## 4 Discussion  
The benefits of the use of bioactive glass in infections of bones and joints have been described in several studies, including larger-scale systematic reviews [19; 20]. A review by [PERSON] et al. assessing eight clinical studies exploring the use of BAG in the setting of osteomyelitisitis found BAG to be an appropriate material for use in the setting of osteomyelitisitis with varying location, causation, and therapeutic strategies employed before its application. Notably, the review reported promising results despite variance in the stages of procedure and indication, location, and other aspects of the underlying pathology [19]. A systematic review was performed by [PERSON] et al. including 15 studies that aimed to evaluate different options of bone graft substitutes (including S53P4 BAG) and their clinical applications and efficacy. The review found promising results in terms of treatment of bone and joint infection as well as the role of bone graft substitutes in promoting bone growth. Due to the differences in study design and risk of bias, as well as the inclusion of different bone graft substitutes into consideration, the review did not yield generalizable results or conclusions in terms of BAG use [20]. However, none of the systematic reviews focused on diabetic foot pathology. Figure 3: (**a**) Patient after insertion of bioactive glass granules and putty (malleolus) with an Iizarov external fixation device. Image captured with Siemens Polydoros SX80® (Siemens, Munich, Germany); (**b**) patient after removal of Iizarov external fixation device (eight months after insertion of bioactive glass granules and putty). Image captured with Philips Digital Diagnost® (Philips, Amsterdam, The Netherlands) (exposure parameters: 68 kv and 4 mAs). The use of BAG in the context of diabetic foot, and particularly in patients with Charcot neuroarthropathy, has seldom been described in previous reports in the literature. However, two previous observational retrospective studies focusing on patients with diabetic foot pathologies complicated with infections have reported beneficial results with BAG. [PERSON] et al. reported 44 patients with diabetes mellitus and diabetic foot pathology, of which 22 received standard treatment with surgical debridement and 22 also received an application of BAG. The group who received the intervention had a higher rate of osteomyelitisis resolution and needed less antibiotic therapy. Three patients in the control group required reoperation, while none in the intervention group did, and one patient less required major amputation in the intervention group. Additionally, no systemic side effects of BAG application were observed [14]. Their study also presented more locations of diabetic foot osteomyelitisis and osteoarthritis; however, no particular focus was placed on Charcot neuroarthropathy. [PERSON] et al. observed healing in 80% of the included 10 patients with diabetic foot osteomyelitisis and osteoarthritis in different joints of the foot in the follow-up period of six weeks, with one patient requiring reoperation. As a secondary outcome, they reported a mean healing time of 34 days. The study reported no early hypersensitivity reactions, which is similar to that in our study, and one patient required surgical revision and amputation due to recidivant infection [13]. Additionally, our previous retrospective observational study with controls, performed in 2019 at the University Medical Centre Ljubljana, conducted on a population of 22 patients total, found potential benefits of using a single-stage procedure employing S53P4 BAG in comparison with a two-stage procedure utilizing a gentamycin antibiotic chain. All patients in the intervention group receiving BAG achieved complete remission of osteomyelitisis and osteoarthritis, while complications were observed in the control group [8].