Examining the Potential Use of a Novel Radiographic Scoring System for Determining Surgical Intervention in Diabetic Charcot Arthropathy.
BACKGROUND
Although Eichenholtz and the Schon systems are commonly used to evaluate foot Charcot arthropathy on radiographs, a novel system with expanded characterization may have added benefit.


METHODS
Patients with Charcot arthropathy and foot radiographs were grouped in nonsurgical group 1 (imaging sets at minimum 2-year interval) and surgical group 2 (imaging preceding fusion and/or amputation). Radiographs were scored with Eichenholtz and Schon systems, and a novel scoring system (summation of 0-3 rank for bone density, distention/swelling, debris, disorganization, and dislocation/subluxation). Summative scores of the 2 groups were compared. Differences in scores of each system from serial images of group 1 were compared and average scores from each of the systems for preoperative imaging sets of group 2 were compared.


RESULTS
A total of 111 patients were included (group 1, 19 patients; group 2, 92 patients). The novel system provided a broad numerical characterization of the radiographs (range 1-15). Summative scores of the novel system for groups 1 and 2 were statistically different with lower median score in the nonsurgical group (nonsurgical median score 6 vs surgical median score 9). Individual characteristic scores from 4 (distention, debris, disorganization, and dislocation) of 5 categories for the novel system were statistically different, with lower scores for the nonoperative group. The narrower numerical scores from the Eichenholtz and Schon systems did not yield statistically significant results.


CONCLUSIONS
The novel scoring system provides a broad numerical description of radiographic findings in Charcot arthropathy of the foot and has potential advantage for surgical predictive value.


METHODS
Level IV: Retrospective.
Carle Foundation Hospital, Internal Medicine, Champaign, Illinois (RB).|Department of Radiology, Loyola University Health Systems, Maywood, Illinois (LML).|Department of Orthopedics, Loyola University Health Systems, Maywood, Illinois (MP, KD).
Rahul
R
Bijlani
Carle Foundation Hospital, Internal Medicine, Champaign, Illinois (RB).|Department of Radiology, Loyola University Health Systems, Maywood, Illinois (LML).|Department of Orthopedics, Loyola University Health Systems, Maywood, Illinois (MP, KD).
Laurie M
LM
Lomasney
Carle Foundation Hospital, Internal Medicine, Champaign, Illinois (RB).|Department of Radiology, Loyola University Health Systems, Maywood, Illinois (LML).|Department of Orthopedics, Loyola University Health Systems, Maywood, Illinois (MP, KD).
Michael
M
Pinzur
Carle Foundation Hospital, Internal Medicine, Champaign, Illinois (RB).|Department of Radiology, Loyola University Health Systems, Maywood, Illinois (LML).|Department of Orthopedics, Loyola University Health Systems, Maywood, Illinois (MP, KD).
Katherine
K
Dux
D000328:Adult; D000368:Aged; D001177:Arthropathy, Neurogenic / Q000175:diagnosis / Q000601:surgery*; D017719:Diabetic Foot / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography / Q000379:methods*; D012189:Retrospective Studies; D012720:Severity of Illness Index
Charcot’s disease; arthritis and joint disease; comorbid conditions; comparative diagnostic studies; diabetes; diagnostic and therapeutic techniques; neurological problems