{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T23:00:02Z","timestamp":1792018802565,"version":"4.4.0"},"reference-count":33,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,2,21]],"date-time":"2024-02-21T00:00:00Z","timestamp":1708473600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,2,21]],"date-time":"2024-02-21T00:00:00Z","timestamp":1708473600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Orthop Traumatol"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>The purpose of this study is to compare peri-operative and short-term outcomes in patients who underwent elective total hip replacement (THA) for primary osteoarthritis (OA) with direct anterior approach (DAA) versus a pair-matched cohort of patients who underwent robotic-assisted THA with posterolateral approach.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Materials and methods<\/jats:title>\n                <jats:p>Data from consecutive patients who underwent elective hip replacement from 2021 to 2023 for primary OA were retrospectively retrieved and divided into two groups: the DAA group, who underwent THA with the DAA approach using conventional instruments, and the robotic posterolateral (R-PL group), who underwent robot arm-assisted THA with the posterolateral approach. Comparative assessed outcomes were: operative time, radiographical implant positioning, intake of rescue analgesics, blood loss, transfusion rate, leg length discrepancy and functional outcomes (Harris hip score and forgotten joint score).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>A total of 100 pair-matched patients were retrieved with a mean age of 66.7\u2009\u00b1\u200910.7 (range: 32\u201385) years and a mean follow-up of 12.8\u2009\u00b1\u20093.6 (range: 7\u201324) months. No differences in patients\u2019 characteristics were detected. Patients in the R-PL group required less rescue tramadol (<jats:italic>p<\/jats:italic>\u2009&gt;\u20090.001), ketorolac (<jats:italic>p<\/jats:italic>\u2009=\u20090.028) and acetaminophen (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). There was no significant difference in the operative time between (MD\u2009=\u20095.0\u00a0min; <jats:italic>p<\/jats:italic>\u2009=\u20090.071). Patients in the DAA group had significantly lower Hb levels at day 1 (<jats:italic>p<\/jats:italic>\u2009=\u20090.002) without significant differences in transfusion rate (<jats:italic>p<\/jats:italic>\u2009=\u20090.283). Patients in the R-PL group had shorter length of stay (LOS) with a mean difference of 1.8\u00a0days [<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001; 95% confidence interval (CI) 1.4\u20132.3]. No difference in clinical outcomes was found [leg length discrepancy (LLD), <jats:italic>p<\/jats:italic>\u2009=\u20090.572; HHS, <jats:italic>p<\/jats:italic>\u2009=\u20090.558; forgotten joint score (FJS), <jats:italic>p<\/jats:italic>\u2009=\u20090.629]. No radiographical differences were measured in cup inclination (MD\u2009=\u20092.0\u00b0, <jats:italic>p<\/jats:italic>\u2009=\u20090.069), malpositioning [odd ratio (OR)\u2009=\u20090.2; <jats:italic>p<\/jats:italic>\u2009=\u20090.141], stem alignment (OR\u2009=\u20090.3; <jats:italic>p<\/jats:italic>\u2009=\u20090.485) and stem sizing (OR\u2009=\u20091.5; <jats:italic>p<\/jats:italic>\u2009=\u20091.000). There was no difference in complication rate except for lateral femoral cutaneous nerve damage, which was higher in DAA group (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>R-PL and DAA THA had comparable short-term clinical and radiological outcomes along with similar complication rates. The R-PL group showed significantly lower Hb drop, rescue analgesic consumption and shorter LOS. This is a preliminary study and no strong recommendation can be provided. Further prospective randomized trials are requested to further investigate the cost-effectiveness of robotic surgery in THA.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>\n                           <jats:italic>Level of evidence<\/jats:italic>\n                        <\/jats:title>\n                <jats:p>Level IV, case\u2013control study.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s10195-024-00753-7","type":"journal-article","created":{"date-parts":[[2024,2,21]],"date-time":"2024-02-21T13:03:32Z","timestamp":1708520612000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Direct anterior approach with conventional instruments versus robotic posterolateral approach in elective total hip replacement for primary osteoarthritis: a case\u2013control study"],"prefix":"10.1186","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6741-3713","authenticated-orcid":false,"given":"Mattia","family":"Alessio-Mazzola","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pietro","family":"Colombo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niccolo\u2019","family":"Barducci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Ghezzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6687-2029","authenticated-orcid":false,"given":"Luigi","family":"Zagra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrizio","family":"Caldora","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Ometti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7101-0404","authenticated-orcid":false,"given":"Giacomo","family":"Placella","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8166-3062","authenticated-orcid":false,"given":"Vincenzo","family":"Salini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,2,21]]},"reference":[{"key":"753_CR1","doi-asserted-by":"publisher","first-page":"1508","DOI":"10.1016\/S0140-6736(07)60457-7","volume":"370","author":"ID Learmonth","year":"2007","unstructured":"Learmonth ID, Young C, Rorabeck C (2007) The operation of the century: total hip replacement. Lancet 370:1508\u20131519","journal-title":"Lancet"},{"key":"753_CR2","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1302\/0301-620X.102B4.BJJ-2020-0183","volume":"102","author":"JS Chang","year":"2020","unstructured":"Chang JS, Haddad FS (2020) Long-term survivorship of hip and knee arthroplasty. Bone Joint J 102:401\u2013402","journal-title":"Bone Joint J"},{"key":"753_CR3","doi-asserted-by":"publisher","first-page":"389","DOI":"10.1016\/j.joca.2013.12.006","volume":"22","author":"L Shan","year":"2014","unstructured":"Shan L, Shan B, Graham D, Saxena A (2014) Total hip replacement: a systematic review and meta-analysis on mid-term quality of life. Osteoarthr Cartil 22:389\u2013406","journal-title":"Osteoarthr Cartil"},{"key":"753_CR4","doi-asserted-by":"publisher","first-page":"443","DOI":"10.1530\/EOR-22-0108","volume":"8","author":"JEJW Geilen","year":"2023","unstructured":"Geilen JEJW, Hermans SMM, Droeghaag R, Schotanus MGM, van Haaren EH, van Hemert WLW (2023) A systematic review comparing the cost-effectiveness of the direct anterior, posterior, and straight lateral approach in total hip arthroplasty. EFORT Open Rev 8:443\u2013450","journal-title":"EFORT Open Rev"},{"key":"753_CR5","doi-asserted-by":"publisher","first-page":"732","DOI":"10.1302\/0301-620X.99B6.38053","volume":"99","author":"G Meermans","year":"2017","unstructured":"Meermans G, Konan S, Das R, Volpin A, Haddad FS (2017) The direct anterior approach in total hip arthroplasty: a systematic review of the literature. Bone Joint J 99:732\u2013740","journal-title":"Bone Joint J"},{"key":"753_CR6","doi-asserted-by":"publisher","first-page":"735","DOI":"10.1007\/s11701-021-01299-0","volume":"16","author":"LT Samuel","year":"2022","unstructured":"Samuel LT, Acu\u00f1a AJ, Mahmood B, Emara AK, Kamath AF (2022) Comparing early and mid-term outcomes between robotic-arm assisted and manual total hip arthroplasty: a systematic review. J Robot Surg 16:735\u2013748","journal-title":"J Robot Surg"},{"key":"753_CR7","doi-asserted-by":"publisher","first-page":"e2463","DOI":"10.1002\/rcs.2463","volume":"19","author":"Y Wang","year":"2023","unstructured":"Wang Y, Wang R, Gong S, Han L, Gong T, Yi Y et\u00a0al. (2023) A comparison of radiological and clinical outcomes between robotic-assisted and conventional total hip arthroplasty: a meta-analysis. Int J Med Robot 19:e2463","journal-title":"Int J Med Robot"},{"key":"753_CR8","doi-asserted-by":"publisher","first-page":"1009","DOI":"10.1302\/0301-620X.103B6.BJJ-2020-1856.R1","volume":"103","author":"N Ng","year":"2021","unstructured":"Ng N, Gaston P, Simpson PM, Macpherson GJ, Patton JT, Clement ND (2021) Robotic arm-assisted versus manual total hip arthroplasty: a systematic review and meta-analysis. Bone Joint J 103:1009\u20131020","journal-title":"Bone Joint J"},{"key":"753_CR9","doi-asserted-by":"publisher","first-page":"2357","DOI":"10.1007\/s00264-013-2093-0","volume":"37","author":"J Parvizi","year":"2013","unstructured":"Parvizi J, Rasouli MR, Jaberi M, Chevrollier G, Vizzi S, Sharkey PF et\u00a0al. (2013) Does the surgical approach in one stage bilateral total hip arthroplasty affect blood loss? Int Orthop 37:2357\u20132362","journal-title":"Int Orthop"},{"key":"753_CR10","doi-asserted-by":"publisher","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","volume":"370","author":"E von Elm","year":"2007","unstructured":"von Elm E, Altman DG, Egger M, Pocock SJ, G\u00f8tzsche PC, Vandenbroucke JP et\u00a0al. (2007) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 370:1453\u20131457","journal-title":"Lancet"},{"key":"753_CR11","doi-asserted-by":"publisher","first-page":"217","DOI":"10.2106\/00004623-197860020-00014","volume":"60","author":"GE Lewinnek","year":"1978","unstructured":"Lewinnek GE, Lewis JL, Tarr R, Compere CL, Zimmerman JR (1978) Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg Am 60:217\u2013220","journal-title":"J Bone Joint Surg Am"},{"key":"753_CR12","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1007\/s11999-010-1487-1","volume":"469","author":"MC Callanan","year":"2011","unstructured":"Callanan MC, Jarrett B, Bragdon CR, Zurakowski D, Rubash HE, Freiberg AA et\u00a0al. (2011) The John Charnley award: risk factors for cup malpositioning: quality improvement through a joint registry at a tertiary hospital. Clin Orthop Relat Res 469:319\u2013329","journal-title":"Clin Orthop Relat Res"},{"key":"753_CR13","doi-asserted-by":"publisher","first-page":"575","DOI":"10.1054\/arth.2001.23716","volume":"16","author":"NN Mahomed","year":"2001","unstructured":"Mahomed NN, Arndt DC, McGrory BJ, Harris WH (2001) The Harris hip score: comparison of patient self-report with surgeon assessment. J Arthroplasty 16:575\u2013580","journal-title":"J Arthroplasty"},{"key":"753_CR14","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1302\/2633-1462.34.BJO-2022-0010.R1","volume":"3","author":"V Singh","year":"2022","unstructured":"Singh V, Bieganowski T, Huang S, Karia R, Davidovitch RI, Schwarzkopf R (2022) The Forgotten joint score patient-acceptable symptom state following primary total hip arthroplasty. Bone Jt Open 3:307\u2013313","journal-title":"Bone Jt Open"},{"key":"753_CR15","doi-asserted-by":"publisher","first-page":"1634","DOI":"10.1016\/j.arth.2013.01.034","volume":"28","author":"WP Barrett","year":"2013","unstructured":"Barrett WP, Turner SE, Leopold JP (2013) Prospective randomized study of direct anterior vs postero-lateral approach for total hip arthroplasty. J Arthroplasty 28:1634\u20131638","journal-title":"J Arthroplasty"},{"key":"753_CR16","doi-asserted-by":"publisher","first-page":"1378","DOI":"10.1080\/07853890.2023.2193424","volume":"55","author":"Z Jin","year":"2023","unstructured":"Jin Z, Wang L, Qin J, Hu H, Wei Q (2023) Direct anterior approach versus posterolateral approach for total hip arthroplasty in the treatment of femoral neck fractures in elderly patients: a meta-analysis and systematic review. Ann Med 55:1378\u20131392","journal-title":"Ann Med"},{"key":"753_CR17","first-page":"528","volume":"12","author":"V Kumar","year":"2021","unstructured":"Kumar V, Patel S, Baburaj V, Rajnish RK, Aggarwal S (2021) Does robotic-assisted surgery improve outcomes of total hip arthroplasty compared to manual technique? A systematic review and meta-analysis. Postgrad Med J 12:528","journal-title":"Postgrad Med J"},{"key":"753_CR18","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1002\/rcs.161","volume":"3","author":"AP Schulz","year":"2007","unstructured":"Schulz AP, Seide K, Queitsch C, von Haugwitz A, Meiners J, Kienast B et\u00a0al. (2007) Results of total hip replacement using the Robodoc surgical assistant system: clinical outcome and evaluation of complications for 97 procedures. Int J Med Robot 3:301\u2013306","journal-title":"Int J Med Robot"},{"key":"753_CR19","first-page":"303","volume":"29","author":"BR Bukowski","year":"2016","unstructured":"Bukowski BR, Anderson P, Khlopas A, Chughtai M, Mont MA, Illgen RL (2016) Improved functional outcomes with robotic compared with manual total hip arthroplasty. Surg Technol Int 29:303\u2013308","journal-title":"Surg Technol Int"},{"key":"753_CR20","doi-asserted-by":"publisher","first-page":"342","DOI":"10.3109\/17453674.2012.711701","volume":"83","author":"AJ Spaans","year":"2012","unstructured":"Spaans AJ, van den Hout JA, Bolder SB (2012) High complication rate in the early experience of minimally invasive total hip arthroplasty by the direct anterior approach. Acta Orthop 83:342\u2013346","journal-title":"Acta Orthop"},{"key":"753_CR21","doi-asserted-by":"publisher","first-page":"e079328","DOI":"10.1136\/bmjopen-2023-079328","volume":"13","author":"J Griffin","year":"2023","unstructured":"Griffin J, Davis ET, Parsons H, Stevens S, Bradley H, Bruce J et\u00a0al. (2023) UK robotic arthroplasty clinical and cost effectiveness randomised controlled trial for hips (RACER-Hip): a study protocol. BMJ Open 13:e079328","journal-title":"BMJ Open"},{"key":"753_CR22","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1302\/2046-3758.101.BJR-2020-0161.R1","volume":"10","author":"ND Clement","year":"2021","unstructured":"Clement ND, Gaston P, Bell A, Simpson P, Macpherson G, Hamilton DF et\u00a0al. (2021) Robotic arm-assisted versus manual total hip arthroplasty. Bone Joint Res 10:22\u201330","journal-title":"Bone Joint Res"},{"key":"753_CR23","doi-asserted-by":"publisher","first-page":"e1990","DOI":"10.1002\/rcs.1990","volume":"15","author":"PF Han","year":"2019","unstructured":"Han PF, Chen CL, Zhang ZL, Han YC, Wei L, Li PC et\u00a0al. (2019) Robotics-assisted versus conventional manual approaches for total hip arthroplasty: a systematic review and meta-analysis of comparative studies. Int J Med Robot 15:e1990","journal-title":"Int J Med Robot"},{"key":"753_CR24","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1080\/17453674.2016.1251255","volume":"88","author":"KG Seagrave","year":"2017","unstructured":"Seagrave KG, Troelsen A, Malchau H, Husted H, Gromov K (2017) Acetabular cup position and risk of dislocation in primary total hip arthroplasty. Acta Orthop 88:10\u201317","journal-title":"Acta Orthop"},{"key":"753_CR25","doi-asserted-by":"publisher","first-page":"250","DOI":"10.1302\/2046-3758.104.BJR-2020-0043.R3","volume":"10","author":"DK Kwak","year":"2021","unstructured":"Kwak DK, Bang SH, Lee SJ, Park JH, Yoo JH (2021) Effect of stem position and length on bone-stem constructs after cementless hip arthroplasty. Bone Joint Res 10:250\u2013258","journal-title":"Bone Joint Res"},{"key":"753_CR26","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1007\/s11999-013-3253-7","volume":"472","author":"BG Domb","year":"2014","unstructured":"Domb BG, El Bitar YF, Sadik AY, Stake CE, Botser IB (2014) Comparison of robotic-assisted and conventional acetabular cup placement in THA: a matched-pair controlled study. Clin Orthop Relat Res 472:329\u2013336","journal-title":"Clin Orthop Relat Res"},{"key":"753_CR27","doi-asserted-by":"publisher","first-page":"335","DOI":"10.1136\/postgradmedj-2017-135352","volume":"94","author":"X Chen","year":"2018","unstructured":"Chen X, Xiong J, Wang P, Zhu S, Qi W, Peng H et\u00a0al. (2018) Robotic-assisted compared with conventional total hip arthroplasty: systematic review and meta-analysis. Postgrad Med J 94:335\u2013341","journal-title":"Postgrad Med J"},{"key":"753_CR28","doi-asserted-by":"publisher","first-page":"e2332","DOI":"10.1002\/rcs.2332","volume":"17","author":"AK Emara","year":"2021","unstructured":"Emara AK, Samuel LT, Acu\u00f1a AJ, Kuo A, Khlopas A, Kamath AF (2021) Robotic-arm assisted versus manual total hip arthroplasty: systematic review and meta-analysis of radiographic accuracy. Int J Med Robot 17:e2332","journal-title":"Int J Med Robot"},{"key":"753_CR29","doi-asserted-by":"publisher","first-page":"445","DOI":"10.1186\/s13018-023-03864-9","volume":"18","author":"M Ma","year":"2023","unstructured":"Ma M, Song P, Zhang S, Kong X, Chai W (2023) Does robot-assisted surgery reduce leg length discrepancy in total hip replacement? Robot-assisted posterior approach versus direct anterior approach and manual posterior approach: a propensity score-matching study. J Orthop Surg Res 18:445","journal-title":"J Orthop Surg Res"},{"key":"753_CR30","first-page":"265","volume":"44","author":"YF El Bitar","year":"2015","unstructured":"El Bitar YF, Stone JC, Jackson TJ, Lindner D, Stake CE, Domb BG (2015) Leg-length discrepancy after total hip arthroplasty: comparison of robot-assisted posterior, fluoroscopy-guided anterior, and conventional posterior approaches. Am J Orthop 44:265\u2013269","journal-title":"Am J Orthop"},{"key":"753_CR31","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1186\/s10195-022-00636-9","volume":"23","author":"F Migliorini","year":"2022","unstructured":"Migliorini F, Cuozzo F, Oliva F, Eschweiler J, Hildebrand F, Maffulli N (2022) Imageless navigation for primary total hip arthroplasty: a meta-analysis study. J Orthop Traumatol 23:21","journal-title":"J Orthop Traumatol"},{"key":"753_CR32","doi-asserted-by":"publisher","first-page":"102956","DOI":"10.1016\/j.otsr.2021.102956","volume":"107","author":"F Dahm","year":"2021","unstructured":"Dahm F, Aichmair A, Dominkus M, Hofstaetter JG (2021) Incidence of lateral femoral cutaneous nerve lesions after direct anterior approach primary total hip arthroplasty\u2014a literature review. Orthop Traumatol Surg Res 107:102956","journal-title":"Orthop Traumatol Surg Res"},{"issue":"7S","key":"753_CR33","doi-asserted-by":"publisher","first-page":"S18","DOI":"10.1016\/j.arth.2021.01.051","volume":"36","author":"MM Kheir","year":"2021","unstructured":"Kheir MM, Dilley JE, Ziemba-Davis M, Meneghini RM (2021) The AAHKS clinical research award: extended oral antibiotics prevent periprosthetic joint infection in high-risk cases: 3855 patients with 1-year follow-up. J Arthroplasty 36(7S):S18\u2013S25","journal-title":"J Arthroplasty"}],"container-title":["Journal of Orthopaedics and Traumatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s10195-024-00753-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s10195-024-00753-7\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s10195-024-00753-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,2,21]],"date-time":"2024-02-21T13:03:44Z","timestamp":1708520624000},"score":1,"resource":{"primary":{"URL":"https:\/\/jorthoptraumatol.springeropen.com\/articles\/10.1186\/s10195-024-00753-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,21]]},"references-count":33,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["753"],"URL":"https:\/\/doi.org\/10.1186\/s10195-024-00753-7","relation":{},"ISSN":["1590-9999"],"issn-type":[{"value":"1590-9999","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,21]]},"assertion":[{"value":"24 November 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 January 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 February 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Other authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"9"}}