title: Outcome of one-stage correction of deformities of the ankle and hindfoot and fusion in Charcot neuroarthropathy using a retrograde intramedullary hindfoot arthrodesis nail.
abstract: We report the outcomes of 20 patients (12 men, 8 women, 21 feet) with Charcot neuro-arthropathy who underwent correction of deformities of the ankle and hindfoot using retrograde intramedullary nail arthrodesis. The mean age of the patients was 62.6 years (46 to 83); their mean BMI was 32.7 (15 to 47) and their median American Society of Anaesthetists score was 3 (2 to 4). All presented with severe deformities and 15 had chronic ulceration. All were treated with reconstructive surgery and seven underwent simultaneous midfoot fusion using a bolt, locking plate or a combination of both. At a mean follow-up of 26 months (8 to 54), limb salvage was achieved in all patients and 12 patients (80%) with ulceration achieved healing and all but one patient regained independent mobilisation. There was failure of fixation with a broken nail requiring revision surgery in one patient. Migration of distal locking screws occurred only when standard screws had been used but not with hydroxyapatite-coated screws. The mean American Academy of Orthopaedic Surgeons Foot and Ankle (AAOS-FAO) score improved from 50.7 (17 to 88) to 65.2 (22 to 88), (p = 0.015). The mean Short Form (SF)-36 Health Survey Physical Component Score improved from 25.2 (16.4 to 42.8) to 29.8 (17.7 to 44.2), (p = 0.003) and the mean Euroqol EQ‑5D‑5L score improved from 0.63 (0.51 to 0.78) to 0.67 (0.57 to 0.84), (p = 0.012). Single-stage correction of deformity using an intramedullary hindfoot arthrodesis nail is a good form of treatment for patients with severe Charcot hindfoot deformity, ulceration and instability provided a multidisciplinary care plan is delivered.
authors.affiliation: King's College Hospital NHS Foundation Trust, London SE5 9RT, UK.
authors.forename: M
authors.initials: M
authors.lastname: Siebachmeyer
authors.affiliation: King's College Hospital NHS Foundation Trust, London SE5 9RT, UK.
authors.forename: K
authors.initials: K
authors.lastname: Boddu
authors.affiliation: King's College Hospital NHS Foundation Trust, London SE5 9RT, UK.
authors.forename: A
authors.initials: A
authors.lastname: Bilal
authors.affiliation: King's College Hospital NHS Foundation Trust, London SE5 9RT, UK.
authors.forename: T W
authors.initials: TW
authors.lastname: Hester
authors.affiliation: King's College Hospital NHS Foundation Trust, London SE5 9RT, UK.
authors.forename: T
authors.initials: T
authors.lastname: Hardwick
authors.affiliation: King's College Hospital NHS Foundation Trust, London SE5 9RT, UK.
authors.forename: T P
authors.initials: TP
authors.lastname: Fox
authors.affiliation: King's College Hospital NHS Foundation Trust, London SE5 9RT, UK.
authors.forename: M
authors.initials: M
authors.lastname: Edmonds
authors.affiliation: King's College Hospital NHS Foundation Trust, London SE5 9RT, UK.
authors.forename: V
authors.initials: V
authors.lastname: Kavarthapu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000843:Ankle Joint / Q000002:abnormalities / Q000601:surgery*; D001174:Arthrodesis / Q000295:instrumentation* / Q000379:methods; D001177:Arthropathy, Neurogenic / Q000000981:diagnostic imaging / Q000601:surgery*; D001858:Bone Nails; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005528:Foot / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000503:physiopathology / Q000628:therapy; D011446:Prospective Studies; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology*; D020127:Recovery of Function; D018570:Risk Assessment; D016896:Treatment Outcome
keywords: Charcot foot; Diabetes mellitus; Hydroxyapatite coating; Neuroarthropathy; Neuropathic; Peripheral neuropathy; Tibiocalcaneal arthrodesis