Idiopathic Charcot Arthropathy of the Knee Presenting as a Bicondylar Tibial Plateau Fracture

Abstract

Charcot arthropathy is an infrequent condition that primarily involves the foot and ankle; rarely, it has been reported to affect the knee. Risk factors for Charcot arthropathy are well described with diabetes being the most common cause. Idiopathic Charcot arthropathy without a secondary etiology is extremely rare, with only a few cases described involving the foot and shoulder. Clinically, idiopathic Charcot arthropathy presents a notable challenge because delayed diagnosis can lead to surgical complications and advancement of joint destruction. We report idiopathic Charcot arthropathy of the knee presenting as a bicondylar tibial plateau fracture successfully managed with total knee arthroplasty after failed open reduction internal fixation. We diagnosed the patient when the clinical/surgical presentation was indicative of Charcot arthropathy and after excluding all other diagnoses. This previously unreported case describes the complexity of idiopathic Charcot arthropathy with subsequent fractures and highlights the importance of patient history, presentation, and surgical intervention.

Figure 1

Axial three-dimensional CT reconstruction indicating bicondylar tibial plateau fracture with notable medial comminution and deficit.

Figure 2

Intraoperative photograph indicating synovitis and advancement of osteoarthritis.

Figure 3

Postoperative AP radiograph after successful total knee arthroplasty.