Charcot osteoarthropathy of the knee secondary to neurosyphilis: a rare condition managed by a challenging arthrodesis

Abstract

The Charcot joint or neuropathic osteoarthropathy was first described as an arthritic sequela of neurosyphilis (tabes dorsalis). It results in significant joint destruction and instability. Nowadays, it is a very rare condition and represents a considerable challenge to the orthopaedic surgeon. The authors describe the case of a patient diagnosed with neurosyphilis who was requested an orthopaedic consultation for an enlarged and unstable knee. The diagnosis of Charcot knee was made and based on the clinical and radiographical findings combined with the patient's medical history. Knee arthrodesis was the surgical treatment chosen to preserve the limb and only succeeded at second attempt. At 4 years of follow-up, it proved to be an effective surgical treatment. In this article, we focus on the importance of early recognition of joint changes in these patients in order to prevent irreversible joint loss.

Keywords: infection (neurology); orthopaedics; osteoarthritis; syphilis.

Figure 1

Patient knees when firstly examined by the orthopaedic surgery consultants.

Figure 2

First radiographs of patient’s right knee.

Figure 3

Postoperatory view of the Charcot knee submitted to arthrodesis.

Figure 4

Postoperatory radiographs of the Charcot knee.

Figure 5

Radiographs 7 months after the index arthrodesis.

Figure 6

Radiographs showing distal femur fracture suffered by the patient before removing the external fixator.

Figure 7

Radiographs with evidence of knee fusion, 8 months after the rearthrodesis and 21 months after the index arthrodesis.