SLR - September 2022 -Neenah C. Aguirre-Wong, DPM
Reference: Bajuri MY, Ong SL, Das S, Mohamed IN. Charcot Neuroarthropathy: Current Surgical Management and Update. A Systematic Review. Front Surg. 2022 Mar 8;9:820826. doi: 389/fsurg.2022.820826. PMID: 35345422; PMCID: PMC8957099.Level of Evidence: Level V
Scientific Literature Review
Reviewed by: Neenah C. Aguirre-Wong, DPM
Residency Program: Legacy Health Podiatric Surgical Residency, Portland, OR
Podiatric Relevance: There is no existing standard consensus regarding surgical tx of ankle Charcot neuroarthropathy due to the heterogeneity of the disease entity and clinical presentations. The purpose of this systematic review was to analyze the existing literature and update on the current trends of the surgical management of Charcot neuroarthropathy of the ankle and the hindfoot.
Methods: Used a variety of search engines/terms to find studies between 2010 and 2022 to investigate method of fixation and outcomes of Charcot reconstruction of the ankle and hindfoot. Measured variables included method of reconstruction, infection, union, amputation, hardware complications.
Results: Sixteen (16) studies classified as level 3 or 4 evidence. Types of fixation constructs included internal fixation (15 studies), circular external fixation (six studies), a combination of retrograde IM nail and circular external fixation (Hybrid construct, 2 studies), comparative studies between internal and circular external fixation (three studies), circular external fixation only (one study).
Conclusion: The use of retrograde IM nail as a treatment of choice in the reconstruction of Charcot neuroarthropathy ankle is recommended before an ulcer occurrence. Due to poor bony quality in the Charcot neuropathy ankle, hydroxyapatite-coated screws are recommended for the locking mechanism to prevent migration. Hybrid fixation is recommended for reconstruction in the condition of ulceration and more complex deformity as it provides a higher rate of limb salvage with less soft tissue irritation. Major limitation of this study is lack of level 1 or 2 evidence included. Due to the uniqueness of Charcot neuroarthropathy in each case, the surgical approach is heterogenous and there is a relatively small population of patients treated in this condition. This makes it challenging to design a higher level of study, however practice guidelines and patient outcomes would benefit from further research on this topic.