Charcot foot reconstruction outcomes: A systematic review

Area of Science:

• Orthopedic surgery
• Diabetic foot complications
• Limb salvage procedures

Background:

• Charcot neuroarthropathy presents challenges with deformity and high amputation rates.
• Surgical reconstruction aims to preserve the foot but lacks comprehensive outcome data.
• Limited information exists on reconstruction methods, outcomes, and complications for Charcot foot.

Purpose of the Study:

• To systematically review surgical reconstruction methods for Charcot neuroarthropathy.
• To assess fixation techniques, outcomes, and complication rates.
• To evaluate amputation rates and return to ambulation post-surgery.

Main Methods:

• Systematic analysis of published data from January 1993 to December 2018.
• Inclusion of studies reporting on fixation methods and outcomes in Charcot neuroarthropathy.
• Statistical analysis of amputation rates, ambulation, and complications.

Main Results:

• 1116 feet (1089 patients) underwent reconstruction; heterogeneity in patient selection was noted.
• Internal fixation (65%), external fixation (31%), and combined (4%) were used; no technique showed significant benefit.
• Bone fusion rate was 86.1%, complications occurred in 36%, amputation rate was 5.5%, and 91% returned to ambulation.

Conclusions:

• Surgical reconstruction offers limb salvage with low amputation risk in selected Charcot neuroarthropathy patients.
• No single fixation method demonstrated superiority.
• Low evidence quality due to lack of controlled studies and inconsistent reporting necessitates cautious interpretation.