Research Article| Volume 60, ISSUE 5, P941-945, September 2021

Complications of Charcot Reconstruction in Patients With Peripheral Arterial Disease

Published:March 31, 2021DOI:


      The primary aim was to determine the rate of complications in patients with peripheral arterial disease and diabetic Charcot neuroarthropathy who underwent osseous reconstruction. Complications included delayed healing, dehiscence, and major lower extremity amputation. A review of patients with Charcot neuroarthropathy requiring reconstruction secondary to ulceration or acute infection was performed. Descriptive analysis compared outcomes between those with and without peripheral arterial disease. Bivariate analysis and multivariate logistic regression were analyzed for delayed healing, dehiscence, and major amputation. In a cohort of 284 patients with diabetic Charcot neuroarthropathy who underwent osseous reconstruction, the rate of peripheral arterial disease was 20.8% (59/284). Bivariate analysis for delayed healing found hypertension (p = .0352), peripheral arterial disease (p = .0051), and smoking history (p = .0276) to be statistically significant factors. Delayed healing was 2.012 times more likely in the presence of peripheral arterial disease [OR 2.012 (95% CI 1.088-3.720)]. Bivariate analysis for major lower extremity amputation found renal disease (0.0003) (renal disease: ESRD and CKD) and peripheral arterial disease (0.0001) to be statistically significant factors. Major amputation was 4.414 times more likely in the presence of peripheral arterial disease [OR 4.414 (95% CI 2.087-9.334)]. Peripheral arterial disease was identified in 20.8% (59/284) of diabetic patients who underwent Charcot osseous reconstruction. Peripheral arterial disease increased the risk of delayed healing by 2.012 fold, and increased the risk of major lower extremity amputation by 4.414 fold. The rates of complications in patients with peripheral arterial disease were significantly higher than those without peripheral arterial disease who underwent osseous reconstruction.

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      1. Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2020. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Department of Health and Human Services; 2020. Available at: Accessed May 3, 2021.

      2. Zemaitis MR, Boll JM, Dreyer MA. NCBI bookshelf: peripheral arterial disease [article online], 2017. Available at: Accessed July 23, 2017.

        • Sohn M
        • Lee T
        • Stuck R
        • Frykberg R
        • Budiman-Mak E
        Mortality risk of Charcot arthropathy compared with that of diabetic foot ulcer and diabetes alone.
        Diabetes Care. 2009; 32: 816-821
      3. Boulton AJM, Whitehouse RW. NCBI bookshelf: the diabetic foot [article online] 2016. Available at: Accessed March 5, 2018.

        • Young MJ
        • Breddy JL
        • Veves A
        • Boulton AJM
        The prediction of diabetic neuropathic foot ulceration using vibration perception thresholds: a prospective study.
        Diabetes Care. 1994; 17: 557-560
        • Fryberg R
        • Belczyk R
        Epidemiology of the Charcot foot.
        Clin Podiatr Med Surg. 2008; 25: 17-28
        • Zgonis T
        • Roukis T
        • Lamm B
        Charcot foot and ankle reconstruction: current thinking and surgical approaches.
        Clin Podiatr Med Surg. 2007; 24: 505-517
        • Lanzer P
        • Boehm M
        • Sorribas V
        • Thiriet M
        • Janzen J
        • Zeller T
        • St Hilaire C
        • Shanahan C
        Medial vascular calcification revisited: review and perspectives.
        Eur Heart J. 2014; 35: 1515-1525
        • Gregg EW
        • Sorlie P
        • Paulose-Ram R
        • q Gu
        • Eberhardt MS
        • Wolz M
        • Burt V
        • Curtin L
        • Engelgau M
        • Geiss L
        Prevalence of lower-extremity disease in the US adult population >= 40 years of age with and without diabetes.
        Diabetes Care. 2004; 27: 1591-1597
        • Prompers L
        • Huijberts M
        • Apelqvist J
        • Jude E
        • Piaggesi A
        • Bakker K
        • Edmonds M
        • Holstein P
        • Jirkovska A
        • Mauricio D
        • Ragnarson Tennvall G
        • Reike H
        • Spraul M
        • Uccioli L
        • Urbancic V
        • Van Acker K
        • vVn Baal J
        • van Merode F
        • Schaper N
        High prevalence of ischaemia, infection and serious comorbidity in patients with diabetic foot disease in Europe. Baseline results from the Eurodiale study.
        Diabetologia. 2007; 50: 18-25
        • Renner N
        • Wirth S
        • Osterhoff G
        • Böni T
        • Berli M
        Outcome after protected full weightbearing treatment in an orthopedic device in diabetic neuropathic arthropathy (Charcot arthropathy): a comparison of unilaterally and bilaterally affected patients.
        BMC Musculoskelet Disord. 2016; 17: 504
        • Marso SP
        • Hiatt WR
        Peripheral arterial disease in patients with diabetes.
        J Am Coll Cardiol. 2006; 47: 921-929
        • Yi CY
        • Zhou DX
        • Li HH
        • Wang Y
        • Chen K
        • Chen J
        • Xu XL
        Comparison of imaging value for diabetic lower extremity arterial disease between FBI and CE-MRA.
        Eur Rev Med Pharmacol Sci. 2016; 20: 3078-3086
        • Beyaz S
        • Güler Ü
        • Bağır G
        Factors affecting lifespan following below-knee amputation in diabetic patients.
        Acta Orthop Traumatol Turc. 2017; 51: 393-397
        • Jeffcoate W
        • Rasmussen L
        • Hofbauer L
        • Game F
        Medial arterial calcification in diabetes and its relationship to neuropathy.
        Diabetologia. 2009; 52: 2478-2488
        • Wukich D
        • Raspovic K
        • Suder N
        Prevalence of peripheral arterial disease in patients with diabetic Charcot neuroarthropathy.
        J Foot Ankle Surg. 2016; 55: 727-731
        • Palena L
        • Brocco E
        • Manzi M
        Critical limb ischemia in association with Charcot neuroarthropathy: complex endovascular therapy for limb salvage.
        Cardiovasc Intervent Radiol. 2013; 37: 257-261