5 year retrospective follow-up of new cases of Charcot neuroarthropathy—A single centre experience

Stark, Chris; Murray, Timothy; Gooday, Catherine; Nunney, Ian; Hutchinson, R.; Loveday, David; Dhatariya, Ketan

doi:10.1016/j.fas.2015.07.003

Cited by 18 publications

(53 citation statements)

References 20 publications

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“…11,[21][22][23][24][25]38 In the second group, the study's primary aim was to report outcomes of CN but they may also describe monitoring techniques used, thus providing data to answer our fifth objective on whether monitoring techniques influence outcomes. [6][7][8][9][10][12][13][14][15][16][26][27][28][29][30][31][32][33][34][35][36][37] 3.3 | Techniques used in the monitoring of CN Armstrong et al 38 Level 3…”

Section: Study and Participant Characteristicsmentioning

confidence: 99%

“…In the United Kingdom, observational studies report treatment times of 9 to 12 months before remission is achieved [4][5][6] whilst data from the United States [7][8][9][10] and other European centres report treatment times of only 4-6 months. [11][12][13][14][15][16] Several factors could contribute to global variation, include participant characteristics, different techniques for monitoring, different protocols for the same monitoring techniques, variations in approach to off-loading and study design variability.…”

Section: Introductionmentioning

confidence: 99%

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Systematic review of techniques to monitor remission of acute Charcot neuroarthropathy in people with diabetes

Gooday

Gray

Game

et al. 2020

Diabetes Metabolism Res

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Aim: The management of acute Charcot neuroarthropathy relies on off-loading which is costly and time-consuming. Published studies have used monitoring techniques with unknown diagnostic precision to detect remission. We performed a systematic review of techniques for monitoring response to offloading in acute Charcot neuroarthropathy. Materials and Methods: We included studies of off-loading which evaluated or described monitoring techniques in acute Charcot neuroarthropathy. PubMed, EMBASE, CINAHL and Cochrane databases were searched (January1993-July 2018). We extracted data from papers including study design, setting, population, monitoring techniques and treatment outcomes. We also extracted information on the cost, clinical applicability, sensitivity and specificity, safety and participant acceptability of the monitoring techniques. Results: We screened 1205 titles, 140 abstracts and 45 full-texts, and included 29 studies. All studies were of low quality and at high risk of bias. In seven studies, the primary aim was to evaluate monitoring techniques: three evaluated magnetic resonance imaging, two thermography monitoring, one three-phase bone scanning and one Doppler spectrum analysis. The remaining 22 observational studies reported treatment outcomes and described the monitoring techniques used to assess the Charcot neuroarthropathy. Heterogeneity prevented the pooling of data. Very few studies included data on cost, clinical applicability, sensitivity and specificity, safety and patient acceptability of the monitoring techniques used. Conclusion: Multiple techniques have been used to evaluate remission in acute Charcot neuroathropathy but uncertainty remains about their effectiveness. We recommend further research into the influences of different monitoring techniques on treatment outcomes.

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Section: Study and Participant Characteristicsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Systematic review of techniques to monitor remission of acute Charcot neuroarthropathy in people with diabetes

Gooday

Gray

Game

et al. 2020

Diabetes Metabolism Res

View full text Add to dashboard Cite

show abstract

“…The evidence base for the treatment of CN is weak. It is based on studies from a few centres which used retrospective designs and case note review methods using small sample sizes, typically in the range of 9-55 participants [3,[9][10][11][12][13]. Many studies failed to standardise monitoring, treatment and outcomes, which makes direct comparison between studies difficult.…”

Section: Introductionmentioning

confidence: 99%

A randomised feasibility study of serial magnetic resonance imaging to reduce treatment times in Charcot neuroarthropathy in people with diabetes (CADOM): a protocol

Gooday

Game

Woodburn

et al. 2020

Pilot Feasibility Stud

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Background: Charcot neuroarthropathy is a complication of peripheral neuropathy associated with diabetes which most frequently affects the lower limb. It can cause fractures and dislocations within the foot, which may progress to deformity and ulceration. Recommended treatment is immobilisation and offloading, with a below knee nonremovable cast or boot. Duration of treatment varies from six months to more than 1 year. Small observational studies suggest that repeated assessment with magnetic resonance imaging improves decision-making about when to stop treatment, but this has not been tested in clinical trials. This study aims to explore the feasibility of using serial magnetic resonance imaging without contrast in the monitoring of Charcot neuroarthropathy to reduce duration of immobilisation of the foot. A nested qualitative study aims to explore participants' lived experience of Charcot neuroarthropathy and of taking part in the feasibility study. Methods: We will undertake a two-arm, open study and randomise 60 people with a suspected or confirmed diagnosis of Charcot neuroarthropathy from five NHS, secondary care multidisciplinary Diabetic Foot Clinics across England. Participants will be randomised 1:1 to receive magnetic resonance imaging at baseline and remission up to 12 months, with repeated foot temperature measurements and X-rays (standard care plus), or standard care plus with additional three-monthly magnetic resonance imaging until remission up to 12 months (intervention). Time to confirmed remission of Charcot neuroarthropathy with off-loading treatment (days) and its variance will be used to inform sample size in a full-scale trial. We will look for opportunities to improve the protocols for monitoring techniques and the clinical, patient-centred and health economic measures used in a future study. For the nested qualitative study, we will invite a purposive sample of 10-14 people able to offer maximally varying experiences from the feasibility study to take part in semi-structured interviews to be analysed using thematic analysis.

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“…A correção cirúrgica pode ser indicada como tentativa de se evitar amputação da extremidade. A artrodese modelante, com ressecção de generosas cunhas ósseas das articulações do tornozelo, subtalar e/ou mediotarso, é utilizada para corrigir deformidades grosseiras e estabilizar articulações altamente instáveis; entretanto, é um procedimento extremamente trabalhoso e não está isento de riscos, especialmente quando indicado em pacientes cuja circulação e sensibilidade estão comprometidas (12)(13)(14) . Esta cirurgia deve ser encarada como uma tentativa de salvamento da extremidade (11,13,(15)(16)(17)(18)(19) .…”

Section: Introductionunclassified

Salvage surgery for Charcot arthropathy of the diabetic hindfoot

Filho

2019

Sci J Foot Ankle

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Objective: This study evaluated the effectiveness of Charcot arthropathy (CA) surgery to align and stabilise the severely deformed hindfeet of patients with diabetes so that the affected limb would be able to support patients’ body weights and restore walking independence. Methods: A total of 25 patients with cases of CA compromising the ankle (type IIIA) or hindfoot (type IV) underwent a procedure to salvage their affected limbs via tibiocalcaneal arthrodesis fixed with an interlocking intramedullary nail. The mean follow-up period was 49 (6–169) months, and the mean age of patients was 54 (30–83) years. The outcome was considered as satisfactory in cases where the patients were able to walk independently and maintain their repaired foot on the ground; the outcome was considered as unsatisfactory when the affected limb presented with frank instability or deformity. Results: The outcomes were satisfactory in 19 of the 25 (76%) repaired limbs, although 11 of the 25 (44%) limbs presented with complications. Conclusions: The salvage of a severely deformed and markedly unstable limb due to CA complications involving the ankle (type IIIA) or hindfoot (type IV) should be considered for patients with diabetes because the prognosis is favourable in cases where the affected limb is surgically treated using tibiocalcaneal arthrodesis and an interlocking intramedullary nail. Level of Evidence IV; Therapeutic Studies; Case Series.

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5 year retrospective follow-up of new cases of Charcot neuroarthropathy—A single centre experience

Cited by 18 publications

References 20 publications

Systematic review of techniques to monitor remission of acute Charcot neuroarthropathy in people with diabetes

Systematic review of techniques to monitor remission of acute Charcot neuroarthropathy in people with diabetes

A randomised feasibility study of serial magnetic resonance imaging to reduce treatment times in Charcot neuroarthropathy in people with diabetes (CADOM): a protocol

Salvage surgery for Charcot arthropathy of the diabetic hindfoot

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