CME OnDemand: 2022 AOFAS Annual Meeting-Hemoglobin A1C In Charcot: Can it predict a BKA?

Pdf Summary

The study aimed to determine if the level of hemoglobin A1c (Hgb A1c) was associated with an increased risk of below-the-knee amputation (BKA) in patients with Charcot Foot. Charcot Foot is a complication of diabetes, peripheral neuropathy, and trauma that can lead to limb-threatening conditions. The researchers separated patients into two groups based on their Hgb A1c levels: group A included patients with Hgb A1c ≥ 6.5% and group B included patients with Hgb A1c < 6.5%. The study analyzed electronic medical records from 2015 to 2021 and included only patients with documented Hgb A1c levels around the time of diagnosis.<br /><br />Out of the 59 patients who met the inclusion criteria, 20.3% (12/59) required a BKA, while 79.6% (47/59) did not. In the cohort, 54.2% of patients had Hgb A1c ≥ 6.5% and 45.8% (27/59) had Hgb A1c < 6.5%. The relative risk of BKA in patients with Hgb A1c ≥ 6.5% was 2.5, but the results were not statistically significant.<br /><br />The findings suggest that there is a trend indicating an increased risk of BKA in patients with Hgb A1c ≥ 6.5%, but a larger sample size is needed to establish statistical significance. Additionally, the study mentions that further research should evaluate other laboratory values to determine their association with various outcomes.<br /><br />Charcot Neuroarthropathy, diabetes, peripheral neuropathy, microtrauma, limb salvage, and amputation are important concepts related to the study. The study's pathophysiology and treatment overview diagram and table show the association between Hgb A1c levels and the incidence of BKA.<br /><br />In conclusion, the study suggests a potential link between higher Hgb A1c levels and an increased risk of BKA in Charcot Foot patients, although the results were not statistically significant. The researchers recommend increasing the sample size and exploring other laboratory values to further understand the predictors of BKA in these patients.<br /><br />References:<br /><br />- Rosskopf AB, et al. The Charcot foot: a pictorial review. Insights Imaging. 2019 Aug;10(1):77.<br />- Rettedal D, et al. Prognostic Scoring System for Patients Undergoing Reconstructive Foot and Ankle Surgery for Charcot Neuroarthropathy: The Charcot Reconstruction Preoperative Prognostic Score. J Foot Ankle Surg. 2018 May-Jun;57(3):451-455.<br />- Sohn MW, et al. Mortality risk of Charcot arthropathy compared with that of diabetic foot ulcer and diabetes alone. Diabetes Care. 2009 May;32(5):816-21.

Asset Subtitle

Brandon J. Martinazzi, BD, Kristen Manto, PhD, Vincenzo Bonaddio, MD, Gregory Kirchner, Hannah Nam, Michael C. Aynardi, MD

Keywords

hemoglobin A1c

below-the-knee amputation

Charcot Foot

diabetes

peripheral neuropathy

trauma

limb-threatening conditions

electronic medical records

relative risk

laboratory values