Total Hip and Knee Arthroplasty for Symptomatic Charcot Arthropathy

Charcot arthropathy of the hip and knee is a progressive neuropathy-driven joint destruction process that is frequently misdiagnosed and often presents with discordance between symptoms and radiographic severity, requiring a high index of suspicion. Initial management centers on nonoperative strategies-including off-loading, immobilization, and pharmacologic modulation of bone turnover-to halt disease progression rather than restore function. Total joint arthroplasty (total knee arthroplasty and total hip arthroplasty) can substantially improve pain and function in patients with symptomatic Charcot arthropathy who fail conservative treatment, despite limited high-level evidence. Arthroplasty in Charcot joints is technically demanding and associated with significantly higher complication rates (approximately 20%-30% for total knee arthroplasty and up to 45%-58% for total hip arthroplasty), with instability, infection, and mechanical failure among the most common complications. Successful outcomes depend on careful patient selection, optimization of modifiable risk factors (e.g., glycemic control), and appropriate implant selection (e.g., constrained or dual mobility constructs), underscoring the importance of meticulous preoperative planning and multidisciplinary care.