Lower Extremity Amputation and Mortality Rates in the Reconstructed Diabetic Charcot Foot and Ankle With External Fixation

Ramanujam, Crystal L.; Han, David K.; Zgonis, Thomas

doi:10.1177/1938640015599036

Cited by 15 publications

(4 citation statements)

References 32 publications

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“…showed a major amputation rate of 6.2% in their retrospective study of 292 persons, comparable with the amputation rate of Wirth et al 6 . and Ramanujam et al 14 . Because of the comparatively large number (31%) of dropouts and short follow‐up (24 months) in Illgner’s study, 9 an incorrectly low amputation rate can be assumed here.…”

Section: Discussionsupporting

confidence: 83%

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Long‐term outcome of persons with diabetic and non‐diabetic neuro‐osteoarthropathy after foot correction using external fixation

et al. 2020

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Aim Diabetic neuro‐osteoarthropathy (Charcot foot) is a serious form of diabetic foot syndrome, often leading to severe deformity of the foot and subsequently to ulcers and osteomyelitis. The aim of this retrospective study was to determine the success rate and long‐term outcomes for a Charcot foot operation using external fixation in 115 individuals who underwent surgery between July 2008 and December 2012. Methods Some 115 consecutive persons, 78 (68%) men and 37 (32%) women, were enrolled in this study. The eligibility criterion for this retrospective study was reconstructive foot surgery using a Hoffmann II external fixator in diabetic and non‐diabetic neuro‐osteoarthropathy. The main examination parameters in the follow‐up were walking ability, amputation and mortality. Average follow‐up was 5.7 (± 3.2) years. Results Ninety‐seven per cent of people were able to walk after the operation with bespoke shoes or an orthosis. At follow‐up, 77% were able to walk and 51% were fully mobile even outside the home. Subsequent amputations were performed in 29 individuals (26%), with 17 (15%) minor and 12 (11%) major amputations. Forty‐seven individuals died before follow‐up, the majority (53%) from cardiovascular events. Average survival time post surgery was 4.5 (± 2.9) years. Conclusion Reconstruction surgery using external fixation is a very useful method for maintaining walking ability in the case of conservatively non‐treatable diabetic and non‐diabetic neuro‐osteoarthropathy. Individuals with severe Charcot foot disease had a low rate of major amputations. Osteomyelitis was the main reason for major amputations.

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Section: Discussionsupporting

confidence: 83%

“…Because of the comparatively large number (31%) of dropouts and short follow‐up (24 months) in Illgner’s study, 9 an incorrectly low amputation rate can be assumed here. In their study of 116 people, Ramanujam et al 14 . had a larger proportion of those without ulcer (48%) compared with our study (42%).…”

Section: Discussioncontrasting

confidence: 67%

Long‐term outcome of persons with diabetic and non‐diabetic neuro‐osteoarthropathy after foot correction using external fixation

et al. 2020

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“…27 Two other series that were not included in this review reported even more impressive results, with LEA rates of 0% 28 and 6%. 20 Other studies demonstrate major LEA rates ranging from 11% to 15%. 25,31 These differences can partially be explained by stage at presentation, the presence or absence of a Charcot-related foot wound, the presence of absence of infection, and the technology available.…”

Section: Discussionmentioning

confidence: 94%

Comparison of Diabetic Charcot Patients With and Without Foot Wounds

et al. 2016

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“…Pinzur et al [ 41 ] reported 3 amputations (4.2%) in a cohort of 71 patients who underwent single-stage resection of infection and correction of deformity with a ring fixateur. Ramanujam et al [ 42 ] reported one lower extremity amputation (3.7%) in 27 patients with diabetic CN and osteomyelitis who underwent surgical reconstruction using circular external fixation.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Charcot Neuroarthropathy and osteomyelitis of the same foot: a retrospective cohort study

Berli

Vlachopoulos

Leupi

et al. 2017

BMC Musculoskelet Disord

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BackgroundWe evaluated treatment of osteomyelitis in the foot in the presence of Charcot neuroarthropathy, a devastating condition with progressive degeneration and joint destruction. We hypothesized that there was a difference in (1) amputation rate, (2) amputation level, (3) duration of antibiotic therapy, and (4) duration of immobilization for treatment of osteomyelitis within versus outside the Charcot zone.MethodsForty patients (43 ft) diagnosed with Charcot neuroarthropathy and osteomyelitis of the same foot were retrospectively analyzed. Some patients were successfully treated for osteomyelitis at different sites on the same foot at different times, thus 60 cases of osteomyelitis were identified in 40 treated patients. Cases were divided according to osteomyelitis localization: Group 1 had osteomyelitis outside the active Charcot region; Group 2 had osteomyelitis within the active Charcot region.ResultsMale patients (n = 29; mean age 58.2, range 40.1 to 77.5 years) were younger than female patients (n = 11; mean age 70.4, range 51.4 to 87.5, p = 0.02 years). Amputation rate was 52% overall (26/40 patients; 26/43 ft): 63% of 30 Group 1 cases and 40% of 30 Group 2 cases (p = 0.09). Amputation level (p = 0.009), duration of antibiotic treatment (p = 0.045) and duration of immobilization (p = 0.01) differed significantly between the groups.ConclusionsOsteomyelitis within the Charcot region is associated with a higher level of amputation and longer durations of antibiotic therapy and immobilization. Osteomyelitis outside and within the Charcot affected region should be considered separately. If osteomyelitis occurs outside the active Charcot region, primary amputation may be preferred to internal resection.Level of EvidenceRetrospective cohort chart review study.

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Lower Extremity Amputation and Mortality Rates in the Reconstructed Diabetic Charcot Foot and Ankle With External Fixation

Abstract: Prognostic, Level III: Retrospective study.

Cited by 15 publications

References 32 publications

Long‐term outcome of persons with diabetic and non‐diabetic neuro‐osteoarthropathy after foot correction using external fixation

Long‐term outcome of persons with diabetic and non‐diabetic neuro‐osteoarthropathy after foot correction using external fixation

Comparison of Diabetic Charcot Patients With and Without Foot Wounds

Treatment of Charcot Neuroarthropathy and osteomyelitis of the same foot: a retrospective cohort study

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