Use of platelet-rich concentrate and bone marrow aspirate in high-risk patients with Charcot arthropathy of the foot.
BACKGROUND
Diabetic patients with Charcot arthropathy of the foot are at high risk for nonunion when undergoing arthrodesis. There is increasing evidence that cytokines identified in platelet rich concentrate and bone marrow aspirate may show equivalence to autologous bone graft in supporting arthrodesis.


METHODS
Prospectively, 44 high-risk diabetic patients with Charcot foot arthropathy underwent surgical correction of 46 feet through a limited surgical approach. The average age of the patients was 54.9 +/- 10.4 years. Their mean BMI was 38.0 +/- 9.7. Twenty-four were male and 20 were female. Twenty-eight had open wounds with chronic draining osteomyelitis. Surgical correction was maintained postoperatively with static circular ring fixation. At the time of wound closure, all of the patients had injection of autologous platelet rich concentrate and bone marrow aspirate.


RESULTS
Forty-two of the 46 feet had radiographic evidence of bony union at 26.2 +/- 12.2 months following surgery. One patient died of unrelated causes. Two underwent amputation for persistent infection. Six had recurrent ulcers which resolved with local treatment. One patient required a fifth ray resection for gangrene following surgery. There were three tibial stress fractures, with two requiring intramedullary nailing to achieve union.


CONCLUSIONS
Platelet-rich concentrate, when combined with a small amount of autologous bone marrow aspirate, may well be as effective as autologous bone grafting when performing arthrodesis of high risk diabetic patients with Charcot foot arthropathy.
Pinzur
Michael S
MS
Loyola University Medical Center, Orthopaedic Surgery, 2160 South First Avenue, Maywood, IL 60153, USA. mpinzu1@lumc.edu
D001177:Arthropathy, Neurogenic / Q000601:surgery / Q000628:therapy*; D001792:Blood Platelets; D001853:Bone Marrow; D003131:Combined Modality Therapy; D016207:Cytokines / Q000627:therapeutic use; D048909:Diabetes Complications / Q000601:surgery / Q000628:therapy*; D005260:Female; D005534:Foot Diseases / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
D016207:Cytokines