Charcot midfoot reconstruction—surgical technique based on deformity patterns

Kavarthapu, Venu; Vris, Alexandros

doi:10.21037/aoj.2020.02.01

Cited by 13 publications

(14 citation statements)

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“…For the final part of the procedure, two locking plates were used, one each for the anterior and the lateral side of the ankle joint with two locking screws added to provide further rigidity of the fixation. This technique was comparable to Kavartaphu and Vris who performed it first and gives a good result [ 6 ]. The patients had no complications after surgery according to Clavien-Dindo Grade 1 [ 7 ].…”

Section: Discussionmentioning

confidence: 68%

“…In the early stages of the diseases, conservative treatment such as offloading of the involved foot, treating the bone disease, and preventing further fractures and/or dislocation could be considered [ 3 ]. Laboratory examination also plays a critical role as the outcome indicator, with HbA1c as one of the values that should be optimized, Kavarthapu reported that an HbA1c level of 8 or less is needed before elective deformity corrections [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

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Different approach to charcot neuroarthropathy: A case report

Subawa

Nugraha

Afandi

et al. 2022

Annals of Medicine &Amp; Surgery

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Introduction and importance Charcot neuroarthropathy (CN) is a degenerative, progressive disease affecting the ankle and foot and it is usually a disabling factor in diabetic patients. Surgical management of CN aims to obtain a painless stable plantigrade foot which can be achieved through fusion. Achieving joint arthrodesis in CN usually carries a high failure rate. Cases presentation We presented two patients with late-stage CN foot deformity. The first case is a 52-year-old female with CN on her left ankle and presented without any infection or prior correction. The second case reported a 47-year-old man with complaints of deformity on his right ankle, he had undergone surgical treatment with an external fixator before, and now presented with infection in the surgical site. Clinical discussion Ankle arthrodesis has been considered by many as the treatment of choice for severe and late-stage CN foot. This treatment aims to give a rigid enough fixation which will maintain the stability of the ankle joint and prevents further destruction of surrounding tissue. Multiple modalities of treatment are available and must be chosen accordingly to each clinical case. Minimal implants and the use of multiple bone grafts could be considered as a plan of treatment. Both patients have promising and positive results from the two procedures. Conclusion Treatment of CN Foot with internal plate fixation combined with fibular strut graft seemed to give promising results, both radiographically and functionally. Furthermore, a slight modification of treatment with a minimal implant or iliac graft may be considered.

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Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Different approach to charcot neuroarthropathy: A case report

Subawa

Nugraha

Afandi

et al. 2022

Annals of Medicine &Amp; Surgery

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“…During the reconstruction procedure, the Charcot deformity correction was achieved through bone osteotomies and wedge resections and the correction was maintained with internal fixation devices. All measures were taken to achieve optimal bone opposition during fixation through compression of the bone fragments [14,15]. However, it is recognised that there are often small bone voids and gaps between the bone fragments even after compressive fixation.…”

Section: Surgical Managementmentioning

confidence: 99%

Evaluation of Adjuvant Antibiotic Loaded Injectable Bio-Composite Material in Diabetic Foot Osteomyelitis and Charcot Foot Reconstruction

Kavarthapu

Giddie

Kommalapati

et al. 2023

JCM

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The management of diabetic foot osteomyelitis (DFO) is extremely challenging with high amputation rates reported alongside a five-year mortality risk of more than fifty percent. We describe our experience in using adjuvant antibiotic-loaded bio-composite material (Cerament) in the surgical management of DFO and infected Charcot foot reconstruction. We undertook a retrospective evaluation of 53 consecutive patients (54 feet) who underwent Gentamicin or Vancomycin-loaded Cerament application during surgery. The feet were categorised into two groups: Group 1, with infected ulcer and DFO, managed with radical debridement only (n = 17), and Group 2, requiring reconstruction surgery for infected and deformed Charcot foot. Group 2 was further subdivided into 2a, with feet previously cleared of infection and undergoing a single-stage reconstruction (n = 19), and 2b, with feet having an active infection managed with a two-stage reconstruction (n = 18). The mean age was 56 years (27–83) and 59% (31/53) were males. The mean BMI was 30.2 kg/m2 (20.8–45.5). Foot ulcers were present in 69% (37/54) feet. At a mean follow-up of 30 months (12–98), there were two patients lost to follow up and the mortality rate was 11% (n = 5). The mean duration of post-operative systemic antibiotic administration was 20 days (4–42). Thirteen out of fifteen feet (87%) in group 1 achieved complete eradication of infection. There was a 100% primary ulcer resolution, 100% limb salvage and 76% bony union rate within Group 2. However, five patients, all in group 2, required reoperations due to problems with bone union. The use of antibiotic-loaded Cerament resulted in a high proportion of patients achieving infection clearance, functional limb salvage and decrease in the duration of postoperative antibiotic therapy. Larger, preferably randomised, studies are required to further validate these observations.

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“…Although the midfoot is the most affected region in Charcot neuroarthropathy (CN) of the foot and ankle, combined midfoot and hindfoot disease is common and has been reported in around a third of patients with CN requiring surgical correction ( 1 ). CN of the midfoot can result in specific patterns of deformities such as (I) rocker bottom and forefoot abduction; (II) dorsal subluxation/dislocation; and (III) forefoot adduction ( 2 ). Hindfoot Charcot disease usually leads to varus or valgus deformity, often with an additional equinus component.…”

Section: Introductionmentioning

confidence: 99%

“…The principles of achieving deformity correction are soft tissue releases, bone wedge resections and optimal fixation using a ‘durable, long-segment and rigid internal fixation with optimal bone opposition’ ( 8 ). Previous literature has reported surgical techniques, using the principles of internal fixation, in isolated CN in midfoot reconstruction ( 2 ) and hindfoot reconstruction ( 9 ). However, surgical reconstruction of a combined hindfoot and midfoot deformity is an evolving technique.…”

Section: Introductionmentioning

confidence: 99%

Combined Charcot hindfoot and midfoot reconstruction using internal fixation method—surgical technique and single surgeon series

Kavarthapu¹,

Guduri²,

Hester³

2023

Ann Joint

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Isolated midfoot and hindfoot Charcot reconstruction using internal fixation is increasingly a common procedure in multidisciplinary diabetic foot units, and the surgical techniques using internal fixation have well been described. However, about a third of Charcot deformities that require surgical limb salvage present with the involvement of midfoot and hindfoot. Surgical reconstruction of a combined hindfoot and midfoot deformity is an evolving technique and technically challenging. We present the surgical technique of deformity correction and stabilisation using internal fixation, developed by the senior author (VK), and present the outcomes. All patients that had undergone combined hindfoot and midfoot reconstruction to address a limb threatening deformity due to Charcot neuroarthropathy, performed by the senior author, with a minimum follow-up of 12 months, have been included in this study. The principles of surgical reconstruction included adequate pre-operative optimisation of the patient, sequential deformity correction and stabilisation of the hindfoot followed by midfoot using the principle of long-segment rigid internal fixation with optimal bone opposition. Standard post-operative regime, including offloading, has been used in all patients. A total of 34 patients (35 feet) had undergone combined midfoot and hindfoot Charcot reconstruction between January 2009 and December 2019. Active ulcers were noted in 13 feet at the time of the procedure. Eleven reconstructions were performed as two-stage procedures due to the presence of active infection. At a mean follow-up of 53 months, 11/13 ulcer healed, and 32 patients (33 feet) were full weightbearing in surgical shoes or a brace at the latest follow-up. Bone fusion was noted in 28 feet in the hindfoot region and 32 feet in the midfoot. Metal work failure was noted in 5 feet requiring removal in 3 feet. Revision procedures were required in 4 patients. Our newly described technique of combined hindfoot and midfoot Charcot has provided functional limb salvage in majority of presentations, with an acceptable level of complications, at a medium-term follow-up of 53 months.

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Charcot midfoot reconstruction—surgical technique based on deformity patterns

Cited by 13 publications

References 0 publications

Different approach to charcot neuroarthropathy: A case report

Different approach to charcot neuroarthropathy: A case report

Evaluation of Adjuvant Antibiotic Loaded Injectable Bio-Composite Material in Diabetic Foot Osteomyelitis and Charcot Foot Reconstruction

Combined Charcot hindfoot and midfoot reconstruction using internal fixation method—surgical technique and single surgeon series

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