title: Charcot Neuroarthropathy in Patients With Diabetes: An Updated Systematic Review of Surgical Management.
abstract: Charcot neuroarthropathy (CN) of the foot and ankle is a demanding clinical dilemma, and surgical management can be very complicated. Historically, the evidence guiding surgical management of CN has been small retrospective case series and expert opinions. The purpose of the present report was to provide a systematic review of studies published from 2009 to 2014 and to review the indications for surgery. A Medline search was performed, and a systematic review of studies discussing the surgical management of CN was undertaken. Thirty reports fit the inclusion criteria for our study, including 860 patients who had undergone a surgical procedure for the treatment of CN. The surgical procedures included amputation, arthrodesis, debridement of ulcers, drainage of infections, and exostectomy. The midfoot was addressed in 26.9% of cases, the hindfoot in 41.6%, and the ankle in 38.4%. Of the 30 studies, 24 were retrospective case series (level 4), 4 were controlled retrospective studies (level 3), and 2 were level II studies. The overall amputation rate was 8.9%. The quality of the published data on the surgical management of CN has improved during the past several years. Evidence concerning the timing of treatment and the use of different fixation methods remains inconclusive.
authors.affiliation: Podiatric Medicine and Surgery Residency Program, UPMC Mercy and University of Pittsburgh School of Medicine, Pittsburgh PA.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Schneekloth
authors.affiliation: Podiatric Medicine and Surgery Residency Program, UPMC Mercy and University of Pittsburgh School of Medicine, Pittsburgh PA; Washington Health System Wound and Skin Healing Center and Hyperbaric Medicine, Washington, PA.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Lowery
authors.affiliation: Professor of Orthopaedic Surgery, University of Pittsburgh School of Medicine. Medical Director, UPMC Mercy Center for Healing and Amputation Prevention, Pittsburgh, PA. Electronic address: wukichdk@upmc.edu.
authors.forename: Dane K
authors.initials: DK
authors.lastname: Wukich
mesh_terms: D000368:Aged; D000671:Amputation, Surgical / Q000009:adverse effects / Q000379:methods; D001174:Arthrodesis / Q000009:adverse effects / Q000379:methods; D001177:Arthropathy, Neurogenic / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery*; D015897:Comorbidity; D017719:Diabetic Foot / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D019317:Evidence-Based Medicine; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: CN; Charcot; Charcot neuropathy; Level of Evidence; Medline; surgical management