Late Corrective Arthrodesis in Nonplantigrade Diabetic Charcot Midfoot Disease Is Associated with High Complication and Reoperation Rates

Abstract

Introduction. Charcot arthropathy may lead to a loss of osteoligamentous foot architecture and consequently loss of the plantigrade alignment. In this series of patients a technique of internal corrective arthrodesis with maximum fixation strength was provided in order to lower complication rates. Materials/Methods. 21 feet with severe nonplantigrade diabetic Charcot deformity Eichenholtz stages II/III (Sanders/Frykberg II/III/IV) and reconstructive arthrodesis with medial and additional lateral column support were retrospectively enrolled. Follow-up averaged 4.0 years and included a clinical (AOFAS score/PSS), radiological, and complication analysis. Results. A mean of 2.4 complications/foot occurred, of which 1.5/foot had to be solved surgically. 76% of feet suffered from soft tissue complications; 43% suffered hardware-associated complications. Feet with only 2 out of 5 high risk criteria according to Pinzur showed significantly lower complication counts. Radiographs revealed a correct restoration of all foot axes postoperatively with superior fixation strength medially. Conclusion. Late corrective arthrodesis with medial and lateral column stabilization in the nonplantigrade stages of neuroosteoarthropathy can provide reasonable reconstruction of the foot alignment. Nonetheless, overall complication/reoperation rates were high. With separation into low/high risk criteria a helpful guide in treatment choice is provided. This trial is registered with German Clinical Trials Register (DRKS) under number DRKS00007537.

Prevalence of Peripheral Arterial Disease in Patients With Diabetic Charcot Neuroarthropathy

“…Patients with CN have a greater risk of infectious and noninfectious complications after surgery (33,34). Although critical limb ischemia might not be present, optimization of perfusion might improve the outcomes of surgery.…”

Acute Charcot neuro‐osteoarthropathy

“…Treatment outcomes and complication rates vary between centres. Late corrective arthrodesis in non‐plantigrade diabetic Charcot foot was associated with high complication and reoperation rates in a series of 19 patients with severe CN . However, we reported recently the outcomes of 20 patients (21 ft) with CN who underwent correction of deformities of the ankle and hindfoot using retrograde intramedullary nail arthrodesis .…”

Clinical Outcomes and Complications of Midfoot Charcot Reconstruction With Intramedullary Beaming

“…All patients had active plantar ulceration at the time of operative intervention and 13/15 patients were able to walk with custom-made extra-depth, wide-toed diabetic shoes at the time of final follow-up (average 42 months). 1 In a similar retrospective review of 21 cases of Charcot osteoarthropathy in Germany, Eschler et al 2 reported higher rates of complication following internal fixation: 33% reulceration and 24% amputation at final follow-up (average 4 years). The rates of amputation and reulceration cannot be directly statistically compared those reported by Assal and Eschler given the small sample size of patients in all series.…”

“…The rates of amputation and reulceration cannot be directly statistically compared those reported by Assal and Eschler given the small sample size of patients in all series. 1,2 Several authors have published reports of midfoot realignment using external fixators for midfoot osteoarthropathy. 7,12 Pinzur et al 12 report that 24/26 "high-risk" patients in their series are ulcer and infection-free 12 months following multiplanar deformity correction and stabilization in a thin-wire fixator; notably, these patients were also treated with culture-specific parenteral antibiotic therapy when applicable and Achilles lengthening at the time of operative intervention.…”