Preliminary Results of an Institutional Charcot Database: Risk Factors of Conversion to Operative Treatment in Charcot Arthropathy Patients

Abstract

Category:Diabetes; Midfoot/Forefoot; OtherIntroduction/Purpose:Operative correction of Charcot is generally accepted for nonplantigrade deformity that cannot be accommodated with commercially available therapeutic footwear, painful 'nonunion' type pain, in addition to the accepted indications of osteomyelitis, persistent wounds, and non-braceability. Classification schemes associated with Charcot foot are primarily descriptive in nature. Scant literature has attempted to correlate characteristics of the deformity with a specific operative strategy to enable correction of the acquired deformity. Hence, the purpose of this study is to create a database that will shed light on much needed guidelines in the management of Charcot arthropathy. Among those guidelines, identifying risk factors for conversion to operative treatment of non-operative Charcot feet is essential.Methods:A query of our institution administrative database was performed based on the Charcot ICD-10 codes for reconstruction procedures between 2015 - 2018. Clinic and hospital medical records were reviewed to determine if Charcot neuropathy was diagnosed and identify treatment plan. Minimal follow up was established at 2 years. Patient must have completed all surveys in the outcomes portion during their follow up period. If bilateral patients are identified, all records will be retained, and patients will be addressed as separate sides. The primary outcome was conversion to surgery. Independent risk factors analyzed were demographics, history of diabetes, peripheral vascular disease, use of anticoagulants, tobacco use, shoe wear, bracing, plantigrade foot, neuropathy, presence of ulcer, infection, and Brodsky classification. The data was both stored and analyzed in the REDCap electronic data capture tools hosted at our institution.Results:A total of one hundred and eighty (180) records were initially queried for. Thirty-four (34) patients met the inclusion criteria. Of the 34 patients, fourteen (41%) patients had conversion to surgery. Average age of patients who converted to surgery was 53.1 compared to patients who remained in the non-operative treatment arm (age = 66.1) (p=0.05) (Table 1). Diabetes, peripheral vascular disease, anticoagulant, and tobacco use were not found to be significant risk factors. 11 (78.6%) patients who underwent surgery had diabetes compared to 8 (40%) patients in the nonoperative arm (p=0.160). 12 (85.7%) patients in the conversion arm were diagnosed with peripheral vascular disease (p=0.184). Type of shoe wear, bracing, plantigrade foot, neuropathy, presence of ulcer, and Brodsky classification were not found to be significant risk factor.Conclusion:Identification of risk factors that lead to conversion to surgical treatment of Charcot is important. There are no well-established guidelines with regards to management or indications for surgery. This database aims to provide valuable insight into guidelines and recommendations for Charcot treatment. Preliminary results did not find independent risk factors for conversion to surgical treatment other than age. Presumably, younger patients with higher functional demands, or patients with high disease burden at younger ages are at higher risk of requiring surgical intervention. As our database expands, we will better identify risk factors and include treatment outcomes Charcot patients.