Mid-term results of hindfoot arthrodesis with a retrograde intra­medullary nail in 24 patients with diabetic Charcot neuroarthropathy

Abstract

Background and purpose — Hindfoot arthrodesis using retrograde intramedullary nailing assumes a critical role in limb salvage for patients with diabetic Charcot neuro­arthropathy (CN). However, this procedure is compelling and fraught with complications in diabetic patients. We report the mid-term clinical and radiological outcomes of retrograde intramedullary nailing for severe foot and ankle deformity in patients with diabetic CN. Patients and methods — Hindfoot arthrodesis was performed using a retrograde intramedullary nail in 24 patients (15 females) with diabetic Charcot foot. The mean age of the patients was 62 years (33–82); the mean follow-up was 45 months (24–70). The primary outcomes were rates of fusion, limb salvage, and complications. Results — The overall fusion rate was 23/24, and none of the patients needed amputation. The rate of superficial wound infection was 4/24, and no deep infection or osteomyelitis was observed postoperatively. Interpretation — For selected cases of diabetic CN with severe foot and ankle deformity, hindfoot arthrodesis using a retrograde intramedullary nail seems to be a good technique in achieving fusion, limb salvage, and avoidance of complications.

Functional outcomes of tibiotalocalcaneal arthrodesis using a hindfoot arthrodesis nail in treating Charcot's arthropathy deformity

“…In the literature, the union rate for hindfoot fusion using allograft or autograft is 58%-93% (22,24). In our study, the mean fusion time is 5.1 months, which is slightly better than that of other studies (6-10 months) that used hindfoot arthrodesis nails (19,25,26).…”

High rate of complications after corrective midfoot/subtalar arthrodesis and Achilles tendon lengthening in Charcot arthropathy type Sanders 2 and 3

“…Recently, several studies were able to show a successful surgical treatment of Charcot arthropathy of the ankle and hindfoot region by means of tibio-talo-calcaneal arthrodesis [ 7 , 15 ]. A meta-analysis recently compared the different implant types for surgical treatment and concluded that arthrodesis via a hindfoot intramedullary nail is the treatment of choice when the hindfoot is involved.…”

Results of Ankle and Hind foot arthrodesis in Diabetic Charcot Neuroarthropathy - A retrospective analysis of 44 patients

“…Literature describes non-union rates in these difficult cases to be in the range of 5e67%. 3e5 Papa et al 4 reported a 34% rate of nonunion, Schwartz et al 5 reported 27% non-union rates while a couple of authors have reported a high union rates: Sundararajan et al 6 reported a union rate of 85% while Mehmet et al 7 reported that 23 of their 24 cases treated by a Hindfoot arthrodesis nail had bony union and none had an amputation. The stark difference in the union rates reported by these two authors could mean a different set of patients, as again the patient selection criteria and other result affecting factors such as diabetes control etc.…”