Risk Factors Associated With Major Lower Extremity Amputation After Osseous Diabetic Charcot Reconstruction

Elmarsafi, Tammer; Anghel, Ersilia; Sinkin, Jeremy C.; Cooper, Paul S.; Steinberg, John S.; Evans, Karen K.; Kim, Paul J.; Attinger, Christopher E.

doi:10.1053/j.jfas.2018.08.059

Cited by 15 publications

(8 citation statements)

References 26 publications

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“…Reinke et al reported successful limb salvage using the Ilizarov principles in all five cases of CN with talar body necrosis after a follow-up of 27 months[ 46 ]. There were no differences in major amputations between the studies by Hegewald et al [ 47 ], Ford et al [ 48 ] and our study ( p = 0.730 and p = 0.125, respectively; test on equality of proportions), but our study showed lower proportions of major amputations compared to Eschler et al [ 49 ] and Elmarsafi et al [ 39 ] (7.1% versus 28.6%, p = 0.030 and 7.1% versus 17.2%, p = 0.002, respectively). Compared to the studies by Hegewald et al [ 47 ], Eschler et al [ 49 ], and Elmarsafi et al [ 39 ], our mean time to amputation was significantly different ( p = 0.020, p = 0.026, and p = 0.006, respectively; t tests) with amputations occurring after a longer time frame in our study.…”

Section: Discussioncontrasting

confidence: 73%

“…Thus, major amputation must be expected in any anatomical location. Elmarsafi et al investigated risk factors for major amputation after CN reconstructive surgery [ 39 ]. They found a major amputation rate of 17.2% and identified PAD, renal disease, postoperative delayed healing (defined as nonhealing > 30 days), postoperative osteomyelitis, postreconstruction nonunions, the development of new CN sites, and increased HbA1c as risk factors for major amputation.…”

Section: Discussionmentioning

confidence: 99%

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Long-term follow-up of conservative treatment of Charcot feet

Gratwohl

Jentzsch

Schöni

et al. 2021

Arch Orthop Trauma Surg

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Background Charcot arthropathy (CN) can ultimately lead to limb loss despite appropriate treatment. Initial conservative treatment is the accepted treatment in case of a plantigrade foot. The aim of this retrospective study was to investigate the mid- to long-term clinical course of CN initially being treated conservatively, and to identify risk factors for reactivation and contralateral development of CN as well as common complications in CN. Methods A total of 184 Charcot feet in 159 patients (median age 60.0 (interquartile range (IQR) 15.5) years, 49 (30.1%) women) were retrospectively analyzed by patient chart review. Rates of limb salvage, reactivation, contralateral development and common complications were recorded. Statistical analysis was performed to identify possible risk factors for limb loss, CN reactivation, contralateral CN development, and ulcer development. Results Major amputation-free survival could be achieved in 92.9% feet after a median follow-up of 5.2 (IQR 4.25, range 2.2–11.25) years. CN recurrence occurred in 13.6%. 32.1% had bilateral CN involvement. Ulcers were present in 72.3%. 88.1% patients were ambulating in orthopaedic footwear without any further aids. Presence of Diabetes mellitus was associated with reactivation of CN, major amputation and ulcer recurrence. Smoking was associated with ulcer development and necessity of amputations. Conclusions With consistent conservative treatment of CN with orthopaedic footwear or orthoses, limb preservation can be achieved in 92.9% after a median follow-up of 5.2 years. Patients with diabetic CN are at an increased risk of developing complications and CN reactivation. To prevent ulcers and amputations, every effort should be made to make patients stop smoking. Level of Evidence III, long-term retrospective cohort study

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Section: Discussioncontrasting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Long-term follow-up of conservative treatment of Charcot feet

Gratwohl

Jentzsch

Schöni

et al. 2021

Arch Orthop Trauma Surg

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“…persons with Charcot‐related foot wounds were more likely to undergo major amputation than those without foot wounds (with ulcer 21%; without ulcer 4.5%). Elmarsafi et al 13 . had 17% major amputations in their large series of different Charcot foot operations.…”

Section: Discussionmentioning

confidence: 99%

Long‐term outcome of persons with diabetic and non‐diabetic neuro‐osteoarthropathy after foot correction using external fixation

et al. 2020

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Aim Diabetic neuro‐osteoarthropathy (Charcot foot) is a serious form of diabetic foot syndrome, often leading to severe deformity of the foot and subsequently to ulcers and osteomyelitis. The aim of this retrospective study was to determine the success rate and long‐term outcomes for a Charcot foot operation using external fixation in 115 individuals who underwent surgery between July 2008 and December 2012. Methods Some 115 consecutive persons, 78 (68%) men and 37 (32%) women, were enrolled in this study. The eligibility criterion for this retrospective study was reconstructive foot surgery using a Hoffmann II external fixator in diabetic and non‐diabetic neuro‐osteoarthropathy. The main examination parameters in the follow‐up were walking ability, amputation and mortality. Average follow‐up was 5.7 (± 3.2) years. Results Ninety‐seven per cent of people were able to walk after the operation with bespoke shoes or an orthosis. At follow‐up, 77% were able to walk and 51% were fully mobile even outside the home. Subsequent amputations were performed in 29 individuals (26%), with 17 (15%) minor and 12 (11%) major amputations. Forty‐seven individuals died before follow‐up, the majority (53%) from cardiovascular events. Average survival time post surgery was 4.5 (± 2.9) years. Conclusion Reconstruction surgery using external fixation is a very useful method for maintaining walking ability in the case of conservatively non‐treatable diabetic and non‐diabetic neuro‐osteoarthropathy. Individuals with severe Charcot foot disease had a low rate of major amputations. Osteomyelitis was the main reason for major amputations.

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“…However, there is a significant risk that these outcome scores may not truly represent patients' expectations following such complex functional limb salvage procedures. 72,73,74 Wulkich et al, reported limb salvage as being perceived by the patients to be more important than death among those with diabetic foot disease; one could conclude that it is desirable to have specific PROMS for this group of conditions. 77…”

Section: Outcome Comparisonmentioning

confidence: 99%

Charcot foot reconstruction outcomes: A systematic review

Hester

Foley

et al. 2020

Journal of Clinical Orthopaedics and Trauma

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Background: Charcot neuroarthropathy is a complex condition characterised by progressive deformity, limited treatment options and a high amputation rate. Surgical reconstruction of Charcot foot has been proposed as a method to preserve the foot. However, limited information exists on the different methods of reconstruction available, their outcomes and complications. Methods: We systematically analysed published data from Jan 1993 to Dec 2018 to assess methods of fixation and associated outcomes for the surgical reconstruction in Charcot neuroarthropathy. Statistical analyses were undertaken to determine the amputation rates, return to ambulation and complications associated with these techniques. Results: A total of 1116 feet (1089 patients) were reported to have undergone reconstruction with significant heterogeneity in patient selection. Of these, 726 (65%) were reported to undergo internal fixation, 346 feet (31%) external fixation and 44 (4%) undergoing simultaneous internal and external fixation. No single technique demonstrated a significant benefit over the other. Overall, the bone fusion rate was 86.1%. Complications directly attributable to the technique employed were noted in 36% of individuals. The reported post-reconstruction amputation rate was only 5.5% with 91% apparently returning to ambulation. Conclusions: Although no preferential method of fixation was identified, we find that the current options for surgical reconstruction could offer limb salvage with a low amputation risk in a highly selected population. However, the lack of controlled studies, inconsistent reporting of outcomes and heterogeneity of patient selection mean that the quality of evidence is low.

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Risk Factors Associated With Major Lower Extremity Amputation After Osseous Diabetic Charcot Reconstruction

Cited by 15 publications

References 26 publications

Long-term follow-up of conservative treatment of Charcot feet

Long-term follow-up of conservative treatment of Charcot feet

Long‐term outcome of persons with diabetic and non‐diabetic neuro‐osteoarthropathy after foot correction using external fixation

Charcot foot reconstruction outcomes: A systematic review

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