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

Abstract

Background: The role of arthrodesis as a salvage procedure in Diabetic Charcot Neuroarthropathic deformities of the Foot and Ankle is controversial due to relatively high complication rates reported in literature. We intend to present our experience with a retrospective analysis of Ankle and Hindfoot arthrodesis in deformities due to Diabetic Charcot Neuroarthropathy. Study design: A retrospective observational analysis of selected Diabetic Neuropathic Ankle and Hindfoot cases operated at a single centre. Patients and methods: In a study duration extending 7.5 years, 46 operated sites in 44 patients were included in the study. These patients were treated by one of the following procedures: Tibiotalocalcaneal arthrodesis, Pantalar arthrodesis, Ankle arthrodesis, Triple arthrodesis and isolated subtalar arthrodesis. The results were analysed with regard to wound healing and its complications, clinical and radiological progress of union and non-union rates and deformity correction (i.e. whether a plantigrade foot could be achieved and a standard foot wear could be worn post correction). Results: There were four superficial and two deep infections (13%). Symptomatic radiological non-union at one or more joints was seen in 12 cases (26%). Thirty cases united primarily (65%) and showed radiological fusion at an average time of 6.8 months post-surgery. Four cases (8.5%) had asymptomatic radiological partial non union at one or more joints but showed clinical union. Five patients (8.3%) had a low energy spiral fracture of the tibia proximal to the locking plate used for TTC fusion. Complete deformity correction with plantigrade foot was achieved in 32 cases (69.5%). Conclusion: Despite a high complication rate associated with Ankle and Hind foot arthrodesis in Diabetic Charcot Neuroarthropathy, an eventually successful fusion can be achieved in two-third patients.

Catastrophic Talar Bone Loss from High Velocity Trauma Treated with Structural Tricorticate Fibula Autograft, Compression Frame and Midfoot Distraction Arthroplasty

“…Pantalar arthrodesis is used in advanced reconstructive cases such as pantalar arthritis Charcot disease, trauma, and failed total ankle arthroplasty [17][18][19]. Pantalar arthrodesis have been used for patients which have instability issues, traumatic events and failed ankle replacements [20][21][22]. The patient has an amalgamation of these indications being the perfect candidate for a pantalar arthrodesis.…”

Presurgical Perspective and Postsurgical Evaluation of the Diabetic Foot

“…There is typically a high complication rate with fusion procedures for Charcot's arthropathy, but eventually successful fusion can be achieved in approximately two thirds of patients. 57 The main goal of surgical reconstruction in Charcot's foot is to create a stable plantigrade foot that is ulcer and infection free, and can be braced and offloaded. Several reconstruction techniques are described, such as excision of bony prominences, osteotomies to correct deformity, intramedullary midfoot beaming, plating, intramedullary nailing, and external fixation 58 .…”

“…There is typically a high complication rate with fusion procedures for Charcot's arthropathy, but eventually successful fusion can be achieved in approximately two thirds of patients. 57…”