Development of Charcot neuroosteoarthropathy of the knee joint after reconstructive surgery for diabetic neuroosteoarthropathy of the ankle joint

• Osnach S.A.
• Bregovskiy V.B.
• Protsko V.G.
• Tamoev S.K.
• Obolenskiy V.N.
• Gogia K.T.

Abstract

We present the results of examination and treatment of a patient with the consecutive development of diabetic neuroosteoarthropathy (DNOAP) of the ankle joint and knee joint of the same limb. The patient 24 y.o. with type 1 diabetes mellitus since age of 13 and DNOAP of the ankle joint (Eichenholtz 2). A supra-malleolar minimally invasive osteotomy of the fibula and tibia was performed with correction of deformation and stabilization of bone fragments by an external fixation device (EFD). EFD was removed 6 months later. During the initiation of walking, the development of the DNOAP of knee joint of the operated limb, diagnosed at stage 0 using magnetic resonance imaging, occurred. Complete unloading (crutches) in combination with immobilization with total contact cast led to the relief of the process in the knee joint without deformity formation for 4 months, which was confirmed by the disappearance of the temperature gradient, as well as magnetic resonance imaging data. 2.5 months after the end of immobilization, the patient walks with a 50% load on the limb, there are no clinical signs of recurrence of arthropathy of both localizations. Supra-malleolar minimally invasive osteotomy in combination with EFD fixation was effective in the defeat of the ankle joint, but it provoked the development of DNOAP of the knee joint. Perhaps other factors contributing to this could be a combination of vitamin deficiency, prolonged diarrhea, as well as aggravation of sarcopenia and weakening of the ligamentous apparatus of the limb due to uncompensated diabetes mellitus and prolonged immobilization.

Keywords:case report; diabetic foot; Charcot foot; arthrodesis; supra-malleolar osteotomy; transosseous osteosynthesis; Ilizarov apparatus

References

1.     Rogers L.C., Frykberg R.G., Armstrong D.G., et al. The Charcot foot in diabetes. Diabetes Care. 2011; 34: 2123–9. DOI: https://doi.org/10.2337/dc11-0844   

2.     Sanders L., Edmonds M., Jeffcoate W. Who was first to diagnose and report neuropathic arthropathy of the foot and ankle: Jean-Martin Charcot or Herbert William Page? Diabetologia. 2013; 56: 1873–7. DOI: https://doi.org/10.1007/s00125-013-2961-6   

3.     Kudaeva F.M., Eliseev M.S., Vladimirov S.A., Barskova V.G. Charcot arthropathy - the place of rendezvous of reumathologist and endocrinologist. Sovremennaya revmatologiya [Modern Rheumatology]. 2010; 4 (4): 77–82. (in Russian)

4.     Arapostathi C., Tentolouris N., Jude E.B. Charcot foot associated with chronic alcohol abuse. BMJ Case Rep. 2013. URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3644892  DOI: https://doi.org/10.1136/bcr-2012-008263  

5.     Grear B.J., Rabinovich A., Brodsky J.W. Charcot arthropathy of the foot and ankle associated with rheumatoid arthritis. Foot Ankle Intern. 2013; 34: 1541–7. DOI: https://doi.org/10.1177/1071100713500490   

6.     Lomax A., Ferrero A., Cullen N., et al. Destructive pseudo-neuroarthropathy associated with calcium pyrophosphate deposition. Foot Ankle Intern. 2015; 36: 383–90. DOI: https://doi.org/10.1177/1071100714560399   

7.     Waibel F.W., Berli M.C., Gratwohl V., et al. Midterm fate of the contralateral foot in Charcot arthropathy. Foot Ankle Int. 2020; 41: 1181–9. DOI: https://doi.org/10.1177/1071100720937654  

8.     Chantelau E., Richter A. The acute diabetic Charcot foot managed on the basis of magnetic resonance imaging – a review of 71 cases. Swiss Med Wkly. 2013; 143: w13831. URL: https://smw.ch/article/doi/smw.2013.13831

9.     Avdeev V.G. Diabetic entheropathy. Farmateka [Pharmateca]. 2010; (3): 46–9. (in Russian)

10. Al-Toma A., Volta U., Auricchio R., et al. European Society for the Study of Coeliac Disease (ESsCD) guideline for coeliac disease and other gluten-related disorders. United European Gastroenterol J. 2019; 7: 583–613. DOI: https://doi.org/10.1177/2050640619844125

All articles in our journal are distributed under the Creative Commons Attribution 4.0 International License (CC BY 4.0 license)