Neuropathic (Charcot) Arthropathy of the Knee

Abstract

Neuropathic arthropathy of the knee (Charcot knee) is a rare pathology defined by progressive destruction of bone and soft tissue in a patient with underlying peripheral neuropathy. Historically, Charcot knee was associated with neurosyphilis, but it has been increasingly described as a late stage of diabetes. The pathophysiology of the disease is not completely understood, but theories include repetitive microtrauma and an abnormal neurovascular response. Patients present with a warm, swollen, and unstable joint and have rapid bone resorption and characteristic findings on pathology. Nonsurgical options for pain and dysfunction include total contact casting and bracing treatment. Pharmacologic management includes diphosphonates, although this use is considered off-label. Surgical management historically included knee fusion. However, recent case series have suggested that newer prostheses allow for successful arthroplasty in this cohort, although complications are higher when compared with joint arthroplasty in patients with normal neurologic function.N europathic arthropathy of the knee (Charcot knee) is a phenomenon that was first described over 150 years ago and is characterized by progressive destruction of the knee joint. Historically, Charcot knee was associated with tabes dorsalis, polio, and cerebral palsy; the disease was not reported in patients with diabetes mellitus until 1936. 1 More recently, diabetes has been described as the most common cause of Charcot knee, which coincides with both the rising prevalence of diabetes and the longer lifespan of patients with diabetes. 2,3 Other associated neurologic conditions that predispose patients to neuropathic joints include syringomyelia, leprosy, chronic alcoholism, cerebral atrophy, and familial dysautonomia. 1,4,5 Given the rarity of the disease, there are no epidemiologic studies estimating the prevalence of Charcot knee. However, up to 7.5% of patients with diabetes have some form of neuropathic arthropathy, most commonly affecting the feet. 3 Some authors suggest that the prevalence of Charcot knee in the diabetic cohort is roughly 0.45%. 6 With the increasing number of patients with diabetes and Charcot knee, a thorough understanding of

Derivaciones quirúrgicas para artroplastia total de cadera desde la atención primaria: la utilidad de los Criterios de Uso Apropiado de la AAOS

“…Como parte de sus programas y pautas de calidad, la American Academy of Orthopaedic Surgeons (AAOS) publicó los Criterios de Uso Apropiado (Appropriate Use Criteria, AUC, en inglés) para el tratamiento de la osteoartritis de cadera. 9 Esta herramienta está destinada a ayudar a los médicos a decidir para quién debe indicarse un procedimiento (conservador o quirúrgico) mediante la implementación de pautas basadas en la evidencia. Puede emplearse como una herramienta en línea o mediante su aplicación de teléfono inteligente homóloga, llamada OrthoGuidelines (AAOS, Rosemont, IL, Estados Unidos).…”

“…As part of its quality programs and guidelines, the American Academy of Orthopaedic Surgeons (AAOS) published the Appropriate Use Criteria (AAOS-AUC) for the management of hip OA. 9 This tool is intended to assist clinicians in deciding for whom a procedure (conservative or surgical) should be indicated by implementing evidence-based guidelines. It can be used as an online tool or through its homologous smartphone application called OrthoGuidelines (AAOS, Rosemont, IL, United States).…”

Management Dilemma of a Neuropathic Knee in a Known Case of Larsen Syndrome: A Case Report

“…The most common skeletal abnormality reported are spinal anomalies and instability of the knee joint [ 4 ]. The knee of LS patient is prone to progressive destruction of bone associated with peripheral neuropathy, traditionally described as neuropathic arthropathy of the knee [ 5 ]. The clinical presentation includes warm and swollen knee with instability.…”

“…The clinical presentation includes warm and swollen knee with instability. The radiographs show rapid and progressive resorption of bones [ 5 ]. The paucity of literature regarding the management of unstable neuropathic knee in a known case of LS poses management dilemma for the orthopedic surgeon.…”