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. 2020 May-Jun;11(3):357-368.
doi: 10.1016/j.jcot.2020.03.025. Epub 2020 Apr 20.

Charcot foot reconstruction outcomes: A systematic review

Joon Ha  1 , Thomas Hester  1 , Robert Foley  1 , Ines L H Reichert  1 , Prashanth R J Vas  1   2 , Raju Ahluwalia  1 , Venu Kavarthapu  1
Affiliations

Charcot foot reconstruction outcomes: A systematic review

Joon Ha et al. J Clin Orthop Trauma. 2020 May-Jun.

Abstract

Background: Charcot neuroarthropathy is a complex condition characterised by progressive deformity, limited treatment options and a high amputation rate. Surgical reconstruction of Charcot foot has been proposed as a method to preserve the foot. However, limited information exists on the different methods of reconstruction available, their outcomes and complications.

Methods: We systematically analysed published data from Jan 1993 to Dec 2018 to assess methods of fixation and associated outcomes for the surgical reconstruction in Charcot neuroarthropathy. Statistical analyses were undertaken to determine the amputation rates, return to ambulation and complications associated with these techniques.

Results: A total of 1116 feet (1089 patients) were reported to have undergone reconstruction with significant heterogeneity in patient selection. Of these, 726 (65%) were reported to undergo internal fixation, 346 feet (31%) external fixation and 44 (4%) undergoing simultaneous internal and external fixation. No single technique demonstrated a significant benefit over the other. Overall, the bone fusion rate was 86.1%. Complications directly attributable to the technique employed were noted in 36% of individuals. The reported post-reconstruction amputation rate was only 5.5% with 91% apparently returning to ambulation.

Conclusions: Although no preferential method of fixation was identified, we find that the current options for surgical reconstruction could offer limb salvage with a low amputation risk in a highly selected population. However, the lack of controlled studies, inconsistent reporting of outcomes and heterogeneity of patient selection mean that the quality of evidence is low.

Keywords: Charcot; Diabetes; Neuroarthropathy; Neuropathy; Surgical reconstruction.

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Conflict of interest statement

The authors have no declaration of interest and neither any conflicts of interest to report. The authors certify that they have obtained all appropriate patient consent and the patient has given their consent for their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published.

Figures

Fig. 1
Fig. 1
Study selection flow diagram. This outlines the filtering process from literature search to study inclusion.
Fig. 2
Fig. 2
Number of feet and type of fixation reported in studies.
Fig. 3
Fig. 3
A & B. Funnel plot assessing heterogeneity of studies following the Cochrane review guidelines, for the outcome of amputation (A) and mobilisation (B). Showing a symmetrical inverted funnel shape suggesting symmetry around the mean and in which 95% of studies are found within the simple triangular region as would be expected to lie in the absence of both significant bias and heterogeneity.
Fig. 1
Fig. 1
Study selection flow diagram. This outlines the filtering process from literature search to study inclusion.
See this image and copyright information in PMC

References

    1. Pinzur M.S., Evans A. Health-related quality of life in patients with Charcot foot. Am J Orthoped. 2003;32:492–496. - PubMed
    1. Schon L.C., Easley M.E., Weinfeld S.B. Charcot neuroarthropathy of the foot and ankle. Clin Orthop Relat Res. 1998:116–131. - PubMed
    1. Robinson A.H., Pasapula C., Brodsky J.W. Surgical aspects of the diabetic foot. J Bone Jt Surg - Br. 2009;91:1–7. - PubMed
    1. Pinzur M.S., Sage R., Stuck R., Kaminsky S., Zmuda A. A treatment algorithm for neuropathic (Charcot) midfoot deformity. Foot Ankle. 1993;14:189–197. - PubMed
    1. Myerson M.S., Edwards W.H. Management of neuropathic fractures in the foot and ankle. J Am Acad Orthop Surg. 1999;7:8–18. - PubMed