Professional Documents
Culture Documents
Osteoarthritis
of the knee
Osteoarthritis
of the knee
This booklet provides information
and answers to your questions
about this condition.
www.arthritisresearchuk.org
Arthritis Research UK
Osteoarthritis of the knee
What’s inside?
This is an interactive table of contents. Simply click a title to go directly to the page.
2
At a glance
Osteoarthritis
of the knee Osteoarthritis
affects
approximately
8 million people
in the UK.
What are the symptoms
of osteoarthritis?
The symptoms of osteoarthritis
can include:
• pain
• stiffness
• a grating or grinding sensation when What can I do to help myself?
the joint moves (crepitus)
There are several ways you can help
• swelling (either hard or soft). yourself, including:
Sometimes the knee may either lock • losing weight if you’re overweight
or give way when you put weight on it.
• exercising regularly (both
muscle-strengthening and
Who gets it? general aerobic exercise)
exercise
Almost anyone can get osteoarthritis, • reducing stress on the affected
but it’s most likely if: joint (for example by pacing activities,
• you’re in your late 40s or older using a walking stick or wearing
appropriate footwear)
• you’re overweight
• you’re a woman
• using painkillers (analgesics
analgesics) or
anti-inflammatory creams, gels
• your parents, brothers or sisters and tablets.
have had osteoarthritis
• you’ve previously had a severe What treatments are there?
knee injury
• your joints have been damaged If you still have pain after trying self-help
by another disease, for example measures, your doctor may recommend
rheumatoid arthritis or gout
out. the following treatments:
• capsaicin cream
• stronger painkillers, for example tramadol
• steroid injections into the painful joint
• surgery, including joint replacement.
3
How does a normal These are called menisci
menisci, which act a bit
like shock absorbers to spread the load
joint work? more evenly across the joint.
A joint is where two or more bones meet
(see Figure 1). The joint allows the bones Your knee joint is held in place by four
to move freely but within limits. The knee large ligaments
ligaments. These are thick, strong
is the largest joint in the body and also bands which run within or just outside the
one of the most complicated. It needs to joint capsule. Together with the capsule,
be strong enough to take our weight and the ligaments prevent the bones moving
must lock into position so we can stand in the wrong directions or dislocating.
upright. But it also has to act as a hinge so The thigh muscles also help to hold the
we can walk and must withstand extreme knee joint in place.
stresses, twists and turns, such as when Your muscles are attached to your bones
we run or play sports. by strong connecting tissues called
The knee joint is where your thigh bone tendons. These tendons run on either
(femur) and shin bone (tibia) meet. The side of the joint, which they also help
end of each bone is covered with cartilage to keep in place. When your muscles
which has a smooth, slippery surface contract they shorten, and this pulls on
that allows the ends of the bones to the tendon attached to the bone and
move against each other almost without makes the joint move.
friction. Your knees have two additional
rings of cartilage between the bones.
Ligament
Tendon
Bone
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Arthritis Research UK
Osteoarthritis of the knee
Figure 2
A joint
with mild
osteoarthritis
(front view)
Osteophytes
(spurs) Mildy
thickened,
Roughened, inflamed
thinning synovium
cartilage
Thickened,
stretched
capsule
5
• The synovium may swell and produce It’s unusual, but some people have
extra fluid, which then causes the joint pain that wakes them up at night. This
to swell. This is called an effusion or generally only happens with severe
sometimes water on the knee. osteoarthritis. You’ll probably find that
• The capsule and ligaments slowly your pain will vary and that you have
thicken and contract as if they were good days and bad days, sometimes
trying to stabilise the joint. depending on how active you’ve been
but sometimes for no obvious reason.
These changes in and around the joint
are partly the result of the inflammatory Your knee may feel stiff at certain times,
process and partly your body’s attempt often in the mornings or after a period of
to repair the damage. In many cases, rest. Walking for a few minutes will usually
the repairs are quite successful and the ease it. However, many people don’t
changes inside the joint don’t cause much have any stiffness at all, even with quite
pain or, if there is pain, it’s mild and may severe osteoarthritis.
come and go. However, in other cases, You may not be able to move your knee
the repair doesn’t work as well and your as freely or as far as normal, and it may
knee becomes damaged. This leads to creak or crunch as you move. If your
instability and more weight being put osteoarthritis is severe, your knee may
onto other parts of the joint, which can become bent and bowed. Sometimes
cause symptoms to become gradually the joint gives way, either because the
worse and more persistent over time. muscles have become weak or because
the joint structure has become less stable.
You may notice that your knee looks
What are the symptoms swollen. The swelling may be hard
of osteoarthritis? (caused by osteophytes around the sides
The main symptoms of osteoarthritis are of the joint) or soft (caused by extra fluid
pain and sometimes stiffness, which can in the joint). The muscles at the front of
affect one or both knees. The pain tends your thigh that help straighten your knee
to be worse when you move the joint or may look thin and wasted.
at the end of the day. You may have pain
all around your knee or just in a particular
place, most likely at the front and sides,
and it may be worse after a particular
movement, such as going up or down
stairs. The pain is usually better when
you rest.
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Arthritis Research UK
Osteoarthritis of the knee
Obesity
7
A torn meniscus is a common injury in
footballers, and an operation to remove
the damaged cartilage (meniscectomy)
or repair cruciate ligaments also increases
the risk of osteoarthritis in later life.
Genetic factors – Genetic factors play a
major part in osteoarthritis of the knee.
If you have a parent, brother or sister with
knee osteoarthritis then you’ll have a
greater chance of developing it yourself.
We don’t know a lot about the genes that
cause the increased risk, but we do know
that a number of genes will have a small
effect rather than one particular gene
being responsible.
Other types of joint disease –
Sometimes osteoarthritis is a result of
damage from different kinds of rarer joint
disease, such as gout, that occurred in
earlier years.
Although there’s no evidence that
different conditions such as cold or
wet weather actually cause or worsen
osteoarthritis, many people find that
their pain and stiffness may vary with
the weather. This may be because
nerve fibres in the capsule of affected
joints are sensitive to changes in
atmospheric pressure.
9
Although there’s
no cure for
osteoarthritis yet,
How is osteoarthritis
a lot can be done diagnosed?
to improve your It’s very important to get an accurate
symptoms. diagnosis if you think you might have
arthritis. There are many different types
of arthritis and some, such as rheumatoid
arthritis, need very different treatments.
Osteoarthritis is usually diagnosed based
on your symptoms and the physical signs
that your doctor finds when examining
your joint, for example:
• tenderness over the joint
Baker’s cysts (popliteal cysts) • creaking or grating of the joint (crepitus)
Baker’s cysts can form when extra • bony swelling
synovial fluid is produced and it becomes • excess fluid
trapped in a pouch (hernia) sticking out
of the joint lining. They’re often painless, • restricted movement
but you may be able to feel a soft-to-firm • joint instability
lump at the back of your knee. Sometimes
• weakness and thinning of your
a cyst can cause aching or tenderness
thigh muscle.
when you exercise.
Occasionally a cyst can press on a blood What tests are there?
vessel, which can lead to swelling in your There’s no blood test for osteoarthritis,
leg, or the cyst may burst (rupture) and although your doctor may suggest them
release joint fluid into your calf muscle, to help rule out other types of arthritis.
which can be very painful. X-rays are taken to assess the severity of
A cyst may not need treatment, but if the changes caused by osteoarthritis,
it does it can generally be treated by although often they won’t be needed. They
drawing off the extra fluid from your knee may show changes such as bony spurs
using a syringe (this is called aspiration) or narrowing of the space between the
and injecting a steroid solution. bones where the cartilage has worn thin.
They may also show whether there are any
calcium deposits within the joint. However,
x-rays aren’t a good indicator of how much
pain or disability you’re likely to have. Some
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Osteoarthritis of the knee
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Arthritis Research UK
Osteoarthritis of the knee
• Use a walking stick to reduce the weight can help to stabilise the kneecap and
and stress on a painful knee. A therapist make it move correctly. You can buy knee
or doctor can advise on the correct braces from sports shops and chemists,
length and the best way to use the stick. but you should speak to your doctor or
• Use the handrail for support when physiotherapist first. They may also be
going up or down stairs. Go up stairs able to provide braces or recommend the
one at a time with your good leg first. best ones for you.
15
affect the level of sugar in your blood, so benefits, you may need to have regular
if you have diabetes you should keep an sessions of acupuncture. There’s also
eye on your blood sugar levels and see some evidence that electro-acupuncture
your doctor if they increase. You should may be effective for pain associated with
also see your doctor for regular blood osteoarthritis of the knee. This technique
checks if you’re taking the blood-thinning is similar to conventional acupuncture
drug warfarin. except that an electrical impulse is
applied via the needles.
Homeopathy
Many people are interested in Chiropractic and osteopathy
homeopathic remedies, and a number are Although manipulation by a chiropractor
used for osteoarthritis. However, there’s or osteopath may be helpful for back or
no conclusive scientific evidence that neck pain, the use of manipulation for
they’re effective. osteoarthritis in other joints is limited.
If you do want to try it, make sure you
Acupuncture choose a practitioner who is registered
There’s some research showing that with the appropriate regulatory body.
acupuncture can sometimes provide relief
Generally speaking complementary and
from arthritis pain, although the effect
alternative therapies are relatively well
may be short-lived. For longer-lasting
tolerated, although you should always
discuss their use with your doctor before
starting treatment. There are some risks
associated with specific therapies.
In many cases the risks associated with
complementary and alternative therapies
are more to do with the therapist than
the therapy. This is why it’s important to
go to a legally registered therapist, or one
who has a set ethical code and is fully
insured. If you decide to try therapies
or supplements, you should be critical
of what they’re doing for you, and base
your decision to continue on whether you
notice any improvement.
Arthritis Research UK
Osteoarthritis of the knee
Drugs
See Arthritis Research UK booklet
and special reports Painkillers
Complementary and alternative If you have severe pain, for example while
medicine for arthritis; Complementary you’re waiting for a knee replacement
and alternative medicines for the operation, and other medications aren’t
treatment of rheumatoid arthritis, giving enough relief, your doctor may
osteoarthritis and fibromyalgia; recommend stronger painkillers (or
Practitioner-based complementary and opioids) such as tramadol, nefopam or
alternative therapies for the treatment meptazinol. Stronger painkillers are more
of rheumatoid arthritis, osteoarthritis, likely to have side-effects – especially
nausea, dizziness and confusion – so
fibromyalgia and low back pain.
you’ll need to see your doctor regularly
and report any problems you have with
these drugs.
What treatments are there
Some opioids can be given as a plaster
for osteoarthritis? patch that you wear on the skin. These
Many people find that self-help can give pain relief for a number of days.
measures, such as those listed above,
are enough to help them manage their Non-steroidal anti-inflammatory
symptoms, but your healthcare team will drugs (NSAIDs)
be able to suggest other treatments If inflammation in the joint is contributing
if you need them. to your pain and stiffness, a short course
of NSAID tablets (for example ibuprofen,
Capsaicin cream naproxen) may be useful.
Capsaicin cream is made from the pepper
plant (capsicum) and is an effective and Like all drugs, NSAIDs can sometimes have
very well-tolerated painkiller. It’s only side-effects, but your doctor will take
available on prescription. It needs to be precautions to reduce the risk of these
applied three times a day to be effective – for example, by prescribing the lowest
and, like NSAID creams and gels, it’s effective dose for the shortest possible
particularly useful for osteoarthritis period of time.
of the knee. NSAIDs can cause digestive problems
Most people feel a warming or burning (stomach upsets, indigestion or damage
sensation when they first use capsaicin, to the lining of the stomach) so in most
but this generally wears off after several cases they’ll be prescribed along with a
days. The pain-relieving effect starts drug called a proton pump inhibitor (PPI)
(PPI),
after several days of regular use and you which will help to protect your stomach.
should try it for at least two weeks before
deciding if it has helped.
17
Because a lot of drug
treatments for osteoarthritis
work in different ways,
they can be combined to
help ease your symptoms.
Figure 7 An X-ray showing the finger of a
person with a nodal osteoarthritis
Self-help methods
like looking after
your joints will also
help to prevent
further damage.
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Arthritis Research UK
Osteoarthritis of the knee
NSAIDs also carry an increased risk of heart Health and Clinical Excellence (NICE) and
attack or stroke. Although the increased isn’t widely used because the evidence
risk is small, your doctor will be cautious that it works isn’t convincing.
about prescribing them if there are other
factors that may increase your overall Transcutaneous electrical nerve
risk – for example, smoking, circulation stimulation (TENS)
problems, high blood pressure, high Some people find that transcutaneous
cholesterol or diabetes. electrical nerve stimulation (TENS
(TENS) can
help to relieve pain, although research
If you have trouble opening childproof evidence on its effectiveness is mixed. A
containers, your pharmacist will put TENS machine is a small electronic device
them in a more suitable container for that sends pulses to the nerve endings
you. Contact us for our special request via pads placed on your skin. It produces
card which you can hand to your a tingling sensation and is thought to
pharmacist with your prescription. modify pain messages transmitted to your
brain. TENS machines are available from
Steroid injections pharmacies and other major stores, but a
Steroid injections are sometimes given physiotherapist may be able to loan you
directly into a particularly painful knee one to try before you decide whether to
joint. The injection can start to work buy one.
within a day or so, and it may improve pain
for several weeks or even months. This is Surgery
mainly used for very painful osteoarthritis Surgery may be recommended if pain
where the knee is swollen, for sudden is very severe or you have mobility
painful attacks caused by the shedding of problems. Many thousands of knee
calcium pyrophosphate crystals or to help replacements are performed each year
people through an important event (such for osteoarthritis, and the operation can
as a holiday or family wedding). However, give substantial pain relief in cases where
it’s important to remember that steroid other treatments haven’t helped enough.
injections can’t be given frequently or Surgical techniques are improving all
indefinitely. If you need repeated steroid the time and replacements now last on
injections into an osteoarthritic knee then average over 15 years.
you may need to consider surgery. Sometimes keyhole surgery techniques
may be used to wash out loose fragments
Hyaluronic acid injections of bone and other tissue from your knee.
When steroid injections don’t work, some
This is called arthroscopic lavage, and it’s
doctors give injections of this lubricating
not recommended unless your knee locks.
substance into the knee joint, either as a
single injection or as a course of several
See Arthritis Research UK booklet
injections. However, this form of treatment
Knee replacement surgery.
isn’t approved by the National Institute for
19
Self-help and daily living Dealing with stress
Living with a long-term condition like
Sleep osteoarthritis can lower your morale and
If pain is a problem at night, heat may may affect your sleep. It’s important to
help. Try a hot bath before going to bed, tackle problems like these as they could
or use a hot-water bottle, wheat bag lead to depression and will certainly make
(which you can heat in a microwave) or the osteoarthritis itself more difficult to
electric blanket. Taking a painkiller before cope with.
going to bed can ease night-time pain so
It often helps to talk about negative
you can get to sleep more easily. Placing a
feelings, so it could be useful to speak to
pillow between your knees can also help
your healthcare team, or your family and
to ease pain.
friends. Support groups are also available
– your doctor may be able to tell you
See Arthritis Research UK booklet about organisations in your area.
Sleep and arthritis.
See Arthritis Research UK booklets
Work and guide Fatigue and arthritis; Pain
Most people with osteoarthritis are able and arthritis; Living with long-term pain:
to continue in their jobs, although you a guide to self-management.
may need to make some alterations to
your working environments, especially
if you have a physically demanding job.
Speak to your employer’s occupational
Research and new
health service if they have one, or your developments
local Jobcentre Plus can put you in touch Research has already shown the
with Disability Employment Advisors who importance of exercise and weight
can arrange work assessments. They can management in reducing the pain of
advise you on changing the way you work osteoarthritis, particularly of the knee.
and on equipment that may help you to There are many studies going on around
do your job more easily. If necessary, they the world to find and test new treatments
can also help with retraining for more for osteoarthritis. These include studies
suitable work. funded by Arthritis Research UK looking
into the benefits of vitamin D (the VIDEO
See Arthritis Research UK booklet study) and a large national study to
Work and arthritis. find the genes responsible for causing
osteoarthritis (the arcOGEN study),
which could lead to new therapies.
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Osteoarthritis of the knee
21
Patient story My doctor examined my knee and sent
me for an x-ray. She told me I’d got
John is a 68-year-old osteoarthritis, and I’d also got some
retired salesman. calcium crystals in the joint. She said it
When I was 25 I injured my knee playing was probably because of my old injury
football. It locked and was very painful for and the operations I’d had. She gave me
several weeks. My doctor sent me to see some paracetamol for the pain and some
an orthopaedic surgeon, and he removed NSAID cream to put on, which helped.
some damaged cartilage (meniscus) from I’ve also had some physiotherapy to help
my knee. I was still in quite a lot of pain strengthen my thigh muscles. The physio
and had to have another operation on said these muscles often get weak when
the same knee a few years later, when I you’ve got arthritis in your knee. The
was 30. After that, I didn’t really have any exercises certainly made walking and
problems for some years. My knee used to climbing stairs a lot easier.
ache occasionally and it was sometimes Now I’m retired I don’t have to rush
stiff, but it didn’t stop me doing the things around so much, and I’m finding things
I wanted to. easier. I like gardening and do some
Then, about 10 years ago, the discomfort home decorating, which is fine as long
and stiffness started getting worse. As I take it gently. I use the tablets and the
time went by the knee got quite painful cream most days, and I’ve kept on with
when I was exercising and it also started the exercises I was shown. I get more pain
to swell a little. By the time I was 64, and some days than others. It usually seems
coming up to retirement, it was getting worse when the weather’s damp. And my
difficult to get up and down stairs, and if I knee does tend to stiffen up if I sit still for
walked more than about half a mile I’d be too long.
in a lot of pain afterwards.
22
Arthritis Research UK
Osteoarthritis of the knee
23
Glossary Hydrotherapy – exercises that take
place in water (usually a warm, shallow
Acupuncture – a method of obtaining
swimming pool or a special hydrotherapy
pain relief which originated in China.
bath) which can improve mobility, help
Very fine needles are inserted, virtually
relieve discomfort and promote recovery
painlessly, at a number of sites (called
from injury.
meridians) but not necessarily at the
painful area. Pain relief is obtained by Inflammation – a normal reaction
interfering with pain signals to the brain to injury or infection of living tissues.
and by causing the release of natural The flow of blood increases, resulting in
painkillers (called endorphins). heat and redness in the affected tissues,
and fluid and cells leak into the tissue,
Aerobic exercise – any exercise that
causing swelling.
increases your pulse rate and makes you
a bit short of breath. Ligaments – tough, fibrous bands
anchoring the bones on either side of a
Analgesics – painkillers. As well as dulling
joint and holding the joint together. In the
pain they lower raised body temperature,
spine they’re attached to the vertebrae
and most of them reduce inflammation.
and restrict spinal movements, therefore
Cartilage – a layer of tough, slippery giving stability to the back.
tissue that covers the ends of the bones
Magnetic resonance imaging
in a joint. It acts as a shock absorber
(MRI) scan – a type of scan that uses
and allows smooth movement
high-frequency radio waves in a strong
between bones.
magnetic field to build up pictures of the
Chiropractor – a specialist who inside of the body. It works by detecting
treats mechanical disorders of the water molecules in the body’s tissue that
musculoskeletal system, often through give out a characteristic signal in the
spine manipulation or adjustment. The magnetic field. An MRI scan can show up
General Chiropractic Council regulates soft-tissue structures as well as bones.
the practice of chiropractic in the UK.
Manipulation – a type of manual
Gout – an inflammatory arthritis caused therapy used to adjust parts of the body,
by a reaction to the formation of urate joints and muscles to treat stiffness
crystals in the joint. Gout comes and and deformity. It’s commonly used in
goes in several flare-ups at first, but if physiotherapy, chiropractic, osteopathy
not treated it can eventually lead to joint and orthopaedics.
damage. It often affects the big toe.
24
Arthritis Research UK
Osteoarthritis of the knee
25
Where can I find • Pain and arthritis
out more? • Practitioner-based complementary and
If you’ve found this information useful alternative therapies for the treatment
you might be interested in these other of rheumatoid arthritis, osteoarthritis,
titles from our range: fibromyalgia and low back pain (66-page
special report)
Conditions • Sex and arthritis
• Calcium crystal diseases including acute
• Sleep and arthritis
CPP crystal arthritis (pseudogout) and
acute calcific tendinitis • Work and arthritis
• Osteoarthritis Drug leaflets
Therapies • Local steroid injections
• Hydrotherapy and arthritis • Non-steroidal anti-inflammatory drugs
• Occupational therapy and arthritis • Painkillers
• Physiotherapy and arthritis You can download all of our booklets
and leaflets from our website or order
Surgeries them by contacting:
• Knee replacement surgery
Arthritis Research UK
Self-help and daily living Copeman House
• Complementary and alternative medicine St Mary’s Court
for arthritis St Mary’s Gate
• Complementary and alternative Chesterfield
medicines for the treatment of Derbyshire S41 7TD.
rheumatoid arthritis, osteoarthritis and Phone: 0300 790 0400
fibromyalgia (63-page special report) www.arthritisresearchuk.org
26
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Osteoarthritis of the knee
27
Get involved
You can help to take the pain away
from millions of people in the UK by:
• volunteering
• supporting our campaigns
• taking part in a fundraising event
• making a donation
• asking your company to support us
• buying products from our online and
high-street shops.
Leg stretch:
2 stretched out in front. Keeping your foot
Straight-leg raise (lying): Get into the you feel it being comfortably stretched.
habit of doing this in the morning and
at night while lying in bed. Bend one leg
at the knee. Hold your other leg straight Repeat 10 times with each leg. If you can’t
6
Knee squats: Hold onto a chair or work
surface for support. Squat down until your
kneecap covers your big toe. Return to 8
standing. Repeat at least 10 times. As you
Sit/stands: Sit on a chair. Without using
improve, try to squat a little further. Don’t
your hands for support, stand up and
bend your knees beyond a right angle.
then sit back down. Make sure each
movement is slow and controlled. Repeat
for one minute. If the chair is too low, start
with rising from a cushion on the seat
and remove when you don’t need it any
more. As you improve, try to increase the
number of sit/stands you can do in
one minute and try the exercise from
lower chairs or the bottom two steps
of a staircase.
Keeping active
It’s important to keep active – you should
try to do the exercises that are suitable for
you every day. Try to repeat each exercise
www.arthritisresearchuk.org
32
We’re here to help
Arthritis Research UK is the charity projects that we’re funding and giving
leading the fight against arthritis. insight into the latest treatment and
We’re the UK’s fourth largest medical self-help available.
research charity and fund scientific and We often feature case studies and
medical research into all types of arthritis have regular columns for questions
and musculoskeletal conditions. and answers, as well as readers’ hints
We’re working to take the pain away and tips for managing arthritis.
for sufferers with all forms of arthritis
and helping people to remain active.
We’ll do this by funding high-quality Tell us what you think
research, providing information
Please send your views to:
and campaigning.
feedback@arthritisresearchuk.org
Everything we do is underpinned or write to us at:
by research. Arthritis Research UK, Copeman
We publish over 60 information booklets House, St Mary’s Court, St Mary’s Gate,
which help people affected by arthritis Chesterfield, Derbyshire S41 7TD.
to understand more about the condition,
its treatment, therapies and how
A team of people contributed to this
to help themselves.
booklet. The original text was written by
We also produce a range of separate consultant rheumatologist Prof. Tim Spector
leaflets on many of the drugs used who has expertise in the subject. It was
for arthritis and related conditions. assessed at draft stage by clinic champion
We recommend that you read the for osteoarthritis Dr Mark Porcheret, GPwSI
relevant leaflet for more detailed (MSK disorders) Dr Chandu Prasannan,
information about your medication. physiotherapist Ros Teweleit. An Arthritis
Research UK editor revised the text to make
Please also let us know if you’d like it easy to read, and a non-medical panel,
to receive our quarterly magazine, including interested societies, checked it
Arthritis Today, which keeps you up for understanding. An Arthritis Research
to date with current research and UK medical advisor, Prof. Anisur Rahman, is
education news, highlighting key responsible for the content overall.
33
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Derbyshire S41 7TD
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