Hi, everybody. My name is Brandon Martinazzi, and I'm a fourth-year medical student here at the Penn State College of Medicine in Hershey, Pennsylvania. And I'm excited to talk to you a little bit today about some of our research titled, Charcot Neuroarthropathy is Associated with Higher Rates of Phantom Limb After Major Amputation. So a little bit of background here. So phantom limb is a well-described complication that's known to be associated with lower extremity amputation. However, it's right in patients with Charcot who require amputation is not well-described. Furthermore, there's really limited research exploring outcomes in patients with Charcot that require an amputation. So the purpose of this study was to determine if patients with Charcot that underwent major amputation had an increased rate of phantom limb compared to patients that underwent a BKA without a coexisting diagnosis of Charcot. So how did we do this? So using ICD and CPT codes, a large online research database was used to identify patients that underwent a major lower extremity amputation. For the purposes of our study, we defined a major amputation as below-knee amputation. Patients were then separated into two groups. Group A consisted of patients that underwent BKA, had a diagnosis of Charcot and diabetes, while Group B consisted of patients that had a diagnosis of diabetes but not Charcot and also underwent a BKA. Statistical analysis was then run to determine the relative risk of developing phantom limb in patients that underwent BKA with a diagnosis of Charcot compared to those without one. We also collected demographic data of the cohort. So what did we find? So from 2012 to 2022, a total of 11,374 patients underwent a BKA. Of these patients, 804 also had a diagnosis of Charcot and 10,570 did not. The rate of phantom limb in Charcot patients was 23.1% compared to 19.5% in patients without Charcot. So patients with Charcot that underwent a BKA had an increased risk of developing phantom limb compared to those without Charcot, and this was found to be statistically significant. So Table 1 here just kind of shows our CPT and ICD-10 codes that we used to collect our data. Table 2 shows the demographics of our cohort. We looked at the age at surgery. We looked at the sex. We looked at the ethnicity as well as the race to just try to understand some of the demographics of our cohort. And then Table 3 kind of sums up our main findings, which shows that patients with Charcot and diabetes who undergo amputation had a statistically significant increased risk of having phantom limb after the procedure compared with patients who underwent BKA and only had diabetes without a coded diagnosis of Charcot. So in closing, phantom limb is a serious complication that is relatively common after major lower extremity amputation. The pathophysiology of phantom limb is complex, and treating the associated symptoms is very difficult. Our results indicate that patients with the coexisting diagnosis of Charcot that undergo BKA may have an increased risk of developing phantom limb, and understanding these complications will better allow us to counsel Charcot patients who require major amputation so that they kind of can know maybe what to expect after the surgery. So future directions, the next phase of the study will be to explore patients with Charcot who undergo above knee amputation also have high rates of phantom limb. Additionally, we plan to retrospectively review all of our own patients at our institution to determine if this association is still holding up. And our ultimate goal is to be able to confidently counsel patients on possible complications that they may experience following major amputation so that we can better improve their quality of life after the surgery. Thank you very much.

Brandon Martinazzi

Charcot Neuroarthropathy

phantom limb

major amputation

complications after amputation