Abstract
Charcot neuroarthropathy is a destructive process that occurs in patients with peripheral
neuropathy, often due to poorly controlled diabetes mellitus. Surgical reconstruction
can be necessary to provide a plantigrade foot that is wound free. A risk of major
amputation exists after a Charcot event and after attempted reconstruction. We retrospectively
reviewed the data from 34 patients (36 reconstructions) who had undergone reconstructive
surgery for Charcot neuroarthropathy. The mean patient age was 56.44 years. The mean
follow-up period was 56 months. We collected patient age, body mass index, presence
of wound or osteomyelitis, anatomic location, activity of disease, and hemoglobin
A1c. Using these data, each patient was given a score using our novel prognostic scoring
system, the Charcot Reconstruction Preoperative Prognostic Score (CRPPS). Our primary
outcome measure was no wound and no major amputation at the final follow-up visit.
The limb salvage rate was 89% (32 of 36), and 78% (28 of 36) had no wound at the final
follow-up examination. For patients without a wound or major amputation at the final
follow-up visit, the mean CRPPS was 2.96 ± 1.23. The mean CRPPS for those with a wound
or major amputation at the final follow-up visit was 4.33 ± 1.07 (p = .0024). Univariate logistic regression revealed 2 statistically significant predictors
of wound and/or amputation: anatomic location (odds ratio [OR] 5.0, 95% confidence
interval [CI] 1.051 to 23.789; p = .043) and CRPPS (OR 2.724, 95% CI 1.274 to 5.823, p = .01). A CRPPS of ≥4 was also predictive of a negative outcome (OR 7.286, 95% CI
1.508 to 35.211; p = .013). This scoring system, with a sensitivity of 75%, specificity of 71%, and
negative predictive value of 85%, is a potential starting point when educating patients
and making treatment decisions in this exceptionally challenging group.
Level of Clinical Evidence
Keywords
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Article info
Publication history
Published online: March 22, 2018
Footnotes
Financial Disclosure: None reported.
Conflict of Interest: None reported.
Identification
Copyright
© 2017 by the American College of Foot and Ankle Surgeons. All rights reserved.
