What is the efficacy of surgery for the treatment of Charcot arthropathy?

Updated: Jun 21, 2018
  • Author: Mrugeshkumar Shah, MD, MPH, MS; Chief Editor: Vinod K Panchbhavi, MD, FACS  more...
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Answer

Wirth et al reported on the use of the Ilizarov ring fixator for surgical treatment of Charcot arthropathy, [20] citing results from their own experience and from the literature. The concluded that the Ilizarov ring fixator is a viable method for preserving the affected foot in patients with Charcot neuro-osteopathy. They recommend that in assembling the apparatus, the principles of Ilizarov be followed to avoid failure and that a detailed preoperative analysis of corrective osseous and soft tissue interventions be undertaken.

Sohn et al performed a retrospective study to compare the risks of lower-extremity amputation in patients with Charcot arthropathy alone and those with diabetic foot ulcers. [21] They found that Charcot arthropathy by itself does not pose a serious amputation risk, but amputation risk is multiplied in the presence of ulcer complications. In patients younger than 65 years, amputation risk, was seven times higher for patients with ulcer alone than for those with Charcot arthropathy alone, and 12 times higher for those with Charcot and ulcer.

Della Paola et al evaluated, as an alternative to amputation in patients with Charcot arthropathy, surgical treatment of osteomyelitis of the midfoot or the ankle and stabilization with external fixation. [22] Of the 45 patients studied, 39 healed when treated with emergency surgery to drain an acute infection with maintenance of fixation (average, 25.7 weeks); two were treated with intramedullary nails in follow-up surgery; and in four, infection could not be controlled and amputation was still necessary. [22]

Hegewald et al retrospectively assessed the clinical and radiographic outcomes of combined internal and external fixation for reconstruction in 22 patients with diagnosed diabetes mellitus and documented peripheral neuropathy. [23]  During a mean follow-up period of 58.60 ± 42.37 weeks (range, 16-164), limb salvage was achieved in 20 patients, and below-the-knee amputation was required in two. Wound dehiscence occurred in eight, pin tract infection in 10, and superficial wound infection in nine. On radiographic analysis of pre- versus postoperative alignment, statistically significant changes were noted in the lateral talo-first metatarsal angle and the lateral talar declination angle.


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