Success and Survivorship Following Charcot Reconstruction: A Review of 151 Cases

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Abstract

Charcot neuroarthropathy is a debilitating condition that frequently leads to skeletal deformity and pedal ulceration in the insensate foot. Results are often poor and no clear guidelines for surgical management exist. Additionally, amputation rates vary widely making it difficult to accurately inform patients of risks. Few studies have assessed outcomes to identify patients for whom reconstruction is likely to fail. The literature is limited, with small sample sizes and mortality infrequently addressed. We performed a retrospective observational study of patients with Charcot neuroarthropathy to assess overall amputation and mortality rates at 30 days, 1 year, and 3 years postreconstruction and evaluated associated risk factors. Rates of infection, re-ulceration, and return to walking were also assessed. We identified 151 patients over a 5-year period. Demographic and clinical characteristics were collected. Descriptive statistics, Cox proportional hazard model, and logistic regression were used. Overall, 22 (14.6%) patients died, and 23 (15.2%) patients advanced to limb amputation postoperatively. End-stage renal disease, peripheral vascular disease, reconstruction during active phase Charcot process, and reconstruction at the ankle or subtalar joint were all associated with poor outcomes. The risk of mortality was 2.5 times higher in patients with end-stage renal disease, and 3.4 times higher among patients with peripheral vascular disease. Patients with ankle or subtalar joint reconstruction were 70% less likely to return to walking compared to medial column reconstruction. Due to these findings, we suggest that patients with such comorbidities be advised of increased risk for complications including failure to return to walking, amputation, and death.

Section snippets

Patients and Methods

This study was carried out within Kaiser Permanente Northern California (KPNC), an integrated healthcare system, and approved by its Institutional Review Board. Electronic medical records (EMR) were retrospectively reviewed for patients with CN who subsequently underwent reconstruction surgery at a KPNC facility between January 2009 and December 2014. Patients were identified using International Classification of Diseases-9 (ICD-9), International Classification of Disesases-10 (ICD-10), and

Subjects

The cohort consisted of 151 patients who underwent foot or ankle CN reconstruction in a 5-year (2009-2014) period within KPNC. The mean age of the cohort at the time of CN diagnosis was 55.1 ± 8.3 (range 29.0-78.0) years. The mean age at the time of reconstruction was 56.0 ± 8.5 (range 29.0-78.0) years. The population was 43.1% (65/151) female. The majority of the cohort were non-Hispanic White (68.2%), followed by Hispanic (21.2%). The mean BMI was 35.1 ± 7.6 (range 20.9-56.0) kg/m2. Almost

Discussion

While the devastating effects of CN are well known among the foot and ankle surgical community, there are still many unknowns pertaining to the treatment of these patients. In the past, conservative treatment via total contact casting and offloading was considered the gold standard, whereas more recently surgical intervention has become favorable. From a surgical standpoint, there are 2 general approaches: a basic exostectomy where bony plantar prominences are resected or a more complex

Acknowledgment

The authors would like to extend our gratitude to the Kaiser Permanente Division of Research and the Kaiser Permanente Department of Graduate Medical Education for their support.

References (24)

Cited by (4)

  • Considerations in Charcot Reconstruction

    2024, Clinics in Podiatric Medicine and Surgery
  • Plate Fixation in Midfoot and Ankle Charcot Neuroarthropathy

    2022, Clinics in Podiatric Medicine and Surgery
    Citation Excerpt :

    When nonoperative care has failed and the patient presents with wounds, infections, and instability, surgical intervention is warranted. Studies have demonstrated compromised successes and increased complications in CN reconstruction alongside patient comorbidities.2,9 McCann and colleagues9 noted in 151 cases that those who underwent ankle or subtalar reconstruction were 70% less likely to return to walking than those undergoing medial column reconstruction.

Financial Disclosure: None reported.

Conflict of Interest: None reported.

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