Charcot neuroarthropathy of the knee due to idiopathic sensory peripheral neuropathy

Abstract

Background: Charcot neuroarthropathy is a systemic disease that generates pathological changes in the musculoskeletal system, causing instability, dislocations, and deformities. Charcot neuroarthropathy of the knee, due to either diabetes mellitus or syringomyelia, is anecdotally reported with the epidemic of the diseases. However, idiopathic sensory peripheral neuropathy can inflict osteoarticular structures directly, inducing a dysfunctional Charcot neuroarthropathy. An early diagnosis and effective relief of the symptomatic deformity is essential for the treatment. Case presentation: We report the case of a patient with idiopathic sensory peripheral neuropathy who presented with a swelling right knee, as well as distorted and painless gait disorder, diagnosed as Charcot neuroarthropathy of the knee. Partial weight bearing with a hinged knee brace was used to correct the abnormal alignment and gait posture, and bisphosphonates were prescribed to decrease pathological bone resorption. Although the alignment and Knee Society Score got a gradual deterioration, the combination of orthosis and pharmacy could alleviate the symptom to a certain extent. Conclusion: The diagnosis of Charcot neuroarthropathy of the knee is rare that requiring early diagnosis. The presence of features, including painlessness, numbness, and deformed arthropathy following chroniconset algesthesia loss should be taken carefully.

Charcot knee — presentation, diagnosis, management — a scoping review

“…One case series reported 4 patients with staphylococcus pyogenes-mediated suppurative CK, diagnosed by a leukocyte count of > 100,000 cells/mm 3 [ 18 ], and one reported presence of CPPD crystals in a patient with pseudogout-induced CK [ 13 ]. Knee deformities Valgus deformation was reported in 19 studies involving 114 patients [ 4 , 7 , 9 , 12 , 19 , 28 , 34 , 35 , 37 , 38 , 45 , 49 – 51 , 53 – 55 , 57 , 58 ] and varus deformation in 14 studies involving 34 patients [ 8 , 16 , 21 , 24 , 28 , 30 , 31 , 34 , 35 , 37 , 43 , 53 , 54 , 62 ], often presenting as instability upon valgus and varus stress tests, or a positive Bohler test [ 52 ]. Ligamentous laxity and joint hypermobility were reported in 7 studies involving 14 patients [ 7 , 19 , 22 , 26 , 32 , 50 , 53 ].…”

“…One patient in one case report presented with bone destruction so severe that it eroded the tibial tuberosity [ 29 ]. Neurology CK presents with characteristic neurological findings, with 29 studies involving 62 patients reporting lower limb hypoesthesia with diminished pain and temperature sensation [ 5 – 7 , 13 , 15 , 17 – 20 , 22 , 27 , 28 , 31 , 35 – 37 , 39 , 41 – 43 , 45 – 47 , 49 – 53 , 55 ], and 6 studies with one patient each reported peripheral neuropathy [ 6 , 7 , 20 , 50 , 55 , 58 ]. One patient presented with scars and burns due to lack of pain sensation [ 27 ].…”

“…[ 64 ]. In six studies involving 47 patients, TF angle was reported as a radiological finding preoperatively [ 4 , 34 , 40 , 49 , 53 , 55 ], and in two studies involving 26 patients, it was reported postoperatively [ 34 , 38 ]. In general, the preoperative deformity caused varus deformity.…”

“…Time to PWB and FWB was reported in 10 studies involving 21 patients [ 10 , 14 , 23 , 29 , 30 , 35 , 43 , 45 , 54 , 57 ] and 11 studies involving 20 patients [ 10 , 14 , 21 , 23 , 32 , 43 , 45 , 46 , 54 , 57 , 61 ], respectively, with the average time to PWB and FWB being 10.5 weeks and 15.1 weeks, respectively. Thirteen studies involving 95 patients reported knee scores [ 4 , 5 , 20 , 28 , 29 , 32 , 34 , 38 , 40 , 51 , 54 , 55 , 58 ], with the majority being American knee society score (AKSS) knee score and function score. Conservative treatment Twenty-eight studies involving 68 patients chose conservative treatment (6,8,13,18,19,20,21,22,25,26,27,29,30,33,35,37,39,41,42,43,46,48,50,55,56,58,59,62).…”

“…Custom made devices work best, considering each patient's unique pathological profile and lifestyle requirements [ 50 ]. Physical therapy [ 55 ] ameliorates patients’ quality of life, helping them adapt to a new lifestyle revolving around joint preservation. Pharmacological treatment is offered when there is a clear underlying cause.…”