This study evaluated the biocompatibility and biological performance of novel additive-manufactured bioabsorbable iron-based porous suture anchors (iron_SAs). Two types of bioabsorbable iron_SAs, with double- and triple-helical structures (iron_SA_2_helix and iron_SA_3_helix, respectively), were compared with the synthetic polymer-based bioabsorbable suture anchor (polymer_SAs). An in vitro mechanical test, MTT assay, and scanning electron microscope (SEM) analysis were performed. An in vivo animal study was also performed. The three types of suture anchors were randomly implanted in the outer cortex of the lateral femoral condyle. The ultimate in vitro pullout strength of the iron_SA_3_helix group was significantly higher than the iron_SA_2_helix and polymer_SA groups. The MTT assay findings demonstrated no significant cytotoxicity, and the SEM analysis showed cells attachment on implant surface. The ultimate failure load of the iron_SA_3_helix group was significantly higher than that of the polymer_SA group. The micro-CT analysis indicated the iron_SA_3_helix group showed a higher bone volume fraction (BV/TV) after surgery. Moreover, both iron SAs underwent degradation with time. Iron_SAs with triple-helical threads and a porous structure demonstrated better mechanical strength and high biocompatibility after short-term implantation. The combined advantages of the mechanical superiority of the iron metal and the possibility of absorption after implantation make the iron_SA a suitable candidate for further development.

Background/Objectives: To evaluate the effectiveness of local antibiotic prophylaxis (e.g., powder, bone cement, intraosseous injection) in reducing periprosthetic joint infections (PJI) and deep wound infections in adults undergoing primary joint replacement surgery. Methods: A comprehensive search of PubMed, EMBASE, and the Cochrane Library was conducted from inception to 7 September 2024, including randomized controlled trials (RCTs) and cohort studies without language restrictions. Quality assessment was performed using the Cochrane Risk of Bias (RoB) 2.0 for RCTs and the Newcastle–Ottawa Scale (NOS) for cohort studies. Infection rates were extracted and analyzed using risk ratios (RR) or odds ratios (OR) in a random-effects model with Review Manager (RevMan) 5.4. Sensitivity analysis and meta-regression were also performed to validate the study results and possible risk factors. Results: Twelve RCTs and 21 cohort studies were included in the review. Vancomycin powder in the cohort studies demonstrated statistical significance (OR = 0.47, 95% confidence interval (CI): 0.36–0.61, I² = 0%), in contrast to the results in the RCTs (RR = 0.37, 95% CI: 0.06–2.47, I² = 49%). Sensitivity analyses confirmed the robustness and statistical significance of these findings. Both the control and treatment groups primarily cultured Gram-positive pathogens, including in the overall data and specifically for vancomycin powder. The evidence for the use of intraosseous injection (RR of RCTs not estimable, I² not applicable; OR of cohorts = 0.12, 95% CI: 0.02–0.63, I² = 0%) and bone cement (RR of RCTs = 0.40, 95% CI: 0.14–1.17, I² = 56%; OR of cohorts = 1.88, 95% CI: 1.25–2.82, I² not applicable) was inconclusive. Smoking was identified as an important risk factor for post-operative infection. Further research, including more robust trials and cohort studies, is needed to confirm these findings. Conclusions: Local administration of vancomycin powder appears effective in preventing deep wound infection after arthroplasty.

Following anterior cruciate ligament (ACL) reconstruction, enhancing hamstring tenocyte activity and minimizing apoptosis are critical for preventing graft failure and promoting ligamentization. This study investigated the therapeutic potential of extracellular vesicles (EVs) derived from a coculture of ACL remnant cells and bone marrow stromal cells (BMSCs), termed coculture‐EV, in comparison with EVs from BMSC monoculture (BMSC‐EV). We hypothesized that coculture‐EVs could enhance tenocyte activity and reduce apoptosis, with greater effects than BMSC‐EVs. ACL remnants, bone marrow, and hamstring tendons were harvested from rabbits 4 weeks post‐ACL transection, and the cultured cells were used for coculture and subsequent experiments. EVs were isolated by ultracentrifugation and characterized by nanoparticle size analysis, electron microscopy, and EV‐specific markers. Hamstring tenocytes treated with coculture‐EVs exhibited significantly improved viability, proliferation (EdU assay), and migration (scratch and transwell assays), along with increased expression of genes related to collagen synthesis, transforming growth factor beta (TGF‐β), and vascular endothelial growth factor (VEGF). Importantly, coculture‐EV treatment more effectively suppressed both intrinsic and extrinsic apoptotic pathways. Coculture‐EV treatment reduced early apoptosis in tenocytes by 54.5%, whereas BMSC‐EV produced a 21.1% reduction. These findings suggest that EVs from ACL/BMSC coculture possess superior bioactivity compared with BMSC‐derived EVs alone. Coculture‐EV enhances tenocyte function and survival, indicating its potential as a cell‐free therapeutic strategy to promote hamstring graft maturation and improve outcomes after ACL reconstruction.