Abstract
Postreconstructive outcomes were compared in diabetic patients with Charcot neuroarthropathy
(CN) who had peripheral arterial disease (PAD) diagnosed with angiography versus patients
who were diagnosed clinically. A retrospective review was performed of patients with
diabetic CN requiring reconstruction secondary to ulceration and/or acute infection.
Of the 284 patients in the CN osseous reconstruction cohort, after accounting for
exclusion criteria, 59 (20.8%) patients with PAD were included in the analyses. Forty
(67.8%) of these 59 patients were diagnosed with PAD clinically and 19 (32.2%) were
diagnosed with the use of angiography. Bivariate analysis was used to compare outcomes
between those diagnosed with PAD via angiography versus those diagnosed clinically
for the following postreconstruction outcomes: wound healing, delayed healing, surgical
site infection, pin tract infection, osteomyelitis, dehiscence, transfer ulcer, new
site of Charcot collapse, contralateral Charcot event, nonunion, major lower extremity
amputation, and return to ambulation. Bivariate analysis found return to ambulation
postreconstruction (p = .0054) to be the only statistically significant factor. There was a trend toward
significance for major lower extremity amputation, with higher rates of amputation
in the clinically diagnosed PAD arm. Return to ambulation indicates improved functional
outcomes. The main goal of limb salvage should be focused on improving the patient's
functional performance. With significantly faster rates of return to ambulation and
a trend toward decreased rates of major amputation, angiography was found to be a
better assessor of PAD than clinical evaluations.
Level of Clinical Evidence
Keywords
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Article info
Footnotes
Financial Disclosure: None reported.
Conflict of Interest: None reported.
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