Bone Defect Replacement in Diabetic Neuropathic Osteoarthropathy (Charcot Foot): Review

Abstract

Background. The number of patients with diabetes mellitus, including those with its severe complications such as Charcot neuropathic osteoarthropathy, is increasing worldwide. Restoration of weight bearing ability and creation of conditions for ulcer healing is challenging for trauma and orthopedic surgeons, especially because of the need to restore bone tissue defects.
 Aim of the review to compare modern methods of replacement of large bone tissue defects of the distal segment of the lower limb in patients with Charcot neuropathic osteoarthropathy.
 Methods. The articles were searched in PubMed/MEDLINE, Google Scholar, Scopus, eLIBRARY, CyberLeninka databases. The search was performed using the following keywords and word combinations: Charcot foot, diabetic neuropathic osteoarthropathy and bone grafting. Full-text articles in Russian and English were selected. The search was carried out without chronological limitations due to the small number of published studies and specific subject of research.
 Results. The possibilities of bone defect replacement in Charcot foot are poorly described in the world literature. The narrow specificity and relative infrequency of this pathology is the probable reason for the small number of publications and the lack of studies with a high level of evidence.
 Conclusion. Bone autografting for lesions of the medial or lateral midfoot column and Ilizarov tibial lengthening to compensate for limb shortening after reconstructive surgeries at the level of the hindfoot and ankle joint are the most commonly used methods of bone defect replacement in patients with Charcot foot. Free bone autografting (possibly with demineralized bone matrix) is the method of choice for small defects of the lateral or medial column of the midfoot.