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. 2023 Dec;33(8):3577-3584.
doi: 10.1007/s00590-023-03592-0. Epub 2023 May 28.

Comparative results of arthroscopic ankle arthrodesis vs. open arthrodesis in patients with diabetes-associated Charcot Neuro-Arthropathy

Natalia Gutteck  1 , Karl-Stefan Delank  2 , Sebastian Schilde  2
Affiliations

Comparative results of arthroscopic ankle arthrodesis vs. open arthrodesis in patients with diabetes-associated Charcot Neuro-Arthropathy

Natalia Gutteck et al. Eur J Orthop Surg Traumatol. 2023 Dec.

Abstract

Background: Several studies demonstrated a considerable complication rate for open ankle or TTC arthrodesis in patients with diabetes, revision surgery and ulceration. Extensive approaches in combination with multimorbide patients have been suggested as the rationale behind the increased complication rate.

Methods: Single-centre, prospective case-control study compared arthroscopic vs. open ankle arthrodesis in patients with Charcot Neuro-Arthropathy of the foot. 18 patients with septic Charcot Neuro-Arthropathy Sanders III-IV received an arthroscopic ankle arthrodesis with TSF (Taylor Spatial Frame®) fixation combined with different additional procedures required for infect treatment and hindfoot realignment. The ankle arthrodesis was required for the realignment of the hindfoot in Sanders IV patients, arthritis or in case of infection. 12 patients were treated with open ankle arthrodesis and TSF fixation combined with various additional procedures.

Results: A significant improvement has been shown in radiological data in both groups. A significant lower complication rate has been registered in arthroscopic group. A significant correlation was seen between major complications and therapeutic anticoagulation as well as smoking.

Conclusion: In high-risk patients with diabetes and plantar ulceration excellent results could be demonstrated in arthroscopically performed ankle arthrodesis with midfoot osteotomy using TSF as fixation devise.

Keywords: Ankle arthrodesis; Arthroscopic ankle arthrodesis; Diabetes-associated Charcot Neuro-Arthropathy; Foot infection; Foot ulceration; Minimal-invasive; Osteomyelitis.

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Conflict of interest statement

The authors explain there were no conflicts of interest.

Figures

Fig. 1
Fig. 1
Patient with diabetes associated Charcot Neuro-Arthropathy, plantar ulceration and chronic osteomyelitis
Fig. 2
Fig. 2
a Preoperative lateral weightbearing x-ray with demonstration of the talar declination (α) and calcaneal inclination (β) angle (artroscopic group). b Preoperative lateral weightbearing x-ray (open approach group)
Fig. 3
Fig. 3
a Lateral weightbearing x-ray with demonstration of the talar declination (α) and calcaneal inclination (β) angle one year postoperatively (arthroscopic group). b Lateral weightbearing x-ray with attached TSF (open approach group). c Lateral weightbearing x-ray shows fused ankle arthrodesis 3 years postoperatively (open approach group)
Fig. 4
Fig. 4
Lateral x-ray shows attached TSF for simultaneous arthrodesis in tibiotalar und subtalar joints
Fig. 5
Fig. 5
Anteroposterior x-ray view with attached TSF for simultaneous arthrodesis in tibiotalar und subtalar joints
Fig. 6
Fig. 6
CT scan 14 weeks postoperatively shows fused TTC arthrodesis
Fig. 7
Fig. 7
Clinical result of the corrected foot 12 months postoperatively in lateral view
Fig. 8
Fig. 8
Clinical result of the corrected foot 12 months postoperatively in plantar view
See this image and copyright information in PMC

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