Primary Total Knee Arthroplasty in Patients With Neuropathic (Charcot) Arthropathy: Contemporary Results

Abstract

Background: Total knee arthroplasty (TKA) for neuropathic (Charcot) arthropathy is technically challenging with higher complication rates than primary TKA for osteoarthritis. There is a paucity of data regarding outcomes of TKA in contemporary cohorts with modern implants, techniques, and indications. Our study aimed to determine the (1) survivorship of implants, (2) rates and types of complications, (3) clinical outcomes, and (4) radiographic outcomes in patients treated with primary TKA for Charcot arthropathy.

Methods: Twenty-seven patients undergoing 37 TKAs for Charcot arthropathy from 2000 to 2015 were retrospectively reviewed. Mean patient age and follow-up were 60 years and 6 years, respectively. Eighty-one percent were treated with either a varus-valgus constrained or rotating-hinge device, and 81% had supplemental stem fixation. Metaphyseal cones were utilized in 19% of cases.

Results: The 10-year survivorship free of aseptic revision was 88% and free of any revision was 70%. There were 6 revisions (16%): 4 for infection, 1 for tibial component loosening, and 1 for global instability. There were 3 reoperations (8%). Additional complications occurred in 6 patients (16%) including 3 patients with an intraoperative fracture. Mean Knee Society scores improved from 37 preoperatively to 82 postoperatively (P < .001). There was no radiographic evidence of component loosening in any unrevised knee at latest follow-up.

Conclusions: Primary TKA for Charcot arthropathy with selective use of increased constraint and enhanced metaphyseal component fixation led to significant improvement in pain and clinical outcomes when compared with older techniques; however, there was a high perioperative complication rate. While 10-year survivorship free of aseptic revision was 88%, periprosthetic joint infection led to the poorer survivorship free of any revision of 70% at 10 years.

Level of evidence: Level IV.

Keywords: Charcot arthropathy; complications; neuropathic arthropathy; survivorship; total knee arthroplasty.