In contrast to other tissues and organs, bone and its marrow have been successfully transplanted to promote bone healing for more than 100 years. Nevertheless, the amount of autologous bone grafts is limited and associated with relevant donor site morbidity. Therefore, intensive efforts have been made to develop adequate bone substitute materials. In combination with regenerative strategies including the application of bone marrow /mononuclear stroma cells, growth factors, cytokines (VEGF, PDGF, BMP2 etc.) as well as extracellular vesicles (EVs), bone substitutes (BS) may augment, supplement or even replace autologous bone grafts. BS provide a three-dimensional network that allows guided cellular migration, proliferation, differentiation, and mineralisation. In accordance with bionic principles, defined CaP-based BS have shown promising clinical results and are frequently applied in daily orthopaedic practice. In recent years and with better understanding, new technologies have been introduced in this area. These trends include ex vivo coating strategies for BS, the implementation of AI in BS design and planning, the combination with growth factors such as NELL-1 or P-15, the consideration of osteoimmunologic aspects, and the application of new material composites. In this study, we provide an overview and update to well-established standards and innovations in the field of ceramic BS and discuss findings reported in the literature.

Knee osteotomies have been established for more than a century as an effective treatment for degenerative and post-traumatic deformities of the lower limb. The aim of this narrative review is to present the current state of knee osteotomies and to outline the relevance of correction in the coronal, sagittal, and axial planes, as based on current evidence and clinical examples.Technical advances, such as digital preoperative planning, biplanar osteotomy techniques, and modern locking plate fixation have significantly reduced complication rates and improved overall clinical outcomes. Open-wedge high tibial osteotomy remains the standard procedure for tibial-based varus deformities and yields excellent results when appropriately indicated. For femoral-based varus or valgus malalignment, biplanar distal femoral osteotomy has become the preferred technique. The use of a hinge wire led to a reduced risk of intraoperative hinge fractures. Double osteotomies are particularly useful in combined deformities of the femur and tibia, and allow preservation of the orientation of the physiological joint line. Several studies have reported excellent functional outcomes with this approach. Corrections in the sagittal and axial planes are gaining increasing importance, especially in cases of patellofemoral pathology, increased tibial slope, or post-traumatic rotational deformities. Overall, knee osteotomies are a reliable and effective method for managing complex deformities. When properly indicated, they can delay or even avoid the need for knee arthroplasty, offering a durable joint-preserving treatment option.

The number of arthroplasty procedures on hip and knee joints is expected to continue to rise in the coming years. At the same time, postgraduate training in arthroplasty faces significant structural challenges in German-speaking countries. This study aimed to assess the current state of postgraduate clinical training, the role of external education offered by the German Society of Arthroplasty (AE), and the ways in which young physicians can access AE-YOUTH (the AE's youth organisation).

The use of minimally invasive techniques for total hip arthroplasty (THA) in at-risk patients is still debated. The purpose of this prospective study was to determine the clinical and radiographic results of obese patients undergoing THA compared with those of normal-weight patients. Material and methods: A total of 476 patients of the 516 patients who underwent THA via the minimally invasive SuperPath approach between January 2016 and December 2019 attended the 1-year follow-up. Based on the WHO criteria for obesity, 22 patients were underweight, 147 were normal-weight, 186 were overweight, 73 were grade 1 obese, 25 grade 2 obese and 22 grade 3 obese. The clinical outcomes were evaluated using the Forgotten Joint Score (FJS). Radiographic analysis was performed with the digital software tool mediCad (HECTEC, Landshut, Germany).

This narrative review summarises structural, cultural, psychosocial, and organisational factors associated with gender-specific disadvantages in surgical training and career progression. The analysis highlights differences in surgical exposure, access to mentoring and sponsorship, hierarchical power structures, work-family compatibility, and the conditions of institutional framework. The available evidence suggests that unequal career trajectories in surgery are not solely attributable to individual choices, but are shaped by modifiable structural conditions. Transparent training structures, documented allocation processes, structured support measures, and family-compatible training models may help promote more equitable career opportunities.

Revision reconstruction of the anterior cruciate ligament (ACL) presents a considerable challenge - due to its technical complexity, variable clinical presentations, and the interplay of multiple risk factors and concomitant pathologies. Optimal treatment requires a thorough analysis of the causes of failure. The preoperative evaluation should include full-leg radiographs, lateral X-rays of the entire lower leg, magnetic resonance imaging (MRI) to assess soft tissue pathologies, and computed tomography (CT) to evaluate tunnel position and tunnel widening. Graft failure is usually multifactorial and may be related to technical, biological, demographic, or biomechanical causes. Technical issues include malpositioning of the tunnels, unaddressed primary instabilities, fixation failure, or inadequate graft tensioning. Biological factors comprise impaired graft incorporation and infections. Biomechanical and anatomical factors-such as increased posterior tibial slope (PTS), coronal plane malalignment, or persistent peripheral or rotational instabilities-must also be recognised and addressed. For this purpose, additional surgical techniques are available - such as slope-reducing osteotomy, varus and valgus osteotomies, as well as lateral extra-articular tenodesis. A successful revision ACL reconstruction is based on a comprehensive analysis of the underlying causes, individually tailored surgical strategies, correction of modifiable predisposing factors, and realistic patient counseling. These measures are crucial for achieving good functional outcomes and long-term stability, while enabling a safe return to the desired level of activity without recurrent injury.