Abstract
BackgroundCharcot neuroarthropathy of the ankle and the hindfoot is a complex clinical entity with a high risk of amputation. Charcot neuroarthropathy limb reconstruction has been proposed as a limb-salvaging procedure. However, there was a lack of information on the various available reconstruction methods, including the outcomes and complications. The present study aimed to evaluate the current literature and update on the trends regarding the surgical management of Charcot neuroarthropathy of the ankle and the hindfoot.MethodsAll data published from January 2010 to January 2020 that investigated the methods of fixation and their respective outcomes for the surgical reconstruction in Charcot neuroarthropathy were analyzed. The union rate, amputation rates, and complications associated with these techniques were taken for statistical analysis.ResultsA total of 16 studies fit the inclusion criteria of this study, with four Level-III studies and 12 Level-IV studies were included. Ten studies utilized internal fixation only; five used a combination of internal fixation and circular external fixator, whereby there are three comparative studies between internal and external fixations, and two studies applied combined technique of internal and external fixations (hybrid fixation). One study describes the usage of circular external fixation only.ConclusionsThe use of retrograde intramedullary nail as a treatment of choice in the reconstruction of Charcot neuroarthropathy ankle is recommended before an ulcer occurrence. Hydroxyapatite (HA)- coated screws are recommended for the locking mechanism to prevent migration in Charcot neuroarthropathy due to poor bony quality. Hybrid fixation is recommended for reconstruction in a condition of ulceration and more complex deformity as it provides a higher rate of limb salvage with less soft tissue irritation.
Highlights
IntroductionAnkle joint complex is a modified synovial hinge joint, which consists of talocalcaneal, tibiotalar, and trans-tarsal joint
Charcot neuroarthropathy at the hindfoot and ankle level is more challenging compared to those involving midfoot as the deformities are often multiplanar (3)
The remaining 53 full texts were assessed for eligibility, five non-English published journals were excluded, and 32 were further eliminated because they had included patients who had undergone Charcot neuroarthropathy surgery in a location other than hindfoot and ankle and did not have separate results for the Charcot patients receiving surgery
Summary
Ankle joint complex is a modified synovial hinge joint, which consists of talocalcaneal, tibiotalar, and trans-tarsal joint. Charcot neuroarthropathy at the hindfoot and ankle level is more challenging compared to those involving midfoot as the deformities are often multiplanar (3). Changes of gait in Charcot neuroarthropathy limbs are caused by alteration of the biomechanics and proprioception of the involved ankle (1). Malalignment in the Charcot limb is prone to ulceration due to altered plantar pressure, limited soft tissue coverage, and pressure over bony prominence. It is always associated with limb shortening due to bone collapse that is caused by avascular necrosis or a neuropathic fracture (3). The present study aimed to evaluate the current literature and update on the trends regarding the surgical management of Charcot neuroarthropathy of the ankle and the hindfoot
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