Infected Charcot ankle neuroarthropathy, any hope before amputation? A prospective study

A.E. Galhoum, M.M. Abd-Ella, M. ElGebeily, A.F. Abdel Rahman, H. El Zahlawy, A. Ramadan, V. Valderrbano

¹George Eliot Hospital NHS Trust, Trauma and Orthopaedic Surgery, Nuneaton, United Kingdom

²Nasser Institute for Research and Treatment, Trauma and Orthopaedic Surgery, Cairo, Egypt

³Ain Shams Univesity, Trauma and Orthopaedic Surgery, Cairo, Egypt

⁴Swiss Ortho Center, Schmerzklinik Basel, Swiss Medical Network, Trauma and Orthopaedic Surgery, Basel, Switzerland 

Background: Charcot neuroarthropathy is a destructive disease characterized by progressive bony fragmentation as a result of the isolated or accumulative trauma in patients with decreased sensation that manifests as dislocation, periarticular fractures and instability. Although amputation can be a reasonable cost economic solution, many patients are willing to avoid that if possible. We explored here one of the salvage procedures.

Methods: 23 patients with infected ulcerated unstable Charcot neuroarthropathy of the ankle were treated between 2012 and 2017. The mean age was 63.5 ±7.9 years; 16 males and 7 females. Aggressive open debridement of ulcers and joint surfaces, with talectomy in some cases, were performed followed by external fixation with an Ilizarov frame. The primary outcome was a stable plantigrade infection free foot and ankle that allows weight bearing in accommodative foot wear.

Results: Limb salvage was achieved in 91.3% of cases at the end of a mean follow up time of 25 months (range: 19-32). Fifteen (71.4%) solid bony unions were evident clinically and radiographically, while 6 (28.5%) patients developed stable painless pseudoarthrosis. Two patients had below knee amputations due to uncontrolled infection.

Conclusion: Aggressive debridement and arthrodesis with ring external fixation can be used successfully to salvage severely infected Charcot arthropathy of the ankle. Pin tract infection, delayed wound healing and stress fracture may complicate the procedure but can be easily managed. Amputation may be the last resort in uncontrolled infection.

 

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