Charcot joint treatment pearls...
In my blog post last week, I discussed how fusion of one joint increases load to adjacent joints resulting in early onset of pain and arthritis. This accelerated deformation of the joint is called adjacent segment disease. Speaking of adjacent segment disease…
I was at a limb salvage seminar today and had a number of great conversations related to reconstructive surgery and limb salvage. A big topic of conversation was Charcot joint surgery. The thread that connected these conversations was that there is no clearly defined ‘correct’ way to treat Charcot arthropathy. Is surgery best? Is conservative care better? There really are no guidelines for care, but it seems that these conversations with my peers are the guideposts that best sum up care.
Here’s a couple of important topics that bubbled up during the day.
- If you surgically fuse a Charcot joint, expect adjacent segment disease at the next proximal joint. This stands to reason in that the load that was once distributed across two joints is now distributed across one. That increase load in a fragile foot will certainly lead to a greater incidence of Charcot arthropathy.
- Don’t treat stage 1 Charcot joints with fusion. Eichenholtz defined the four stages of Charcot arthropathy.(1) In stage 1 where the foot is hot, active and weak, primary fusion is a poor choice. An external frame to support the foot is the best way to protect the foot from deformation. Total contact casting is the next best alternative.
- When you’re using an ex-fix frame to treat Charcot joints, expect three problems. What will those problems be? It’s hard to say. Just expect three.
Great to be able to join with peers today to discuss these complex foot and ankle challenges.
- Clin Orthop Relat Res. 2015 Mar; 473(3): 1168–1171.