Silver ions (Ag+) have strong bactericidal effects and Ag-coated medical devices proved their effectiveness in reducing infections in revision total joint arthroplasty. We quantitatively determined the antimicrobial potency of different surface treatments on a titanium alloy (Ti), which had been conversed to diamond-like carbon (DLC-Ti) and doped with high (Ag:PVP = 1:2) and low (Ag:PVP = 1:10 and 1:20) concentrations of Ag (Ag-DLC-Ti) with a modified technique of ion implantation. Bacterial adhesion and planktonic growth of clinically relevant bacterial strains (Staphylococcus epidermidis, Staphylococcus aureus, and Pseudomonas aeruginosa) on Ag-DLC-Ti were compared to untreated Ti by quantification of colony forming units on the adherent surface and in the growth medium as well as semiquantitatively by determining the grade of biofilm formation by scanning electron microscopy. (1) A significant (p < 0.05) antimicrobial effect could be found for all Ag-DLC-Ti samples (reduced growth by 5.6–2.5 logarithmic levels). (2) The antimicrobial effect was depending on the tested bacterial strain (most for P. aeruginosa, least for S. aureus). (3) Antimicrobial potency was positively correlated with Ag concentrations. (4) Biofilm formation was decreased by Ag-DLC-Ti surfaces. This study revealed potent antibacterial effects of Ag-DLC-Ti. This may serve as a promising novel approach to close the gap in antimicrobial protection of musculoskeletal implants.

Objective: According to current recommendations, large cartilage defects of the hip over 2 cm² are suggested to undergo autologous chondrocyte transplantation (ACT), while small defects should be treated with microfracture. We investigated if patients with small chondral defects of the hip joint (≤100 mm²) actually benefit from microfracture. Design: In this retrospective multicenter cohort study 40 patients with focal acetabular cartilage defects smaller than 100 mm² and of ICRS grade ≥2 caused by femoroacetabular impingement were included. Twenty-six unrandomized patients underwent microfracture besides treatment of the underlying pathology; in 14 patients cartilage lesions were left untreated during arthroscopy. Over a mean follow-up of 28.8 months patient-reported outcome was determined using the iHOT33 (international hip outcome tool) and the VAS (visual analog scale) for pain. Results: The untreated group showed a statistically significant improvement of the iHOT33 after 12 (p = 0.005), 24 (p = 0.019), and 36 months (p = 0.002) compared to the preoperative score, whereas iHOT33 in the microfracture group did not reveal statistically significant changes over time. There was no significant difference between both groups on any time point. Regarding pain both groups did not show a significant improvement over time in the VAS. Conclusion: The subjective outcome of patients with small cartilage defects of the hip (≤100 mm²) improves 12 months after arthroscopic FAIS surgery without any cartilage treatment. However, no improvement could be seen after microfracture. Therefore, a reserved surgical treatment for small cartilage defects of the hip under preservation of the subchondral bone is recommended especially if a simultaneous impingement correction is performed.

Chronic osteomyelitis due to direct bone trauma or vascular insufficiency is a frequent problem in orthopaedic surgery. In contrast, acute haematogenous osteomyelitis represents a rare entity that almost exclusively affects prepubescent children or immunodeficient adults. In this article, we report the case of acute pneumococcal osteomyelitis of the humerus in an immunocompetent and otherwise healthy 44-year-old male patient presenting with minor inflammation signs and misleading clinical features. The diagnosis had to be confirmed by open biopsy which allowed the initiation of a targeted therapy. A case of pneumococcal osteomyelitis of a long bone, lacking predisposing factors or trauma, is unique in adults and has not been reported previously.

Purpose: Evidence on short-term outcomes of open versus endoscopic gluteal tendon repair is available, but the durability of these results beyond the early postoperative phase remains unclear. To date, no data synthesis has specifically addressed mid- to long-term outcomes. The aim of this study was, therefore, to conduct a systematic review and multilevel meta-analysis to compare mid- and long-term functional and pain outcomes following open versus endoscopic gluteal tendon repair. Methods: PubMed, Embase, CENTRAL, and Epistemonikos were searched through 30 September 2025. Outcomes of open versus endoscopic gluteal tendon repair were synthesized using a multilevel random-effects meta-analysis with restricted maximum likelihood and Hartung–Knapp adjustments. Continuous data were reported as mean differences with 95% confidence intervals, and heterogeneity was assessed with Higgins’ I ² . Results: Nine studies comprising 264 patients (269 hips) were included. Endoscopic repair demonstrated significantly superior mid- to long-term functional improvement compared with open repair ( F = 7.91, P = 0.01) and greater functional gain over time ( F = 8.79, P = 0.01). Postoperative pain outcomes were comparable between groups ( F = 0.98, P = 0.34), yet endoscopic repair achieved a significantly greater reduction in pain at follow-up ( F = 9.79, P < 0.01). Conclusion: Endoscopic gluteal tendon repair is associated with superior long-term functional outcomes and lower complication rates compared to open repair, supporting its role as the preferred surgical approach for most patients. Level of evidence: IV (systematic review and meta-analysis of Level IV studies).