Increased Arthrodesis Rates in Charcot Neuroarthropathy Utilizing Distal Tibial Distraction Osteogenesis Principles

Area of Science:

• Orthopedic Surgery
• Podiatric Medicine
• Regenerative Medicine

Background:

• Charcot neuroarthropathy presents significant challenges including deformity and bone loss, often leading to high complication rates with traditional arthrodesis.
• Hindfoot and ankle fusion (arthrodesis) for Charcot neuroarthropathy frequently results in nonunion and other complications.

Purpose of the Study:

• To evaluate the efficacy of combining distal tibial distraction osteogenesis with tibiotalocalcaneal or tibiocalcaneal arthrodesis in patients with Charcot neuroarthropathy.
• To assess the fusion and consolidation rates, and complication profile of this combined surgical technique.

Main Methods:

• A consecutive series of 15 patients with Charcot neuroarthropathy underwent simultaneous distal tibial distraction osteogenesis and hindfoot/ankle arthrodesis.
• Follow-up included assessment of arthrodesis and distraction site consolidation, time to fusion, and clinical outcomes.

Main Results:

• An overall arthrodesis rate of 93.3% was achieved, with a mean time to fusion of 4.75 months.
• Distraction site consolidation occurred in 93.3% of patients within a mean of 9.8 months.
• One case of hypertrophic nonunion occurred at both the arthrodesis and distraction sites.

Conclusions:

• Simultaneous distal tibial distraction osteogenesis with hindfoot/ankle arthrodesis is a viable technique to enhance fusion rates in Charcot neuroarthropathy.
• This combined approach may improve vascularity to the arthrodesis site, potentially leading to better healing outcomes in complex cases.