Charcot foot reconstruction - how does hardware failure and non-union affect the clinical outcomes?

I. Kummen, N. Phyo, I. Reichert, R. Ahluwalia, V. Kavarthapu

Aim: Surgical reconstruction of severe Charcot foot deformities using internal fixation is a commonly used option. However, there has been a concern that this carries a higher risk of major hardware failure. The aim of our study was to look at the demographics of hardware failure and non-union in Charcot midfoot and hindfoot reconstructions, the radiological and clinical outcomes in those with and without hardware failure.

Results: 19/78 (24.4%) patients had major hardware failure. 14/25 (56.0%) of patients who underwent combination hindfoot and midfoot surgery had hardware failure, in comparison to 5/53 (9.4%) in cases with surgery in either hindfoot or midfoot (p < .001). 7/19 (36,8%) patients developed full fusion radiologically, compared to 49/59 (83.1%) of the non-hardware failure patients (p < .001). In the hardware failure group 9/19 (47.4%) were able to weight bear in shoes, in comparison to 43/59 (72.9%) in the non-hardware failure patients (p=.040). 10/19 (52.6%) patients from the hardware failure group needed a cast or orthosis to ambulate compared to 11/59 (18.6%) in the non-hardware failure group (p= .004). 8/19 (42.2%) in hardware failure cases required revision surgery, compared to 19/59 (32.2%) in the non-hardware failure cases (p= .089) The patients with BMI over 30 were 3.5 times more likely to have hardware failure (95% CI [1.08, 12.22], p = .038). Limb salvage was achieved in all patients.

Conclusion: The hardware breakage is common following Charcot hindfoot and midfoot deformity corrections, highest among combined reconstructions. However, the clinical and radiological outcomes are still satisfactory following such complex procedures. Dedicated durable hardware designed for Charcot foot reconstructions will potentially reduce this complication and improve the patient outcomes further.