Two-stage replacement of total and subtotal foot bone defects in Charcot neuroosteoarthropathy using personalised...

Charcot diabetic arthropathy is one of the most serious complications in patients with diabetes mellitus with sensorimotor neuropathy of the lower extremities, accompanied by metabolic disturbances and subsequent destruction of bones and joints. There are many methods of surgical treatment of diabetic charcot's foot described in the literature. A review of the literature found no publications describing the surgical treatment of Charcot arthropathy patients using the method of two-stage replacement of total and subtotal foot bone defects with heterotopic allografts using 3D modelling.

The aim of the study is to determine the clinical efficacy of surgical treatment of patients with diabetic Charcot foot with destruction of the middle and hindfoot in remission (without active infectious process) and with active purulent infection by two-stage replacement of total and subtotal bone defects of the foot with heterotopic allografts using 3D modeling.

This study analysed the treatment outcomes of 40 patients with bone defects due to Charcot neuroosteoarthropathy who were treated at the Centre for Foot and Diabetic Foot Surgery, Yudin City Clinical Hospital in 2022 to 2023. The localisation of the pathological process was diagnosed in the bones of the midfoot in seven patients (type 2 to 3, Sanders & Frykberg classification), of the hindfoot in 30 patients (type 4 to 5, Sanders & Frykberg classification) and of the combined midfoot and hindfoot in three patients (type 3 to 4 to 5, Sanders & Frykberg classification). There were 12 men and 23 women. The mean age was 51.1 ± 2.1 M ± σ (24 to 71) years. The average body mass index was 30.0 ± 1.2 M ± σ (18 to 46.9). Type 1 diabetes mellitus was present in 9 patients and type 2 diabetes mellitus was present in 31 patients.

The mean volume of the simulated allografts for the midfoot was 22.7 ± 6.2 cm3 M ± σ, 37.8 ± 2.9 cm3 for the hindfoot and 41.2 ± 7.6 cm3 for combined defects of the hindfoot and midfoot. The duration of follow-up after the end of treatment ranged from 12 to 36 months. Good results were obtained in all patients with midfoot damage and with combined midfoot and hindfoot damage. In isolated hindfoot lesions, a good result was seen in 19 of 30 patients, or 60.7%. In six patients with hindfoot damage (21.4%), crushing of the allograft was observed with the neoarthrosis formation in supporting region with relative limb shortening, which was considered a satisfactory outcome. Non-union or recurrent osteomyelitis was noted in five patients with hindfoot lesions (17.9%), requiring allograft removal and arthrodesis in an external fixation device (EFD) with intraoperative segment shortening. These results were considered unsatisfactory despite the preservation of the limb. Overall, for the entire cohort of patients, 29 of 40 (72.5 per cent) had a good outcome, six (15 per cent) had a satisfactory outcome and five (12.5 per cent) had an unsatisfactory outcome.

The utilisation of 3D allografts provides a solution to the issue of restoration total bone defects in Charcot osteoarthropathy, not only at the level of individual bones, but also across the entire segments of the foot while enabling the precise replication of the intricate contours of a complex geometry. The proposed method of restoration bone defects in Charcot arthropathy has been demonstrated to be sustainable and enabling the successful filling of extensive bone defects without complications and the staged compression throughout the entire fixation period, while minimising the risk of implant damage.