Orthop Relat Res. 1978;1978(133):215–8.

    Google Scholar 

  2. Bohsali KI, Wirth MA, Rockwood CA Jr. Complications of total shoulder arthroplasty. J Bone Joint Surg Am. 2006;88(10):2279–92.

    PubMed  Google Scholar 

  3. Jain NB, Yamaguchi K. The contribution of reverse shoulder arthroplasty to utilization of primary shoulder arthroplasty. J Shoulder Elb Surg. 2014;23(12):1905–12.

    Article  Google Scholar 

  4. Westermann RW, Pugely AJ, Martin CT, Gao Y, Wolf BR, Hettrich CM. Reverse Shoulder Arthroplasty in the United States: A Comparison of National Volume, Patient Demographics, Complications, and Surgical Indications. Iowa Orthop J. 2015;35:1–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  5. Chin PY, Sperling JW, Cofield RH, Schleck C. Complications of total shoulder arthroplasty: are they fewer or different? J Shoulder Elbow Surg/Am J Shoulder Elbow Surg [et al.]. 2006;15(1):19–22.

    Article  PubMed  Google Scholar 

  6. Miller BS, Joseph TA, Noonan TJ, Horan MP, Hawkins RJ. Rupture of the subscapularis tendon after shoulder arthroplasty: diagnosis, treatment, and outcome. J Shoulder Elbow Surg/Am J Shoulder Elbow Surg [et al.]. 2005;14(5):492–6.

    Article  PubMed  Google Scholar 

  7. Labek G, Thaler M, Janda W, Agreiter M, Stöckl B. Revision rates after total joint replacement: cumulative results from worldwide joint register datasets. J Bone Joint Surg Br. 2011;93(3):293–7.

    Article  CAS  PubMed  Google Scholar 

  8. Favard L. Revision of total shoulder arthroplasty. Orthop Traumatol Surg Res. 2013;99(1 Suppl):S12–21.

    Article  CAS  PubMed  Google Scholar 

  9. Morris BJ, O’Connor DP, Torres D, Elkousy HA, Gartsman GM, Edwards TB. Risk factors for periprosthetic infection after reverse shoulder arthroplasty. J Shoulder Elb Surg. 2015;24(2):161–6.

    Article  Google Scholar 

  10. Coste JS, Reig S, Trojani C, Berg M, Walch G, Boileau P. The management of infection in arthroplasty of the shoulder. J Bone Joint Surg Br. 2004;86(1):65–9.

    Article  CAS  PubMed  Google Scholar 

  11. Hatta T, Werthel JD, Wagner ER, et al. Effect of smoking on complications following primary shoulder arthroplasty. J Shoulder Elb Surg. 2017;26(1):1–6.

    Article  Google Scholar 

  12. Nelson GN, Davis DE, Namdari S. Outcomes in the treatment of periprosthetic joint infection after shoulder arthroplasty: a systematic review. J Shoulder Elb Surg. 2016;25(8):1337–45.

    Article  Google Scholar 

  13. Cheung E, Willis M, Walker M, Clark R, Frankle MA. Complications in reverse total shoulder arthroplasty. J Am Acad Orthop Surg. 2011;19(7):439–49.

    Article  PubMed  Google Scholar 

  14. Cofield RH, Sperling JW. Revision and complex shoulder arthroplasty. Philadelphia: Wolters Kluwer Health/Lippincott William & Wilkins; 2010.

    Google Scholar 

  15. Cisneros LG, Atoun E, Abraham R, Tsvieli O, Bruguera J, Levy O. Revision shoulder arthroplasty: does the stem really matter? J Shoulder Elb Surg. 2016;25(5):747–55.

    Article  Google Scholar 

  16. Antoni M, Barthoulot M, Kempf JF, Clavert P. Revisions of total shoulder arthroplasty: Clinical results and complications of various modalities. Orthop Traumatol Surg Res. 2016;102(3):297–303.

    Article  CAS  PubMed  Google Scholar 

  17. Zumstein MA, Pinedo M, Old J, Boileau P. Problems, complications, reoperations, and revisions in reverse total shoulder arthroplasty: a systematic review. J Shoulder Elb Surg. 2011;20(1):146–57.

    Article  Google Scholar 

  18. Boileau P, Watkinson D, Hatzidakis AM, Hovorka I. Neer Award 2005: The Grammont reverse shoulder prosthesis: results in cuff tear arthritis, fracture sequelae, and revision arthroplasty. J Shoulder Elb Surg. 2006;15(5):527–40.

    Article  Google Scholar 

  19. Williams GR. Shoulder and elbow arthroplasty. Philadelphia: Lippincott Williams & Wilkins; 2005.

    Google Scholar 

  20. Walch G, Moraga C, Young A, Castellanos-Rosas J. Results of anatomic nonconstrained prosthesis in primary osteoarthritis with biconcave glenoid. J Shoulder Elb Surg. 2012;21(11):1526–33.

    Article  Google Scholar 

  21. Lädermann A, Edwards TB, Walch G. Arm lengthening after reverse shoulder arthroplasty: a review. Int Orthop. 2014;38(5):991–1000.

    Article  PubMed  Google Scholar 

  22. Affonso J, Nicholson GP, Frankle MA, et al. Complications of the reverse prosthesis: prevention and treatment. Instr Course Lect. 2012;61:157–68.

    PubMed  Google Scholar 

  23. Boileau P. Complications and revision of reverse total shoulder arthroplasty. Orthop Traumatol Surg Res. 2016;102(1 Suppl):S33–43.

    Article  CAS  PubMed  Google Scholar 

  24. Rockwood CA. The shoulder. 3rd ed. Philadelphia: Saunders; 2004.

    Google Scholar 

  25. Franklin JL, Barrett WP, Jackins SE, Matsen FA. Glenoid loosening in total shoulder arthroplasty. Association with rotator cuff deficiency. J Arthroplast. 1988;3(1):39–46.

    Article  CAS  Google Scholar 

  26. Gartsman GM, Edwards TB. Shoulder arthroplasty. Edinburgh: Saunders; 2008. http://www.clinicalkey.com/dura/browse/bookChapter/3-s2.0-B9781416038573X50017

    Book  Google Scholar 

  27. Matsen FA, Clinton J, Lynch J, Bertelsen A, Richardson ML. Glenoid component failure in total shoulder arthroplasty. J Bone Joint Surg Am. 2008;90(4):885–96.

    Article  PubMed  Google Scholar 

  28. Anglin C, Wyss UP, Nyffeler RW, Gerber C. Loosening performance of cemented glenoid prosthesis design pairs. Clin Biomech (Bristol, Avon). 2001;16(2):144–50.

    Article  CAS  Google Scholar 

  29. Lazarus MD, Jensen KL, Southworth C, Matsen FA. The radiographic evaluation of keeled and pegged glenoid component insertion. J Bone Joint Surg Am. 2002;84-A(7):1174–82.

    Article  Google Scholar 

  30. Matsen FA, Iannotti JP, Rockwood CA. Humeral fixation by press-fitting of a tapered metaphyseal stem: a prospective radiographic study. J Bone Joint Surg Am. 2003;85-A(2):304–8.

    Article  Google Scholar 

  31. Sperling JW, Cofield RH, O’Driscoll SW, Torchia ME, Rowland CM. Radiographic assessment of ingrowth total shoulder arthroplasty. J Shoulder Elb Surg. 2000;9(6):507–13.

    Article  CAS  Google Scholar 

  32. Maynou C, Petroff E, Mestdagh H, Dubois HH, Lerue O. Clinical and radiologic outcome of humeral implants in shoulder arthroplasty. Acta Orthop Belg. 1999;65(1):57–64.

    CAS  PubMed  Google Scholar 

  33. Herschel R, Wieser K, Morrey ME, Ramos CH, Gerber C, Meyer DC. Risk factors for glenoid erosion in patients with shoulder hemiarthroplasty: an analysis of 118 cases. J Shoulder Elb Surg. 2016; 26(2):246–52.

    Article  PubMed  Google Scholar 

  34. Singh JA, Sperling J, Schleck C, Harmsen W, Cofield R. Periprosthetic fractures associated with primary total shoulder arthroplasty and primary humeral head replacement: a thirty-three-year study. J Bone Joint Surg Am. 2012;94(19):1777–85.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Kelly JD, Hobgood ER. Positive culture rate in revision shoulder arthroplasty. Clin Orthop Relat Res. 2009;467(9):2343–8.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Topolski MS, Chin PY, Sperling JW, Cofield RH. Revision shoulder arthroplasty with positive intraoperative cultures: the value of preoperative studies and intraoperative histology. J Shoulder Elb Surg. 2006;15(4):402–6.

    Article  Google Scholar 

  37. Moeckel BH, Altchek DW, Warren RF, Wickiewicz TL, Dines DM. Instability of the shoulder after arthroplasty. J Bone Joint Surg Am. 1993;75(4):492–7.

    Article  CAS  PubMed  Google Scholar 

  38. Elhassan B, Ozbaydar M, Massimini D, Diller D, Higgins L, Warner JJ. Transfer of pectoralis major for the treatment of irreparable tears of subscapularis: does it work? J Bone Joint Surg Br. 2008;90(8):1059–65.

    Article  CAS  PubMed  Google Scholar 

  39. Wirth MA, Rockwood CA Jr. Complications of shoulder arthroplasty. Clin Orthop Relat Res. 1994;307:47–69.

    Google Scholar 

  40. Levy DM, Abrams GD, Harris JD, Bach BR, Nicholson GP, Romeo AA. Rotator cuff tears after total shoulder arthroplasty in primary osteoarthritis: A systematic review. Int J Shoulder Surg. 2016;10(2):78–84.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Godeneche A, Boileau P, Favard L, et al. Prosthetic replacement in the treatment of osteoarthritis of the shoulder: early results of 268 cases. J Shoulder Elbow Surg/Am J Shoulder Elbow Surg [et al.]. 2002;11(1):11–8.

    Article  PubMed  Google Scholar 

  42. Buckingham BP, Parsons IM, Campbell B, Titelman RM, Smith KL, Matsen FA. Patient functional self-assessment in late glenoid component failure at three to eleven years after total shoulder arthroplasty. J Shoulder Elb Surg. 2005;14(4):368–74.

    Article  Google Scholar 

  43. Hawkins RJ, Greis PE, Bonutti PM. Treatment of symptomatic glenoid loosening following unconstrained shoulder arthroplasty. Orthopedics. 1999;22(2):229–34.

    CAS  PubMed  Google Scholar 

  44. Iannotti JP, Williams GR. Ovid Technologies Inc. Disorders of the shoulder diagnosis and management. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2007. http://ovidsp.ovid.com/ovidweb.cgi?T=JS&MODE=ovid&NEWS=n&PAGE=booktext&D=books&AN=01257005

    Google Scholar 

  45. Pinkas D, Wiater B, Wiater JM. The glenoid component in anatomic shoulder arthroplasty. J Am Acad Orthop Surg. 2015;23(5):317–26.

    Article  PubMed  Google Scholar 

  46. Martin SD, Zurakowski D, Thornhill TS. Uncemented glenoid component in total shoulder arthroplasty. Survivorship and outcomes. J Bone Joint Surg Am. 2005;87(6):1284–92.

    PubMed  Google Scholar 

  47. O’Driscoll SW, Petrie RS, Torchia ME. Arthroscopic removal of the glenoid component for failed total shoulder arthroplasty. A report of five cases. J Bone Joint Surg Am. 2005;87(4):858–63.

    Article  PubMed  Google Scholar 

  48. Namdari S, Glaser D. Arthroscopically assisted conversion of total shoulder arthroplasty to hemiarthroplasty with glenoid bone grafting. Orthopedics. 2011;34(11):862–5.

    Article  PubMed  Google Scholar 

  49. Cil A, Veillette CJ, Sanchez-Sotelo J, Sperling JW, Schleck C, Cofield RH. Revision of the humeral component for aseptic loosening in arthroplasty of the shoulder. J Bone Joint Surg Br. 2009;91(1):75–81.

    Article  CAS  PubMed  Google Scholar 

  50. Kumar S, Sperling JW, Haidukewych GH, Cofield RH. Periprosthetic humeral fractures after shoulder arthroplasty. J Bone Joint Surg Am. 2004;86-A(4):680–9.

    Article  Google Scholar 

  51. Foruria AM, Oh LS, Sperling JW, Cofield RH. Anteromedial approach for shoulder arthroplasty: current indications, complications, and results. J Shoulder Elbow Surg/Am J Shoulder Elbow Surg [et al.]. 2010;19(5):734–8.

    Article  PubMed  Google Scholar 

  52. Goldberg SH, Cohen MS, Young M, Bradnock B. Thermal tissue damage caused by ultrasonic cement removal from the humerus. J Bone Joint Surg Am. 2005;87(3):583–91.

    Article  PubMed  Google Scholar 

  53. Neer CS 2nd, Morrison DS. Glenoid bone-grafting in total shoulder arthroplasty. J Bone Joint Surg Am. 1988;70(8):1154–62.

    Article  PubMed  Google Scholar 

  54. Phipatanakul WP, Norris TR. Treatment of glenoid loosening and bone loss due to osteolysis with glenoid bone grafting. J Shoulder Elbow Surg/Am J Shoulder Elbow Surg [et al.]. 2006;15(1):84–7.

    Article  PubMed  Google Scholar 

  55. Scalise JJ, Iannotti JP. Bone grafting severe glenoid defects in revision shoulder arthroplasty. Clin Orthop Relat Res. 2008;466(1):139–45.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Gonzalez JF, Alami GB, Baque F, Walch G, Boileau P. Complications of unconstrained shoulder prostheses. J Shoulder Elbow Surg/Am J Shoulder Elbow Surg [et al.]. 2011;20(4):666–82.

    Article  PubMed  Google Scholar 

  57. Whatley AN, Fowler RL, Warner JJ, Higgins LD. Postoperative rupture of the anterolateral deltoid muscle following reverse total shoulder arthroplasty in patients who have undergone open rotator cuff repair. J Shoulder Elbow Surg/Am J Shoulder Elbow Surg [et al.]. 2011;20(1):114–22.

    Article  PubMed  Google Scholar 

  58. Wagner E, Houdek MT, Griffith T, et al. Glenoid Bone-Grafting in Revision to a Reverse Total Shoulder Arthroplasty. J Bone Joint Surg Am. 2015;97(20):1653–60.

    Article  PubMed  Google Scholar 

  59. Bateman E, Donald SM. Reconstruction of massive uncontained glenoid defects using a combined autograft-allograft construct with reverse shoulder arthroplasty: preliminary results. J Shoulder Elbow Surg/Am J Shoulder Elbow Surg [et al]. 2012;21(7):925–34.

    Article  PubMed  Google Scholar 

  60. Norris TR, Kelly JD, Humphrey SC. Management of glenoid bone defects in revision shoulder arthroplasty: a new application of the reverse total shoulder prosthesis. Tech Should Elbow Surg. 2007;8(1):37–46.

    Article  Google Scholar 

  61. Boileau P, Moineau G, Roussanne Y, O’Shea K. Bony increased-offset reversed shoulder arthroplasty: minimizing scapular impingement while maximizing glenoid fixation. Clin Orthop Relat Res. 2011;469(9):2558–67.

    Article  PubMed  PubMed Central  Google Scholar 

  62. George DA, Volpin A, Scarponi S, Haddad FS, Romanò CL. Does exchange arthroplasty of an infected shoulder prosthesis provide better eradication rate and better functional outcome, compared to a permanent spacer or resection arthroplasty? a systematic review. BMC Musculoskelet Disord. 2016;17:52.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  63. Cuff DJ, Virani NA, Levy J, et al. The treatment of deep shoulder infection and glenohumeral instability with debridement, reverse shoulder arthroplasty and postoperative antibiotics. J Bone Joint Surg Br. 2008;90(3):336–42.

    Article  CAS  PubMed  Google Scholar 

  64. Stine IA, Lee B, Zalavras CG, Hatch G, Itamura JM. Management of chronic shoulder infections utilizing a fixed articulating antibiotic-loaded spacer. J Shoulder Elb Surg. 2010;19(5):739–48.

    Article  Google Scholar 

  65. Verhelst L, Stuyck J, Bellemans J, Debeer P. Resection arthroplasty of the shoulder as a salvage procedure for deep shoulder infection: does the use of a cement spacer improve outcome? J Shoulder Elb Surg. 2011;20(8):1224–33.

    Article  Google Scholar 

  66. Dodson CC, Craig EV, Cordasco FA, et al. Propionibacterium acnes infection after shoulder arthroplasty: a diagnostic challenge. J Shoulder Elb Surg. 2010;19(2):303–7.

    Article  Google Scholar 

  67. Sanchez-Sotelo J, Sperling JW, Rowland CM, Cofield RH. Instability after shoulder arthroplasty: results of surgical treatment. J Bone Joint Surg Am. 2003;85-A(4):622–31.

    Article  Google Scholar 

  68. Farshad M, Grögli M, Catanzaro S, Gerber C. Revision of reversed total shoulder arthroplasty. Indications and outcome BMC Musculoskelet Disord. 2012;13:160.

    Article  PubMed  Google Scholar 

  69. Hattrup SJ, Cofield RH, Cha SS. Rotator cuff repair after shoulder replacement. J Shoulder Elb Surg. 2006;15(1):78–83.

    Article  Google Scholar 

  70. Kelly JD, Zhao JX, Hobgood ER, Norris TR. Clinical results of revision shoulder arthroplasty using the reverse prosthesis. J Shoulder Elb Surg. 2012;21(11):1516–25.

    Article  Google Scholar 

  71. Flury MP, Frey P, Goldhahn J, Schwyzer HK, Simmen BR. Reverse shoulder arthroplasty as a salvage procedure for failed conventional shoulder replacement due to cuff failure–midterm results. Int Orthop. 2011;35(1):53–60.

    Article  PubMed  Google Scholar 

  72. Bonnevialle N, Melis B, Neyton L, et al. Aseptic glenoid loosening or failure in total shoulder arthroplasty: revision with glenoid reimplantation. J Shoulder Elbow Surg/Am J Shoulder Elbow Surg [et al.]. 2013;22(6):745–51.

    Article  PubMed  Google Scholar 

  73. Melis B, Bonnevialle N, Neyton L, et al. Glenoid loosening and failure in anatomical total shoulder arthroplasty: is revision with a reverse shoulder arthroplasty a reliable option? J Shoulder Elbow Surg/Am J Shoulder Elbow Surg [et al.]. 2012;21(3):342–9.

    Article  PubMed  Google Scholar 

  74. Sperling JW, Cofield RH. Revision total shoulder arthroplasty for the treatment of glenoid arthrosis. J Bone Joint Surg Am. 1998;80(6):860–7.

    Article  CAS  PubMed  Google Scholar 

  75. Hattrup SJ. Revision total shoulder arthroplasty for painful humeral head replacement with glenoid arthrosis. J Shoulder Elb Surg. 2009;18(2):220–4.

    Article  Google Scholar 

  76. Athwal GS, Sperling JW, Rispoli DM, Cofield RH. Periprosthetic humeral fractures during shoulder arthroplasty. J Bone Joint Surg Am. 2009;91(3):594–603.

    Article  PubMed  Google Scholar 

  77. Valenti P, Kilinc AS, Sauzières P, Katz D. Results of 30 reverse shoulder prostheses for revision of failed hemi- or total shoulder arthroplasty. Eur J Orthop Surg Traumatol. 2014;24(8):1375–82.

    Article  PubMed  Google Scholar 

  78. Levy J, Frankle M, Mighell M, Pupello D. The use of the reverse shoulder prosthesis for the treatment of failed hemiarthroplasty for proximal humeral fracture. J Bone Joint Surg Am. 2007;89(2):292–300.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Sports Medicine and Shoulder Surgery, University of Colorado, Aurora, CO, USA

    Adam Seidl

  2. Resident Physician, Department of Orthopaedic Surgery, University of Colorado, Aurora, CO, USA

    Derek Axibal

  3. Department of Orthopaedics and Traumatology, University Hospital of Nice, Nice, France

    Mikaël Chelli

  4. Department of Orthopaedics, University Institute of Locomotion and Sports, Pasteur 2 Hospital, Nice, France

    Pascal Boileau

Authors
  1. Adam Seidl
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Derek Axibal
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mikaël Chelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Pascal Boileau
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Adam Seidl .

Editor information

Editors and Affiliations

  1. Wrightington Hospital, Wigan, Lancashire, UK

    Ian A. Trail

  2. Wrightington Hospital, Wigan, Lancashire, UK

    Lennard Funk

  3. Orthopaedic Surgery Department, The James Cook University Hospital, Middlesbrough, North Yorkshire, UK

    Amar Rangan

  4. Trauma & Orthopaedics Department, Countess of Chester Hospital, Chester, Cheshire, UK

    Matthew Nixon

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Seidl, A., Axibal, D., Chelli, M., Boileau, P. (2019). Revision Shoulder Arthroplasty. In: Trail, I., Funk, L., Rangan, A., Nixon, M. (eds) Textbook of Shoulder Surgery . Springer, Cham. https://doi.org/10.1007/978-3-319-70099-1_24

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-70099-1_24

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-70098-4

  • Online ISBN: 978-3-319-70099-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation