Outcomes of Tibiotalocalcaneal Arthrodesis in Hindfoot Charcot Neuroarthropathy According to Coronal-Plane Deformity and Talar Osteolysis.

IF 1.9 2区 医学 Q2 ORTHOPEDICS
Clinics in Orthopedic Surgery Pub Date : 2025-04-01 Epub Date: 2025-03-14 DOI:10.4055/cios24319
Sunghoo Kim, Ho-Seong Lee, Youngrak Choi
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引用次数: 0

Abstract

Background: Patients with severe hindfoot Charcot neuroarthropathy may experience various complications following tibiotalocalcaneal arthrodesis. Therefore, it is crucial to establish appropriate treatment plans to prevent potential complications and predict prognosis before surgery. This study aimed to investigate the impact of the degree of preoperative deformity in hindfoot Charcot neuroarthropathy on the outcomes of tibiotalocalcaneal arthrodesis.

Methods: Twenty patients who underwent tibiotalocalcaneal arthrodesis for hindfoot Charcot neuroarthropathy were grouped by the severity of their deformities into a mild deformity group (tibiotalar angle between 80° and 100° with minimal or no talar osteolysis) and a severe deformity group (tibiotalar angle < 80° or > 100°, or severe talar osteolysis precluding tibiotalocalcaneal arthrodesis and necessitating tibiocalcaneal arthrodesis). Their demographics, comorbidities, and various surgical outcomes were compared between the 2 groups. Additional analyses were conducted to determine the factors associated with poor clinical outcome, defined as the inability to achieve independent ambulation or the need for below-knee amputation.

Results: There were no significant differences in demographics and comorbidities between the 2 groups. Postoperative clinical outcomes, including the rate of postoperative infection and poor clinical outcome (inability to walk independently or having undergone below-knee amputation), showed no significant differences between the 2 groups. In terms of radiological outcomes, the bony union rates were 66.7% in the mild deformity group and 54.5% in the severe deformity group, with no significant difference. Similarly, other radiological outcomes, such as postoperative malalignment and time to union, did not vary significantly between the 2 groups. Factors associated with poor clinical outcome were the presence of preoperative infected wound and postoperative infection.

Conclusions: The severity of preoperative coronal deformity or talar osteolysis was not associated with clinical or radiological outcomes of tibiotalocalcaneal arthrodesis for hindfoot Charcot neuroarthropathy. However, preoperative infected wound and postoperative infection were associated with poor clinical outcomes. Therefore, instead of early amputation in cases of severe coronal deformity or insufficient talar bone stock, limb salvage with tibiotalocalcaneal arthrodesis may be a viable alternative, with particular attention to patients with preoperative infected wound and postoperative infection.

根据冠状面畸形和距骨骨质溶解对后足Charcot神经关节病进行胫骨-踝关节置换术的结果
背景:严重的后足Charcot神经关节病患者在胫距跟骨关节融合术后可能会出现各种并发症。因此,术前制定合适的治疗方案,预防潜在的并发症,预测预后至关重要。本研究旨在探讨后足Charcot神经关节病术前畸形程度对胫距跟骨关节融合术疗效的影响。方法:20例后足Charcot神经关节病行胫距跟关节融合术的患者,按畸形严重程度分为轻度畸形组(胫距角在80°~ 100°之间,有少量或无距骨松解)和重度畸形组(胫距角< 80°或小于100°,或严重的距骨松解导致无法进行胫距跟关节融合术,需要进行胫跟关节融合术)。比较两组患者的人口统计学特征、合并症和各种手术结果。进行了额外的分析,以确定与临床结果不良相关的因素,定义为无法实现独立行走或需要膝下截肢。结果:两组患者在人口统计学和合并症方面无显著差异。术后临床结果,包括术后感染率和不良临床结果(不能独立行走或进行过膝下截肢),两组间无显著差异。放射学结果方面,轻度畸形组骨愈合率为66.7%,重度畸形组为54.5%,差异无统计学意义。同样,其他放射学结果,如术后不对准和愈合时间,在两组之间没有显著差异。与临床预后差相关的因素是术前伤口感染和术后感染的存在。结论:术前冠状畸形或距骨溶解的严重程度与后足Charcot神经关节病胫距跟骨关节融合术的临床或影像学结果无关。然而,术前伤口感染和术后感染与较差的临床预后相关。因此,对于严重冠状畸形或距骨缺损的患者,与其早期截肢,胫距跟骨关节融合术可能是一种可行的选择,尤其要注意术前伤口感染和术后感染的患者。
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来源期刊
CiteScore
3.50
自引率
4.00%
发文量
85
审稿时长
36 weeks
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