Hello, my name is Daniel Choi, and I'll be presenting Charcot Ankle Deformity, Can the Limb Be Salvaged? This is a project from Harbor UCLA in Torrance, California. I'd like to thank my co-authors, Jalal Saggada Kordi, James Black, Dr. David Lee, Dr. Thomas Harris, and Dr. Arash Manium for their work on this project. Diabetes mellitus may result in Charcot arthropathy in 0.1 to 2.5 of diabetic patients with an incidence of 0.3 per 1,000 per year. Symptoms may arise including joint dislocation, deformities, ulcerations, and limb amputation. Leading cause of Charcot arthropathy is diabetes with approximately 0.08 to 7.5 of diabetic cases being recognized as having Charcot arthropathy. Surgical intervention has been shown to improve patient's walking ability and health-related quality of life compared to use of orthotics alone, in addition to reducing the risk of ulcer, bone infection, use of arthrosis, and amputation. In the current investigation, a retrospective review of patients with ankle Charcot arthropathy treated with high foot nail fixation was performed. The aim of the study was to determine radiographic healing, complication rates of surgical intervention, and the patient's ability to ambulate with therapeutic inserts or boots. The results obtained from this study serve to provide evidence for intervention via operative fixation and limb salvage in this cohort of patients. Methods. A retrospective review of patients with Charcot ankle treated with high foot nail was performed between 2016 and 2022. Demographic data, BMI, cause of Charcot arthropathy, the preoperative radiographic deformity, and prior wounds and infection was reported. We identified 18 consecutive patients that underwent surgical intervention. The surgical technique included bimaliolar exposure, correction of the deformity, and high foot nail fusion with or without structural femoral head graft. Follow-up data included post-operative complications, radiographic evaluation of union, and clinical data on type of shoe wear or boots used with ambulation. Results. We identified 18 consecutive patients undergoing high foot deformity correction with high foot nail. The average follow-up for the patients was 21 months. The cause of neuropathy was diabetes in 16 patients and idiopathic in two patients. The average BMI for the cohort was 29.3. Two patients had wounds and infection prior to surgery. The initial 90-day complication rate for surgical intervention was 17% or 3 out of 18. This included one superficial infection that results with vocal wound care and antibiotics, one deep infection leading to a below-knee amputation, and one death related to a cardiac event in the post-operative period. At latest follow-up, 10 patients were ambulating with ProBoot, seven in diabetic shoes with therapeutic inserts, and one with a below-knee prosthesis. The radiographic union was seen in 13 patients. Four patients had stable pseudo-union of the ankle joint with neutral alignment, and one patient died within three months of the operation. All patients healed in neutral alignment except for one patient with 10 degrees of valgus of the ankle. Long-term complications in the patients included one patient with loosened hardware that was removed without affecting union or alignment, one with a broken screw that was retained, one patient developed a late infection in the ankle from sepsis and underwent washout and hardware removal, however achieved full union of the ankle and resolved infection, and one patient needed a plantar foot helectomy due to a wound from a cuboid prominence that resolved post-surgery. Conclusion. This retrospective study was not meant to support one method of fixation as various techniques have been shown to produce similar results. However, this experience produced multiple valuable lessons. Not surprisingly, this patient population is highly comorbid. The impact of Charcot ankle spans beyond limb salvage and eradication of the infection. As such, more metrics are required to determine successful treatment of Charcot arthropathy. However, the ability to walk without burdensome arthrosis may in time become a reasonable surrogate for measuring functional resolution of Charcot arthropathic disease. It is our hope that deformity stratification may one day be used to aid in providing guidance prior to surgery, allowing for optimal selection of therapeutic interventions. This data places confidence in the current approach to deformity correction with hindfoot nail as a means for improving health-related quality of life in this complex patient population. In our cohort, we achieved meaningful improvement in ambulatory status post-surgery with curr boots or shoes with therapeutic inserts. Thank you for your interest.

Charcot Ankle Deformity

limb salvage

diabetic patients

surgical intervention

Charcot arthropathy