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Perioperative implications were evaluated with emphasis on orthopaedic surgical risk domains relevant to total joint arthroplasty (TJA), including wound complications, hematoma formation, immune modulation, infection susceptibility, heterotopic ossification, and implant fixation considerations

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Development of auto-antibodies Some cobalamin preparations in rare cases can stimulate an allergenic response where there is development of antibodies to the cobalmin injected