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Casciato DJ, Raja S, Aubertin G, Kirkham K, Mendicino R, Wynes J. Comparing Clinical Characteristics and Short-Term Outcomes Between Adult and Geriatric Patients Undergoing Charcot Reconstruction. J Foot Ankle Surg 2024:S1067-2516(24)00111-X. [PMID: 38876206 DOI: 10.1053/j.jfas.2024.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 05/19/2024] [Accepted: 05/25/2024] [Indexed: 06/16/2024]
Abstract
Maintaining an acceptable quality of life following a lifetime of chronic diseases and resulting physiologic effects poses a challenge when treating an aging population. In those with Charcot neuroarthropathy, wounds, and infection complicate decision making when considering limb preservation versus amputation. The purpose of this investigation is to describe the clinical characteristics and short-term outcomes of geriatric patients undergoing Charcot reconstruction. A retrospective chart review of patients who underwent Charcot reconstruction from 2016 to 2022 was conducted. Demographics, medical history, deformity type, surgical intervention, discharge planning, and short-term complications were collected. Descriptive statistics were calculated, and clinical characteristics and short-term outcomes were compared between the non-geriatric, adult (A) and geriatric (G) cohorts using Student's t-test or chi-squared test. Overall, 125 patients were reviewed for final analysis. Charcot deformity type, prevalence of wounds, osteomyelitis, and fixation construct did not significantly differ between groups. While the proportion of those experiencing a prolonged admission did not significantly differ between cohorts, the geriatric group showed age-related pathology including delirium and urinary tract infections. While discharge to nursing facilities did differ between groups (G 43% versus A 19%), baseline function did not. The 30-day unplanned readmission and mortality rates did differ between groups, though this difference was not statistically significant. Prior to geriatric Charcot reconstruction, consideration should be given to age-related comorbidities. Specifically, with a greater incidence of age-related complications unrelated to the surgery as well as mortality in the geriatric group, complications should be discussed at length.
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Affiliation(s)
| | | | | | | | | | - Jacob Wynes
- University of Maryland Medical Center, Baltimore, MD
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McCann LJ, Dickinson JD. Considerations in Charcot Reconstruction. Clin Podiatr Med Surg 2024; 41:141-151. [PMID: 37951671 DOI: 10.1016/j.cpm.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
Charcot deformity is a challenging condition often leading to foot and ankle deformity that subsequently causes decreased function, ulceration, infection, and limb loss. There are various treatment measures to take into consideration when managing these patients. Treatment approaches range from conservative casting to surgical reconstruction. The authors believe that when faced with deformity, aggressive reconstruction to maintain a plantigrade foot and prevent loss of function is critical. Because of the nature of the Charcot condition, timing and fixation are often debated. This article discusses the authors' approach to Charcot reconstruction in a large integrated health care system.
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Affiliation(s)
- Luke J McCann
- Kaiser South San Francisco Medical Center, 1200 El Camino Real, South San Francisco, CA 94108, USA.
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Meyer C, Marshall A, Burns P. Long-Term Mortality After Charcot Reconstruction. Clin Diabetes 2023; 42:295-299. [PMID: 38694242 PMCID: PMC11060629 DOI: 10.2337/cd23-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
Charcot neuroarthropathy is a complicated phenomenon with the potential to cause significant deformity, morbidity, and mortality. Costs associated with Charcot-related complications are substantial, with thousands of amputations occurring annually. The purpose of this study was to retrospectively review a single surgeon's experience and record the 10-year mortality rate among patients after Charcot reconstruction at a single institution between 2007 and 2013. Lower-extremity limb salvage is crucial to reduce the burden of Charcot neuroarthropathy. This article provides an example of the potential long-term success of reconstruction surgery for this condition.
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Affiliation(s)
- Cameron Meyer
- Podiatric Medicine and Surgery Residency Program, Department of Orthopedics, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Amanda Marshall
- Podiatric Medicine and Surgery Residency Program, Department of Orthopedics, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Patrick Burns
- Departments of Orthopedic Surgery and Physical Therapy, University of Pittsburgh Medical Center, Pittsburgh, PA
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Khan O, Kavarthapu M, Edmonds M, Kavarthapu V. Surgical management of Charcot foot - The advancements over the past decade. J Clin Orthop Trauma 2023; 47:102317. [PMID: 38196500 PMCID: PMC10772398 DOI: 10.1016/j.jcot.2023.102317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 11/13/2023] [Accepted: 12/13/2023] [Indexed: 01/11/2024] Open
Abstract
Charcot neuroarthropathy is a progressive, destructive condition leading to deformity, dysfunction and, in some cases, amputation. Much evolution has occurred over the last couple of decades in the management of Charcot foot with a focus on developing limb salvage and reconstructive techniques. The aim has been to achieve a stable plantigrade foot that remains pain and ulcer-free whilst reducing amputation rates. Soft tissue and bony reconstructions have been explored, and various modalities of fixation, including internal, external, and combined techniques, have been described and their outcomes published. Currently, no strong evidence exists which supports a particular modality of treatment, nor have there been any randomised studies to this effect, but the results are nevertheless promising. Recent studies have reported on minimally invasive techniques, the use of super construct fixation, computer-navigated deformity correction, the efficacy of techniques such as subtalar arthrodesis or tendon balancing procedures and staged deformity corrections. There is a need for more controlled and comparative studies with consistent reporting of intended outcomes to create a stronger portfolio of evidence on the surgical management of Charcot foot.
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Affiliation(s)
- Omeair Khan
- Specialty Orthopaedic Registrar, Department of Trauma and Orthopaedics, King's College Hospital, London, UK
| | | | - Michael Edmonds
- Diabetic Foot Physician, Diabetic Foot Clinic and Diabetic Department, King's College Hospital, London, SE5 9RS, UK
- Department of Diabetes, Faculty of Life Sciences and Medicine, King's College, Strand, London, WC2R 2LS, UK
| | - Venu Kavarthapu
- Consultant Orthopaedic Surgeon, Department of Trauma and Orthopaedics, King's College Hospital, London, UK
- University of Southern Denmark, Denmark
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Spingola HD, Martucci J, DiDomenico LA. Plate Fixation in Midfoot and Ankle Charcot Neuroarthropathy. Clin Podiatr Med Surg 2022; 39:675-693. [PMID: 36180196 DOI: 10.1016/j.cpm.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Surgical reconstruction of Charcot arthropathy in the foot and ankle is extremely difficult. The fundamentals of reconstruction are necessary to provide adequate outcome. Removing and resecting the diseased bone is needed along with good anatomic alignment and rigid fixation. This reconstructive surgery is not only difficult from medical management point of view but also involves patient compliance and good technical components of the surgery from the surgeon. The surgeon must have skills with internal and external fixation, a good understanding of lower extremity vascular disease, and a good understanding of infectious disease and plastic surgical techniques of the lower extremity.
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Affiliation(s)
- Henry D Spingola
- NOMS Ankle and Foot Care Centers, 8175 Market Street, Youngstown, Ohio 44512, USA
| | - John Martucci
- NOMS Ankle and Foot Care Centers, 8175 Market Street, Youngstown, Ohio 44512, USA
| | - Lawrence A DiDomenico
- NOMS Ankle and Foot Care Centers, 8175 Market Street, Youngstown, Ohio 44512, USA; NOMS Ankle and Foot Care Centers, 16844 Street, Clair Avenue, East Liverpool, Ohio 43920, USA.
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Mehlhorn AT, Illgner U, Lemperle S, Huber V, Hoerterer H, Gottschalk O, Legrand MA, Krenn V, Walther M. [Does inflammatory activity of Charcot foot affect successful corrective arthrodesis?]. DER ORTHOPADE 2022; 51:499-506. [PMID: 35476118 DOI: 10.1007/s00132-022-04251-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/14/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Neuro-osteoarthropathy of the foot (CN) is divided into an active and inactive stage, with impact on the further treatment. The histopathological Charcot score (HCS) can be used, to grade the inflammatory activity in tissue samples. RESEARCH QUESTION This study aims to clarify whether successful bony healing after arthrodesis is related to inflammatory activity of the disease. MATERIAL AND METHOD N = 80 patients underwent corrective arthrodesis of the midfoot (group 1) or hindfoot/ankle (group 2). A distinction was made between patients with/without diabetes mellitus and with/without pain perception. Intraoperative samples were taken to determine HCS. The osseous healing of the arthrodesis was determined by computed tomography 12 weeks postoperatively. RESULTS There was an indirect correlation between bony consolidation and HCS. In group 2, there was a significantly worse bony healing in patients without pain sensation. There seems to be a tendency for HCS to be increased in patients without diabetes/no pain sensation. DISCUSSION The present study confirms the assumption that corrective arthrodesis should be performed in the inactive stage of CN only. High activity levels obviously impede bony healing. HCS represents a relevant prognostic tool for surgical treatment.
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Affiliation(s)
- Alexander T Mehlhorn
- Zentrum für Fuß- und Sprunggelenkschirurgie, Schönklinik München-Harlaching, München, Deutschland.
- Klinik für Orthopädie und Unfallchirurgie, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland.
- Sektion für Diabetische und Neuropathische Fußerkrankungen, Zentrum für Fuß- und Sprunggelenkschirurgie, Schönklinik München-Harlaching, Harlachinger Straße 51, 81547, München, Deutschland.
| | - Ulrich Illgner
- Orthopädische Privatpraxis Seintsch Illgner, Koblenz, Deutschland
| | - Stefan Lemperle
- Zentrum für Fuß- und Sprunggelenkschirurgie, Schönklinik München-Harlaching, München, Deutschland
| | - Verena Huber
- Zentrum für Fuß- und Sprunggelenkschirurgie, Schönklinik München-Harlaching, München, Deutschland
| | - Hubert Hoerterer
- Zentrum für Fuß- und Sprunggelenkschirurgie, Schönklinik München-Harlaching, München, Deutschland
- Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Universitätsklinikum der LMU München, München, Deutschland
| | - Oliver Gottschalk
- Zentrum für Fuß- und Sprunggelenkschirurgie, Schönklinik München-Harlaching, München, Deutschland
- Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Universitätsklinikum der LMU München, München, Deutschland
| | - Maria Anna Legrand
- Zentrum für Anästhesiologie und Intensivmedizin, Schönklinik München-Harlaching, München, Deutschland
| | - Veit Krenn
- MVZ-Zentrum für Histologie, Zytologie und Molekulare Diagnostik GmbH, Trier, Deutschland
| | - Markus Walther
- Zentrum für Fuß- und Sprunggelenkschirurgie, Schönklinik München-Harlaching, München, Deutschland
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