Tibiocalcaneal arthrodesis for the treatment of advanced stage Charcot arthropathy: Clinical and radiological outcome analysis of patients with diabetes mellitus followed for at least 2 years

Abstract

Aim: Charcot arthropathy (CA) described by Jean-Martin Charcot is a noninfectious degenerative and destructive process of the bones, joints and soft tissues in the area of the foot and ankle which associated with peripheral neuropathy. The purpose of this study was to evaluate the outcomes of tibiocalcaneal fusion using a retrograde hind foot ankle nail fixation system in 5 Charcot patients.

Material and Methods: Between 2014 and 2016, a total of 5 patients (4 women and 1 man) who underwent tibiocalcaneal arthrodesis for the treatment of advanced CA (Brodsky type 4) were evaluated. The demographic characteristics, clinical (AOFAS scores, early and late complications) and radiological (time for a union) evaluation parameters and patient satisfaction were analyzed before and after surgery.

Results: The mean preoperative AOFAS score was 64.8 ± 8.55 and mean postoperative score was 82.6 ± 12.99. The difference between preoperative AOFAS and postoperative AOFAS scores were statistically significant. During the clinical and radiological follow-up; infection, implant failure, and peri-implant fractures were checked and complications were recorded.

Conclusion: AOFAS scores were recorded before surgery after full weight bearing and it was found that talocalcaneal arthrodesis which was achieved with intramedullary nailing significantly increased AOFAS score compared to the preoperative AOFAS score.

Keywords

• Charcot arthropathy
• tibiocalcaneal arthrodesis
• limb-salvage
• nail fixation
• diabetes mellitus

İleri evre Charcot artropatisinin tedavisi için tibiokalkaneal artrodez: Diyabetes mellituslu hastaların en az 2 yıllık takibi ile klinik ve radyolojik sonuç analizi

Abstract

Amaç: Jean-Martin Charcot tarafından tanımlanan Charcotartropatisi, periferiknöropati ile ilişkili ayak ve ayak bileği bölgesindeki kemiklerin, eklemlerin ve yumuşak dokuların enfeksiyöz olmayan dejeneratif bir hastalığıdır. Bu çalışmanın amacı, 5 Charcotartropati hastasında retrograd arka ayak bileği fiksasyon sistemi kullanılarak yapılan tibiokalkaneal füzyonun sonuçlarını değerlendirmektir.

Gereç ve Yöntemler: 2014-2016 yılları arasında ileri Charcotartropati tedavisi için tibiokalkanealartrodez uygulanan 5 hasta (4 kadın ve 1 erkek) değerlendirildi. Ameliyat öncesi ve sonrası demografik özellikler, klinik (AOFAS skorları, erken ve geç komplikasyonlar) ve radyolojik (birleşme zamanı) değerlendirme parametreleri ve hasta memnuniyeti analiz edildi.

Bulgular: Ameliyat öncesi ortalama AOFAS skoru 64.8 ± 8.55 ve ortalama ameliyat sonrası skor 82.6 ± 12.99 idi. Ameliyat öncesi AOFAS ve ameliyat sonrası AOFAS skorları arasındaki fark istatistiksel olarak anlamlı bulundu. Klinik ve radyolojik takip sırasında; enfeksiyon, implant yetmezliği ve implant çevresi kırıklar ve komplikasyonlar kaydedildi.

Sonuç: AOFAS skorları ameliyat öncesi kaydedilmiş ve intramedüller çivileme ile elde edilen talokalkanealartrodezin AOFAS skorunu preoperatif AOFAS skoruna göre anlamlı derecede artırdığı bulunmuştur.

Keywords

• Charcot artropati
• tibiokalkaneal artrodez
• uzuv kurtarma
• çivileme
• diabetes mellitus

References

1. 1. Molines L, Darmon P, Raccah D. Charcot's foot: newest findings on its pathophysiology, diagnosis and treatment. Diabetes Metab 2010; 36: 251-5.
2. 2. Frykberg RG, Belczyk R. Epidemiology of the Charcot foot. Clin Podiatr Med Surg 2008; 25:17-28.
3. 3. Olivera Stojadinovic IP, Katherine A. Gordon, Marjana Tomic-Canic. Physiology and Pathophysiology of Wound Healing in Diabetes. In: Aristidis Veves JMG, Frank W. LoGerfo, editor. The Diabetic Foot Medical and Surgical Management. 1. 3 ed. Springer New York Dordrecht Heidelberg London: Springer Science+Business Media; 2012. p. 127.
4. 4. Dalla Paola L. Confronting a dramatic situation: the charcot foot complicated by osteomyelitis. Int J Low Extrem Wounds 2014; 13: 247-62.
5. 5. Wukich DK, Sung W. Charcot arthropathy of the foot and ankle: modern concepts and management review. J Diabetes Complications 2009; 23: 409-26.
6. 6. Myerson MS, Alvarez RG, Lam PW. Tibiocalcaneal arthrodesis for the management of severe ankle and hindfoot deformities. Foot Ankle Int 2000; 21: 643-50.
7. 7. Rosenbaum AJ, DiPreta JA. Classifications in brief: Eichenholtz classification of Charcot arthropathy. Clin Orthop Relat Res 2015; 473: 1168-71.
8. 8. Van Lieshout EM, De Boer AS, Meuffels DE et al. American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score: a study protocol for the translation and validation of the Dutch language version. BMJ Open 2017; 7: 12884.

9. 9. Boonstra AM, Schiphorst Preuper HR, Reneman MF, Posthumus JB, Stewart RE. Reliability and validity of the visual analogue scale for disability in patients with chronic musculoskeletal pain. Int J Rehabil Res 2008 ;31: 165-9.
10. 10. Moore TJ, Prince R, Pochatko D, Smith JW, Fleming S. Retrograde intramedullary nailing for ankle arthrodesis. Foot Ankle Int 1995; 16: 433-6.
11. 11. Schneekloth BJ, Lowery NJ, Wukich DK. Charcot Neuroarthropathy in Patients With Diabetes: An Updated Systematic Review of Surgical Management. J Foot Ankle Surg 2016; 55: 586-90.
12. 12. Caravaggi CM, Sganzaroli AB, Galenda P et al. Long-term follow-up of tibiocalcaneal arthrodesis in diabetic patients with early chronic Charcot osteoarthropathy. J Foot Ankle Surg 2012; 51: 408-11.
13. 13. Ettinger S, Stukenborg-Colsman C, Plaass C et al. Tibiocalcaneal arthrodesis as a limb salvage procedure for complex hindfoot deformities. Arch Orthop Trauma Surg 2016; 136: 457-62.
14. 14. Caravaggi C, Cimmino M, Caruso S, Dalla Noce S. Intramedullary compressive nail fixation for the treatment of severe Charcot deformity of the ankle and rear foot. J Foot Ankle Surg 2006; 45:20-4.
15. 15. Abhijit R. Guha DS, Razi Zaidi, Ali Abbassian. Talectomy and Tibiocalcaneal Arthrodesis in Adult Complex Hindfoot Reconstruction. Techniques in Foot & Ankle Surgery 2013; 12: 158-62
16. 16. Aikawa T, Watanabe K, Matsubara H, Nomura I, Tsuchiya H. Tibiocalcaneal Fusion for Charcot Ankle With Severe Talar Body Loss: Case Report and a Review of the Surgical Literature. J Foot Ankle Surg 2016; 55: 247-51.
17. 17. Alvarez RG, Barbour TM, Perkins TD. Tibiocalcaneal arthrodesis for nonbraceable neuropathic ankle deformity. Foot Ankle Int 1994; 15:354-9.
18. 18. LaPorta GA, Nasser EM, Mulhern JL. Tibiocalcaneal arthrodesis in the high-risk foot. J Foot Ankle Surg 2014; 53:774-86.