title: Extension and grading of osteomyelitis are not related to limb salvage in Charcot neuropathic osteoarthropathy: A cohort prospective study.
abstract: OBJECTIVE
  Charcot neuropathic osteoarthropathy (CN) represents a complication for diabetic patients which involves a progressive alteration of the osteoarticular apparatus with high risk of amputation. The aim of the study was to assess whether the localization of CN and the extent or grading of the osteomyelitis have an influence on the rate of limb salvage and the time to recovery.
  
  
  METHODS
  We treated a diabetic population affected by CN complicated by ulceration and widespread osteomyelitic involvement. All patients were treated surgically to eliminate infected tissues, stabilize and correct the bone deformities. Histopathological and microbiological analyses were carried out on the bone specimens.
  
  
  RESULTS
  Thirty-three patients affected by CN complicated by large osteomyelitic involvement of midfoot and/or ankle were treated between January 2010 and May 2014. The mean follow-up was 409,35 ± 154,06 days. Thirty patients had complete recovery (90.91%) at the end of follow-up. No difference in limb salvage rate and time to recovery was observed when stratifying the population according to CN localization, extent and grading of osteomyelitis.
  
  
  CONCLUSIONS
  In this cohort prospective study we observed a high percentage of limb salvage in patients affected by CN complicated by diffuse midfoot/hindfoot osteomyelitis. The localization of Charcot deformity and the extent/stage of osteomyelitis did not change the rate of limb salvage.
authors.affiliation: Diabetic Foot Department, Maria Cecilia Hospital, GVM Care & Research, Via Corriera 1, Cotignola, RA, Italy. Electronic address: ldallapaola@libero.it.
authors.forename: Luca
authors.initials: L
authors.lastname: Dalla Paola
authors.affiliation: Diabetic Foot Department, Maria Cecilia Hospital, GVM Care & Research, Via Corriera 1, Cotignola, RA, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Carone
authors.affiliation: Diabetic Foot Department, Maria Cecilia Hospital, GVM Care & Research, Via Corriera 1, Cotignola, RA, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Baglioni
authors.affiliation: Diabetic Foot Department, Maria Cecilia Hospital, GVM Care & Research, Via Corriera 1, Cotignola, RA, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Boscarino
authors.affiliation: Diabetic Foot Department, Maria Cecilia Hospital, GVM Care & Research, Via Corriera 1, Cotignola, RA, Italy.
authors.forename: Lucian
authors.initials: L
authors.lastname: Vasilache
mesh_terms: D000368:Aged; D001424:Bacterial Infections / Q000150:complications / Q000382:microbiology / Q000503:physiopathology; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D017719:Diabetic Foot / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D033023:Foot Joints / Q000382:microbiology* / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D007558:Italy; D023821:Limb Salvage / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D010019:Osteomyelitis / Q000150:complications / Q000382:microbiology / Q000503:physiopathology*; D011379:Prognosis; D011446:Prospective Studies; D020127:Recovery of Function; D012720:Severity of Illness Index; D013997:Time Factors
keywords: Charcot foot; Diabetic foot surgery; Foot infection; Foot ulcer; Osteomyelitis