Knee Arthrodesis in a Patient with Charcot Neuroarthropathy Secondary to Familial Amyloid Polyneuropathy

Rebelo, Tiago; Agostinho, Francisco; Abrantes, A. B. M. B.; Simões, Nuno; Simões, I.

doi:10.2106/jbjs.cc.17.00110

Cited by 1 publication

(16 citation statements)

References 15 publications

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“…Specific triggers are sometimes described, for example a misstep whilst hiking on the Appalachian Trail [ 60 ], or traumatic incidents [ 15 , 23 , 25 , 35 , 43 ]. Pain Twenty-one studies involving 52 patients described a degree of pain and tenderness as a presenting complaint [ 7 , 16 , 17 , 19 – 24 , 28 , 35 , 37 , 38 , 44 , 47 , 54 , 57 – 61 ] especially during movement [ 21 , 37 , 57 ]. However, neuropathic arthropathy is classically described as a painless condition, with 9 studies involving 11 patients reporting an initial painless presentation [ 6 , 8 , 12 , 13 , 15 , 36 , 39 , 41 , 48 ].…”

Section: Resultsmentioning

confidence: 99%

“…Furthermore, varying cultures around the globe means that some groups such as the Japanese spend more time seated, making knee arthrodesis more debilitating [40]. Nevertheless, for elderly patients, arthrodesis can promote mobilisation and prevent extreme limb shortening [7,19,40].…”

Section: Discussionmentioning

confidence: 99%

“…Patient ethnicity was reported by 8 studies involving 17 patients, mostly in those that were published in the twentieth century. Among them, 50% were Caucasian, 41.7% Afro-Caribbean origin, and 8.3% Asian [12][13][14][15][16][17][18][19]. Table 1 shows aetiologies of CK patients.…”

Section: Demographicsmentioning

confidence: 99%

“…Valgus deformation was reported in 19 studies involving 114 patients [4, 7, 9, 12, 19, 28, 34, 35, 37, 38, 45, 49-51, 53-55, 57, 58] and varus deformation in 14 studies involving 34 patients [8,16,21,24,28,30,31,34,35,37,43,53,54,62], often presenting as instability upon valgus and varus stress tests, or a positive Bohler test [52]. Ligamentous laxity and joint hypermobility were reported in 7 studies involving 14 patients [7,19,22,26,32,50,53]. This resulted in increased knee range of motion seen that decreased after treatment [34,38,44].…”

Section: Knee Deformitiesmentioning

confidence: 99%

“…At best, patients were able to walk around pain-free with a quad cane [21], which allowed them to independently perform daily life activities [19], and even return to work [12]. Arthrodesis techniques include spring compression fixators [7], positive pressure fixators [17], intramedullary locking nail and bone grafting [19,35]. Intramedullary nailing technique consists of the removal of the entire patella and synovium, followed by debridement of sclerotic tissue.…”

Section: A Conservative Treatmentmentioning

confidence: 99%

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Charcot knee — presentation, diagnosis, management — a scoping review

Zhang

Thahir

et al. 2021

Clin Rheumatol

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Background Charcot arthropathy is a progressive, non-infectious, destructive inflammatory process. Charcot arthropathy of the knee (CK) is rare and diagnosis is often delayed, resulting in detrimental outcomes. This scoping review aims to investigate the literature on CK, present the pathognomonic features of CK to aid early diagnosis, and suggest gaps in the literature for future research. Methods A systematic search of PubMed, EMBASE, Web of Science for literature relevant to CK was performed. Primary studies such as case reports, case series, retrospective studies were included. Review articles and animal studies were excluded. Results Of the 513 results, 58 were included in qualitative synthesis. Average time from symptom onset to CK diagnosis was 50.5 months. Eighteen and twenty-one studies included patients who had diabetes mellitus and syphilis, respectively. Twenty-one studies reported pain as a presenting complaint, but the degree of pain didn’t correspond with the level of destruction. Oedema and joint effusion were noticed in 34 studies. Twenty-nine studies reported lower limb hypoesthesia and 17 studies reported decreased tendon reflex. Twenty-eight studies reported initial conservative treatment, often in a knee brace with minimal weight bearing, 9 of which needed subsequent surgical management. Twelve studies utilised arthrodesis, with fracture at the intramedullary nail entry site being the most common complication. Twenty-four studies utilised TKA. Conclusion The literature on CK remains sparse, with most publications being case reports. Given that CK dramatically reduces quality of life, increases morbidity of patients, there is need for more literature on evidence-based options for early diagnoses and management.

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