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Use of Zonal Fixation Therapy and Metal Augmentation for Rotating-Hinge Knee Arthroplasty in Charcot Arthropathy: A
Weikun Zheng1, Junfen Tang2, Wende Xiao1
1Department of Orthopedics, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China.
Background:
Charcot knee arthropathy requiring primary total knee arthroplasty (pTKA) with a rotating-hinge knee (RHK) is rare, with no established reconstructive guidelines. Bone defect management in these cases is technically challenging. This study evaluated the zonal fixation theory for guiding RHK-pTKA, compared outcomes between Charcot and non-Charcot arthropathy, and assessed bone defect reconstruction methods.
Methods:
We retrospectively analyzed 51 patients (53 knees) undergoing RHK-pTKA. Preoperative planning followed the zonal fixation theory using a square zoning method. The mean follow-up was 87.0 months (range, 61 to 108). The cohort comprised 16 Charcot patients (18 knees) and 35 non-Charcot patients (35 knees). Demographic data, surgical parameters, clinical outcomes, radiographic indicators, prosthesis survival, and complications were compared between groups. Metal augmentation for bone defect reconstruction in Charcot knees was specifically evaluated.
Results:
Postoperative imaging confirmed reliable prosthesis fixation in at least two zones, with substantial limb alignment improvement. Overall, patient-reported outcomes improved significantly. Prosthesis survival at 60 months was 94.34% overall, 94.44% in the Charcot group, and 94.29% in the non-Charcot group. Compared to non-Charcot patients, the Charcot group was older, had more diabetes, and exhibited lower preoperative patient-reported outcomes (P < 0.05). The Charcot group also required more frequent metal augmentation (P < 0.05). During follow-up, one Charcot and two non-Charcot patients underwent revision. At final follow-up, no significant differences existed between groups in postoperative patient-reported outcomes or prosthesis survival (P > 0.05).
Conclusions:
The zonal fixation theory effectively guides RHK-pTKA, achieving favorable outcomes and prosthesis survival. RHK-pTKA is effective for severe Charcot knee arthropathy, with metal augmentation offering a viable option for bone defect management.
