Charcot arthropathy of the knee. A case-based review

Abstract

The diagnosis of Charcot arthropathy in the knee is rare. However, there is an increasing number of diabetic patients, and they are living longer due to improvements in treatment. Because neuropathic arthropathy is a late effect of peripheral neuropathy, we can expect an increasing incidence of neuropathic arthropathy. Total knee arthroplasty is the preferred choice of treatment by patients, although it may also be associated with a high incidence of serious complications. This case report presents a young female with diabetes mellitus and Charcot arthropathy of the knee managed by total knee arthroplasty and a literature review. The report encompasses a 5-year follow-up of the patient, from the first contact after knee distortion through diagnosis of Charcot arthropathy and the performance of total knee arthroplasty with outpatient controls. The diagnosis was established on the basis of the rapid destruction of the medial tibial condyle after knee distortion in a patient with neuropathy. Neuropathic arthropathy was confirmed by histology. The patient refused knee fusion and total knee arthroplasty was performed. The patient quickly achieved a painless, stable knee with a 130-degree range of motion. However, a radiolucent line appeared under the tibial component due to premature weight-bearing. The patient was ordered to refrain from weight-bearing for the next 3 months, and the knee was healed. While the management of Charcot arthropathy in the knee remains controversial, total knee arthroplasty is not a contraindication. Early diagnosis, appropriate choice of implant and operative technique, and long-term weight protection are essential.

Allograft bone transplantation for neuropathic arthropathy of the knee associated with type 1 diabetes mellitus

“…Previous cases of neuropathic arthropathy of the knee detected at an early stage have been described by Lambert and Close [15], Traina et al [16], and Kucera et al [17]. These three cases were all identified through a fracture in the medial part of the proximal tibia, similarly to our case.…”

“…However, at 8 months after the operation, destruction of the knee joint had advanced to the late stage of arthropathy. The third patient [17] had varus deformity and medial tibial condyle necrosis of the knee, and was finally treated with TKA. These three cases show that once neuropathic arthropathy has developed in the knee, conservative treatment by immobilization or surgical realignment by osteotomy of the tibia is unlikely to prevent progression of joint destruction, even if performed at an early stage.…”

Une localisation rare d’une neuroarthropathie diabétique : un cas exceptionnel d’atteinte du genou

“…L'aspect de fracture-enfoncement du plateau tibial interne semble caractéristique dans ce contexte d'un genou de Charcot [1,[3][4][5][6]. La durée du diabète et un déséquilibre profond semblent être des facteurs favorisants [1,[3][4][5][6].…”

“…La durée du diabète et un déséquilibre profond semblent être des facteurs favorisants [1,[3][4][5][6]. Le caractère indolore des lésions et la rareté de cette localisation peuvent être à l'origine d'un retard de prise en charge.…”

Diabetic Charcot Neuroarthropathy of the Knee: Conservative Treatment Options as Alternatives to Surgery

“…In a literature search, we only found five articles on total knee arthroplasty for Charcot joints (1)(2)(3)(4)(5). We did not find a single article dealing with alternative treatment options or the general clinical course of this disease.…”