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Deformity and Clinical Outcomes Following Operative Correction of Charcot Ankle.
Foot Ankle Int. 2019 Feb; 40(2):145-151.FA

Abstract

BACKGROUND:

Deformity associated with Charcot foot arthropathy leads to a poor quality of life in affected individuals. Deformity in the midfoot appears to be predictive of clinical outcomes following operative correction. The goal of this retrospective study was to determine if that same methodology could be applied to patients treated for Charcot foot arthropathy involving the ankle joint.

METHODS:

Fifty-six consecutive patients underwent operative reconstruction of Charcot foot deformity involving the ankle joint by a single surgeon over a 14-year period. Preoperative patient characteristics and tibiotalar alignment, were recorded. Surgical treatment included single-stage debridement of active infection and ankle arthrodesis with application of a circular external fixator when infection was present (39 of 56, 69.6%) or retrograde locked intramedullary nailing in the absence of infection (17 of 56, 30.3%). Clinical outcomes were graded based on limb salvage, resolution of infection and chronic wounds, and the ability to ambulate with therapeutic footwear or accommodative orthoses. The average follow-up was 7.5 (range 1.1-14.0) years.

RESULTS:

One patient died at 134.3 weeks following surgery of unrelated causes and 8 underwent amputation. Twenty-eight of 56 patients (50.0%) achieved a favorable (excellent or good) clinical outcome. There was no significant association between pre- or postoperative alignment and clinical outcomes. Insulin-dependent diabetics were approximately 3 times more likely to have a poor clinical outcome.

CONCLUSIONS:

Operative correction of Charcot deformity involving the ankle joint was associated with a high complication rate and risk for failure. The lessons learned from this highly comorbid patient population with complex deformities can be used as a benchmark for applying modern surgical techniques.

LEVEL OF EVIDENCE:

Level IV, case series.

Authors+Show Affiliations

1 Department of Orthopaedic Surgery & Rehabilitation, Loyola University Medical Center, Maywood, IL, USA.1 Department of Orthopaedic Surgery & Rehabilitation, Loyola University Medical Center, Maywood, IL, USA.2 Loyola University Medical School, Maywood, IL, USA.1 Department of Orthopaedic Surgery & Rehabilitation, Loyola University Medical Center, Maywood, IL, USA.1 Department of Orthopaedic Surgery & Rehabilitation, Loyola University Medical Center, Maywood, IL, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30526048

Citation

Harkin, Elizabeth A., et al. "Deformity and Clinical Outcomes Following Operative Correction of Charcot Ankle." Foot & Ankle International, vol. 40, no. 2, 2019, pp. 145-151.
Harkin EA, Schneider AM, Murphy M, et al. Deformity and Clinical Outcomes Following Operative Correction of Charcot Ankle. Foot Ankle Int. 2019;40(2):145-151.
Harkin, E. A., Schneider, A. M., Murphy, M., Schiff, A. P., & Pinzur, M. S. (2019). Deformity and Clinical Outcomes Following Operative Correction of Charcot Ankle. Foot & Ankle International, 40(2), 145-151. https://doi.org/10.1177/1071100718805076
Harkin EA, et al. Deformity and Clinical Outcomes Following Operative Correction of Charcot Ankle. Foot Ankle Int. 2019;40(2):145-151. PubMed PMID: 30526048.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Deformity and Clinical Outcomes Following Operative Correction of Charcot Ankle. AU - Harkin,Elizabeth A, AU - Schneider,Andrew M, AU - Murphy,Michael, AU - Schiff,Adam P, AU - Pinzur,Michael S, Y1 - 2018/12/10/ PY - 2018/12/12/pubmed PY - 2020/1/10/medline PY - 2018/12/12/entrez KW - Charcot ankle KW - deformity KW - diabetes SP - 145 EP - 151 JF - Foot & ankle international JO - Foot Ankle Int VL - 40 IS - 2 N2 - BACKGROUND:: Deformity associated with Charcot foot arthropathy leads to a poor quality of life in affected individuals. Deformity in the midfoot appears to be predictive of clinical outcomes following operative correction. The goal of this retrospective study was to determine if that same methodology could be applied to patients treated for Charcot foot arthropathy involving the ankle joint. METHODS:: Fifty-six consecutive patients underwent operative reconstruction of Charcot foot deformity involving the ankle joint by a single surgeon over a 14-year period. Preoperative patient characteristics and tibiotalar alignment, were recorded. Surgical treatment included single-stage debridement of active infection and ankle arthrodesis with application of a circular external fixator when infection was present (39 of 56, 69.6%) or retrograde locked intramedullary nailing in the absence of infection (17 of 56, 30.3%). Clinical outcomes were graded based on limb salvage, resolution of infection and chronic wounds, and the ability to ambulate with therapeutic footwear or accommodative orthoses. The average follow-up was 7.5 (range 1.1-14.0) years. RESULTS:: One patient died at 134.3 weeks following surgery of unrelated causes and 8 underwent amputation. Twenty-eight of 56 patients (50.0%) achieved a favorable (excellent or good) clinical outcome. There was no significant association between pre- or postoperative alignment and clinical outcomes. Insulin-dependent diabetics were approximately 3 times more likely to have a poor clinical outcome. CONCLUSIONS:: Operative correction of Charcot deformity involving the ankle joint was associated with a high complication rate and risk for failure. The lessons learned from this highly comorbid patient population with complex deformities can be used as a benchmark for applying modern surgical techniques. LEVEL OF EVIDENCE:: Level IV, case series. SN - 1944-7876 UR - https://www.unboundmedicine.com/medline/citation/30526048/Deformity_and_Clinical_Outcomes_Following_Operative_Correction_of_Charcot_Ankle_ DB - PRIME DP - Unbound Medicine ER -