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Greater need for surgery found among patients with Charcot neuroarthropathy and ulcers

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TORONTO — Researchers found a significant increase in the need for surgery, complications of surgery and the risk of lower extremity amputation among patients with Charcot neuroarthropathy who developed an ulcer, according to results presented here.

“We had an overall limb salvage of 78.5% but, in looking at those patients we only deemed constructible, [this] increased to 87.5%,” Nicholas Vaudreuil, MD, said in his presentation. “We did have a high mortality rate of 13.9% and most of these were the surgical patients; but for us, these were the more severe disease prostheses as marked by the lower hemoglobin in preop.”

Vaudreuil and colleagues identified 280 diabetic patients with Charcot neuroarthropathy. According to the study abstract, slightly more than half of patients had a foot ulcer. Of the 280 total patients, 205 patients underwent surgery and 75 patients had nonoperative treatment.

Results showed the surgical group had a significantly higher increase in ulceration, and patients were more likely to undergo surgery if they had Charcot changes in the ankle.

“There is a trend toward significance for mortality with an increase in [the] surgical group, but it did not reach significance,” Vaudreuil said.

Researchers categorized patients in the surgical group into either a reconstructive group or ankle infection group. Vaudreuil noted 87.5% of patients who underwent reconstruction had their limb salvaged vs. 48.9% of patients with acute infection.

“Now this is not to say that patients in the reconstruction group did not have infection,” Vaudreuil said. “In fact, 40% of these patients had chronic underlying osteomyelitis confirmed by bone biopsy or culture.” – by Casey Tingle

Reference:

Vaudreuil N, et al. Charcot neuroarthropathy in patients with diabetes: Assessment of outcomes in 256 consecutive patients. Presented at: American Orthopaedic Foot & Ankle Society Annual Meeting; July 21-23, 2016; Toronto.

Disclosure: Vaudreuil reports no relevant financial disclosures.