Locally obtained autologous bone grafts are effective for achieving arthrodesis while managing foot and ankle charcot's neuroarthropathy: short to mid-term results from a specialized north African foot and ankle surgery unit.
Humans
Arthrodesis
/ methods
Middle Aged
Arthropathy, Neurogenic
/ surgery
Female
Male
Bone Transplantation
/ methods
Aged
Adult
Transplantation, Autologous
/ methods
Treatment Outcome
Follow-Up Studies
Ankle Joint
/ surgery
Time Factors
Foot Joints
/ surgery
Retrospective Studies
North African People
Arthrodesis
Autograft
Charcot’s neuroarthropathy
Limb-salvage
Journal
Journal of orthopaedic surgery and research
ISSN: 1749-799X
Titre abrégé: J Orthop Surg Res
Pays: England
ID NLM: 101265112
Informations de publication
Date de publication:
16 Sep 2024
16 Sep 2024
Historique:
received:
03
08
2024
accepted:
27
08
2024
medline:
17
9
2024
pubmed:
17
9
2024
entrez:
16
9
2024
Statut:
epublish
Résumé
We aimed to report the union rate after only utilizing a locally obtained autologous bone graft while correcting the deformity and performing joint arthrodesis in patients with foot and ankle Charcot neuropathy (CN) and to report on the radiographic, functional, complications incidence outcomes at a minimum of two years of follow up. We included 24 patients having a mean age of 55.4 ± 10.1 years diagnosed with CN of the foot, ankle, or both. Seven (29.2%) cases were classified as Brodsky type 1, 11 (45.8%) as type 3 A, and six (25%) were type 4. Hindfoot and Midfoot bi-columnar arthrodesis was performed in 70.8% and 29.2% of the patients, respectively. Eight (33.3%) cases had preoperative ulcers. Functional outcomes were evaluated using a modified AOFAS score. Arthrodesis site union was assessed clinically and radiographically. All patients were available for a mean follow up of 35.7 ± 9.5 (24-54) months. Arthrodesis site union was achieved in 23 (95.8%) cases after a mean of 4 ± 1.7 (2-7.5) months. The mean modified AOFAS score was 72.4 ± 10.41 (46-83) points; 79.2% achieved excellent and good scores. Ulcers healed in 87.5% of the patients. Twenty-two (91.7%) patients were satisfied with their functional results. Infection incidence was 12.5%, and no patients required revision or amputation. Foot and ankle Charcot neuroarthropathy deformity correction by arthrodesis of the affected joint as a salvage management option resulted in acceptable clinical and radiological outcomes. To enhance the local environment for arthrodesis consolidation, locally obtained autografts led to higher union rates and avoided the drawbacks of using other graft types.
Identifiants
pubmed: 39285265
doi: 10.1186/s13018-024-05036-9
pii: 10.1186/s13018-024-05036-9
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
570Informations de copyright
© 2024. The Author(s).
Références
Rogers LC, Frykberg RG, Armstrong DG, Boulton AJ, Edmonds M, Van GH, Hartemann A, Game F, Jeffcoate W, Jirkovska A, Jude E, Morbach S, Morrison WB, Pinzur M, Pitocco D, Sanders L, Wukich DK, Uccioli L. The Charcot foot in diabetes. Diabetes Care. 2011;34(9):2123–9. https://doi.org/10.2337/dc11-0844 .
doi: 10.2337/dc11-0844
pubmed: 21868781
pmcid: 3161273
Schmidt BM, Holmes CM. Updates on Diabetic Foot and Charcot Osteopathic Arthropathy. Curr Diab Rep. 2018;18(10):74. https://doi.org/10.1007/s11892-018-1047-8 .
doi: 10.1007/s11892-018-1047-8
pubmed: 30112582
Ramanujam CL, Zgonis T. The Diabetic Charcot Foot from 1936 to 2016: eighty years later and still growing. Clin Podiatr Med Surg. 2017;34(1):1–8. https://doi.org/10.1016/j.cpm.2016.07.001 .
doi: 10.1016/j.cpm.2016.07.001
pubmed: 27865310
El-Mowafi H, Elghazy MA, Kandil YR, Ali S, El-Hawary A, Abulsaad MS. Charcot Arthropathy of Foot and Ankle: Radiographic and clinical patterns with related outcomes. Int Orthop. 2021;45(9):2201–8. https://doi.org/10.1007/s00264-021-05082-6 .
doi: 10.1007/s00264-021-05082-6
pubmed: 34050383
Brodsky J. Patterns of breakdown in the Charcot Tarsus of diabetes and relation to treatment. Orthop Trans. 1987;2:484.
Strotman PK, Reif TJ, Pinzur MS. Charcot Arthropathy of the Foot and Ankle. Foot Ankle Int. 2016;37(11):1255–63. https://doi.org/10.1177/1071100716674434 .
doi: 10.1177/1071100716674434
pubmed: 27765871
Rana B, Patel S. Results of ankle and Hind foot arthrodesis in Diabetic Charcot Neuroarthropathy - A retrospective analysis of 44 patients. J Clin Orthop Trauma. 2021;23:101637. https://doi.org/10.1016/j.jcot.2021.101637 .
doi: 10.1016/j.jcot.2021.101637
pubmed: 34824972
pmcid: 8600528
Bajuri MY, Ong SL, Das S, Mohamed IN. Charcot Neuroarthropathy: current Surgical Management and Update. A systematic review. Front Surg. 2022;9:820826. https://doi.org/10.3389/fsurg.2022.820826 .
doi: 10.3389/fsurg.2022.820826
pubmed: 35345422
pmcid: 8957099
Cianni L, Bocchi MB, Vitiello R, Greco T, De Marco D, Masci G, Maccauro G, Pitocco D, Perisano C. Arthrodesis in the Charcot foot: a systematic review. Orthop Rev (Pavia). 2020;12(Suppl 1):8670. https://doi.org/10.4081/or.2020.8670 .
doi: 10.4081/or.2020.8670
pubmed: 32913602
Wukich DK, Raspovic KM, Hobizal KB, Sadoskas D. Surgical management of Charcot neuroarthropathy of the ankle and hindfoot in patients with diabetes. Diabetes Metab Res Rev. 2016;32(Suppl 1):292–6. https://doi.org/10.1002/dmrr.2748 .
doi: 10.1002/dmrr.2748
pubmed: 26452590
Kucera T, Grinac M, Valtr O, Sponer P. [Mid-Term outcomes of Reconstruction of Charcot Foot Neuroarthropathy in Diabetic patients]. Acta Chir Orthop Traumatol Cech. 2019;86(1):51–7.
doi: 10.55095/achot2019/008
pubmed: 30843514
Siebachmeyer M, Boddu K, Bilal A, Hester TW, Hardwick T, Fox TP, Edmonds M, Kavarthapu V. Outcome of one-stage correction of deformities of the ankle and hindfoot and fusion in Charcot neuroarthropathy using a retrograde intramedullary hindfoot arthrodesis nail. Bone Joint J. 2015;197–B. https://doi.org/10.1302/0301-620X.97B1.34542 .
Ramanujam CL, Facaros Z, Zgonis T. An overview of bone grafting techniques for the diabetic Charcot foot and ankle. Clin Podiatr Med Surg. 2012;29(4):589–95. https://doi.org/10.1016/j.cpm.2012.07.005 .
doi: 10.1016/j.cpm.2012.07.005
pubmed: 23044065
Miller CP, Chiodo CP. Autologous bone graft in foot and ankle surgery. Foot Ankle Clin. 2016;21(4):825–37. https://doi.org/10.1016/j.fcl.2016.07.007 .
doi: 10.1016/j.fcl.2016.07.007
pubmed: 27871415
Peterson JR, Chen F, Nwankwo E, Dekker TJ, Adams SB. The use of bone grafts, bone graft substitutes, and Orthobiologics for Osseous Healing in Foot and Ankle surgery. Foot Ankle Orthop. 2019;4(3):2473011419849019. https://doi.org/10.1177/2473011419849019 .
doi: 10.1177/2473011419849019
pubmed: 35097327
pmcid: 8500392
Muller MA, Frank A, Briel M, Valderrabano V, Vavken P, Entezari V, Mehrkens A. Substitutes of structural and non-structural autologous bone grafts in hindfoot arthrodeses and osteotomies: a systematic review. BMC Musculoskelet Disord. 2013;14:59. https://doi.org/10.1186/1471-2474-14-59 .
doi: 10.1186/1471-2474-14-59
pubmed: 23390993
pmcid: 3608147
Agha RA, Sohrabi C, Mathew G, Franchi T, Kerwan A, O’Neill N, Group P. The PROCESS 2020 Guideline: updating Consensus Preferred Reporting of CasESeries in surgery (PROCESS) guidelines. Int J Surg. 2020;84:231–5. https://doi.org/10.1016/j.ijsu.2020.11.005 .
doi: 10.1016/j.ijsu.2020.11.005
pubmed: 33189880
Brodsky JW. (2007) The diabetic foot. Surg Foot Ankle:1281–368.
Lamm BM, Stasko PA, Gesheff MG, Bhave A. Normal foot and ankle radiographic angles, measurements, and reference points. J Foot Ankle Surg. 2016;55(5):991–8. https://doi.org/10.1053/j.jfas.2016.05.005 .
doi: 10.1053/j.jfas.2016.05.005
pubmed: 27320694
Corrales LA, Morshed S, Bhandari M, Miclau T 3rd. Variability in the assessment of fracture-healing in orthopaedic trauma studies. J Bone Joint Surg Am. 2008;90(9):1862–8. https://doi.org/10.2106/JBJS.G.01580 .
doi: 10.2106/JBJS.G.01580
pubmed: 18762645
pmcid: 2663323
Willems A, Houkes CM, Bierma-Zeinstra SMA, Meuffels DE. How to assess consolidation after foot and ankle arthrodesis with computed tomography. A systematic review. Eur J Radiol. 2022;156:110511. https://doi.org/10.1016/j.ejrad.2022.110511 .
doi: 10.1016/j.ejrad.2022.110511
pubmed: 36108477
Coughlin MJ, Grimes JS, Traughber PD, Jones CP. Comparison of radiographs and CT scans in the prospective evaluation of the fusion of hindfoot arthrodesis. Foot Ankle Int. 2006;27(10):780–7. https://doi.org/10.1177/107110070602701004 .
doi: 10.1177/107110070602701004
pubmed: 17054877
ElAlfy B, Ali AM, Fawzy SI. Ilizarov External Fixator Versus Retrograde Intramedullary Nailing for Ankle Joint Arthrodesis in Diabetic Charcot Neuroarthropathy. J Foot Ankle Surg. 2017;56(2):309–13. https://doi.org/10.1053/j.jfas.2016.10.014 .
doi: 10.1053/j.jfas.2016.10.014
pubmed: 28231964
Fadle AA, El-Adly W, Fekry MA, Osman AE, Khalifa AA. Primary arthrodesis for diabetic ankle fractures using a modified retrograde femoral intramedullary locking nail combined with lateral plating, surgical technique, and early results of a pilot study. Eur J Orthop Surg Traumatol. 2024;34(5):2549–56. https://doi.org/10.1007/s00590-024-03947-1 .
doi: 10.1007/s00590-024-03947-1
pubmed: 38693347
pmcid: 11291572
Thompson N, Gordey L, Bowles H, Parslow N, Houghton P. Reliability and validity of the revised photographic wound assessment tool on digital images taken of various types of chronic wounds. Adv Skin Wound Care. 2013;26(8):360–73. https://doi.org/10.1097/01.ASW.0000431329.50869.6f .
doi: 10.1097/01.ASW.0000431329.50869.6f
pubmed: 23860221
Yasui Y, Hannon CP, Seow D, Kennedy JG. Ankle arthrodesis: a systematic approach and review of the literature. World J Orthop. 2016;7(11):700–8. https://doi.org/10.5312/wjo.v7.i11.700 .
doi: 10.5312/wjo.v7.i11.700
pubmed: 27900266
pmcid: 5112338
Papa J, Myerson M, Girard P. Salvage, with arthrodesis, in intractable diabetic neuropathic arthropathy of the foot and ankle. J Bone Joint Surg Am. 1993;75(7):1056–66. https://doi.org/10.2106/00004623-199307000-00012 .
doi: 10.2106/00004623-199307000-00012
pubmed: 8335665
Schwarz RJ, Macdonald MR, van der Pas M. Results of arthrodesis in neuropathic feet. J Bone Joint Surg Br. 2006;88(6):747–50. https://doi.org/10.1302/0301-620X.88B6.17276 .
doi: 10.1302/0301-620X.88B6.17276
pubmed: 16720767
Ersin M, Demirel M, Chodza M, Bilgili F, Kilicoglu OI. Mid-term results of hindfoot arthrodesis with a retrograde intra-medullary nail in 24 patients with diabetic Charcot neuroarthropathy. Acta Orthop. 2020;91(3):336–40. https://doi.org/10.1080/17453674.2020.1746605 .
doi: 10.1080/17453674.2020.1746605
pubmed: 32233910
pmcid: 8023973
Rabinovich RV, Haleem AM, Rozbruch SR. Complex ankle arthrodesis: review of the literature. World J Orthop. 2015;6(8):602–13. https://doi.org/10.5312/wjo.v6.i8.602 .
doi: 10.5312/wjo.v6.i8.602
pubmed: 26396936
pmcid: 4573504
La Fontaine J, Shibuya N, Sampson HW, Valderrama P. Trabecular quality and cellular characteristics of normal, diabetic, and charcot bone. J Foot Ankle Surg. 2011;50(6):648–53. https://doi.org/10.1053/j.jfas.2011.05.005 .
doi: 10.1053/j.jfas.2011.05.005
pubmed: 21705241
Grambart ST, Anderson DS, Anderson TD. Bone Grafting options. Clin Podiatr Med Surg. 2020;37(3):593–600. https://doi.org/10.1016/j.cpm.2020.03.012 .
doi: 10.1016/j.cpm.2020.03.012
pubmed: 32471621
Bolia IK, Covell DJ, Tan EW. Comparative studies of bone graft and Orthobiologics for Foot Ankle Arthrodesis: a critical review. J Am Acad Orthop Surg Glob Res Rev. 2024;8(5). https://doi.org/10.5435/JAAOSGlobal-D-23-00216 .
Nodzo SR, Kaplan NB, Hohman DW, Ritter CA. A radiographic and clinical comparison of reamer-irrigator-aspirator versus iliac crest bone graft in ankle arthrodesis. Int Orthop. 2014;38(6):1199–203. https://doi.org/10.1007/s00264-014-2348-4 .
doi: 10.1007/s00264-014-2348-4
pubmed: 24770726
pmcid: 4037515
Sagi HC, Young ML, Gerstenfeld L, Einhorn TA, Tornetta P. Qualitative and quantitative differences between bone graft obtained from the medullary canal (with a Reamer/Irrigator/Aspirator) and the iliac crest of the same patient. J Bone Joint Surg Am. 2012;94(23):2128–35. https://doi.org/10.2106/JBJS.L.00159 .
doi: 10.2106/JBJS.L.00159
pubmed: 23224383
El-Hawary A, Kandil YR, Ahmed M, Elgeidi A, El-Mowafi H. Distraction subtalar arthrodesis for calcaneal malunion: comparison of local versus iliac bone graft. Bone Joint J 101-B. 2019;5596–602. https://doi.org/10.1302/0301-620X.101B5.BJJ-2018-1306.R1 .
Wee J, Thevendran G. The role of orthobiologics in foot and ankle surgery: allogenic bone grafts and bone graft substitutes. EFORT Open Rev. 2017;2(6):272–80. https://doi.org/10.1302/2058-5241.2.160044 .
doi: 10.1302/2058-5241.2.160044
pubmed: 28736619
pmcid: 5508857
Yeoh JC, Taylor BA. Osseous Healing in Foot and Ankle surgery with autograft, allograft, and other Orthobiologics. Orthop Clin North Am. 2017;48(3):359–69. https://doi.org/10.1016/j.ocl.2017.03.009 .
doi: 10.1016/j.ocl.2017.03.009
pubmed: 28577785