Tags

Type your tag names separated by a space and hit enter

Complications from ankle arthrodesis in diabetes-related Charcot foot syndrome.
J Diabetes Complications. 2021 12; 35(12):108071.JD

Abstract

INTRODUCTION

Charcot neuroarthropathy (CN) is an inflammatory arthropathy associated with bony destruction, dislocation, and deformity in patients with neuropathy. Surgical procedures involving foot and ankle in CN for deformity correction have been shown to result in high rate of complications. The purpose of this study was to compare post-operative outcomes and assess odds of complication after ankle arthrodesis among patients with diabetes-related Charcot neuroarthropathy, non-Charcot patients with diabetes, and non-Charcot patients without diabetes.

METHODS

The PearlDiver Patient Records Database was queried for patients who underwent ankle fusion and maintained at least one year of post-operative follow-up. The following post-operative complications were assessed among groups: overall nonunion and amputation, one-year nonunion, amputation, and hardware removal, 90-day and 30-day surgical site infection, dehiscence, acute kidney injury, and pneumonia, and 90-day myocardial infarction and deep vein thrombosis. The odds and prevalence of each complication for each group were assessed and compared.

RESULTS

Higher rates of amputation (OR 3.43, CI 2.89-4.06), hardware removal (OR 1.63, CI 1.45-1.83), wound dehiscence (OR 1.75, CI 1.44-2.13), acute kidney injury (OR 2.87, CI 2.32-3.54), pneumonia (OR 1.53, CI 1.13-2.07), and surgical site infection (OR 2.46, CI 2.12-2.85), were observed in patients with diabetes-related CN compared to non-Charcot patients with diabetes. In patients without CN, higher rates of nonunion (OR 1.38, CI 1.19-1.61), amputation (OR 2.26, CI 1.74-2.93), surgical site infection (OR 1.57, CI 1.30-1.90), and acute kidney injury (OR 1.57, CI 1.18-2.09) were observed in patients with diabetes compared to patients without diabetes. Time to hardware removal was significantly shorter in diabetes-related Charcot patients compared to non-Charcot patients without diabetes (368.0 ± 446.7 vs 438.5 ± 487.5 days, P < 0.001).

CONCLUSION

Patients with diabetes demonstrated increased odds of nonunion, amputation, surgical site infection, and acute kidney injury compared to patients without diabetes. In the population of patients with diabetes, odds of most of these complications were further increased with the addition of Charcot diagnosis compared to patients without diabetes. Other local and multisystemic medical conditions, including pneumonia and wound dehiscence, also demonstrated increased odds in patients of CN.

LEVEL OF EVIDENCE

Cohort study; Level of evidence, 3.

Authors+Show Affiliations

University of Texas Southwestern Medical School, Dallas, TX, USA.Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA; Division of Orthopaedic Surgery, Veterans Affairs North Texas Health Care System, Dallas, TX, USA.Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA; Division of Orthopaedic Surgery, Veterans Affairs North Texas Health Care System, Dallas, TX, USA. Electronic address: sambandamortho@gmail.com.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

34674895

Citation

Wang, Benjamin K., et al. "Complications From Ankle Arthrodesis in Diabetes-related Charcot Foot Syndrome." Journal of Diabetes and Its Complications, vol. 35, no. 12, 2021, p. 108071.
Wang BK, Wukich DK, Sambandam S. Complications from ankle arthrodesis in diabetes-related Charcot foot syndrome. J Diabetes Complications. 2021;35(12):108071.
Wang, B. K., Wukich, D. K., & Sambandam, S. (2021). Complications from ankle arthrodesis in diabetes-related Charcot foot syndrome. Journal of Diabetes and Its Complications, 35(12), 108071. https://doi.org/10.1016/j.jdiacomp.2021.108071
Wang BK, Wukich DK, Sambandam S. Complications From Ankle Arthrodesis in Diabetes-related Charcot Foot Syndrome. J Diabetes Complications. 2021;35(12):108071. PubMed PMID: 34674895.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Complications from ankle arthrodesis in diabetes-related Charcot foot syndrome. AU - Wang,Benjamin K, AU - Wukich,Dane K, AU - Sambandam,Senthil, Y1 - 2021/10/06/ PY - 2021/07/15/received PY - 2021/09/13/revised PY - 2021/10/01/accepted PY - 2021/10/23/pubmed PY - 2022/1/11/medline PY - 2021/10/22/entrez KW - Ankle fusion KW - Charcot neuroarthropathy KW - Complications KW - Diabetes SP - 108071 EP - 108071 JF - Journal of diabetes and its complications JO - J Diabetes Complications VL - 35 IS - 12 N2 - INTRODUCTION: Charcot neuroarthropathy (CN) is an inflammatory arthropathy associated with bony destruction, dislocation, and deformity in patients with neuropathy. Surgical procedures involving foot and ankle in CN for deformity correction have been shown to result in high rate of complications. The purpose of this study was to compare post-operative outcomes and assess odds of complication after ankle arthrodesis among patients with diabetes-related Charcot neuroarthropathy, non-Charcot patients with diabetes, and non-Charcot patients without diabetes. METHODS: The PearlDiver Patient Records Database was queried for patients who underwent ankle fusion and maintained at least one year of post-operative follow-up. The following post-operative complications were assessed among groups: overall nonunion and amputation, one-year nonunion, amputation, and hardware removal, 90-day and 30-day surgical site infection, dehiscence, acute kidney injury, and pneumonia, and 90-day myocardial infarction and deep vein thrombosis. The odds and prevalence of each complication for each group were assessed and compared. RESULTS: Higher rates of amputation (OR 3.43, CI 2.89-4.06), hardware removal (OR 1.63, CI 1.45-1.83), wound dehiscence (OR 1.75, CI 1.44-2.13), acute kidney injury (OR 2.87, CI 2.32-3.54), pneumonia (OR 1.53, CI 1.13-2.07), and surgical site infection (OR 2.46, CI 2.12-2.85), were observed in patients with diabetes-related CN compared to non-Charcot patients with diabetes. In patients without CN, higher rates of nonunion (OR 1.38, CI 1.19-1.61), amputation (OR 2.26, CI 1.74-2.93), surgical site infection (OR 1.57, CI 1.30-1.90), and acute kidney injury (OR 1.57, CI 1.18-2.09) were observed in patients with diabetes compared to patients without diabetes. Time to hardware removal was significantly shorter in diabetes-related Charcot patients compared to non-Charcot patients without diabetes (368.0 ± 446.7 vs 438.5 ± 487.5 days, P < 0.001). CONCLUSION: Patients with diabetes demonstrated increased odds of nonunion, amputation, surgical site infection, and acute kidney injury compared to patients without diabetes. In the population of patients with diabetes, odds of most of these complications were further increased with the addition of Charcot diagnosis compared to patients without diabetes. Other local and multisystemic medical conditions, including pneumonia and wound dehiscence, also demonstrated increased odds in patients of CN. LEVEL OF EVIDENCE: Cohort study; Level of evidence, 3. SN - 1873-460X UR - https://www.unboundmedicine.com/medline/citation/34674895/Complications_from_ankle_arthrodesis_in_diabetes_related_Charcot_foot_syndrome_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1056-8727(21)00290-7 DB - PRIME DP - Unbound Medicine ER -