Revascularization and subsequent orthopedic reconstruction of the foot for diabetic Charcot neuroosteoarthropathy

• Osnach S.A.
• Vinogradov V.A.
• Eroshenko A.V.
• Obolenskiy V.N.
• Protsko V.G.
• Tamoev S.K.
• Gogia K.T.
• Kovylov A.O.

Abstract

Aim of the study was to determine the safety and effectiveness of a two–stage strategy of surgical treatment for patients with diabetic neuroosteoarthropathy Charcot (DNOAP) and peripheral artery diseases (PAD) with endovascular revascularization of the limb as the first stage, taking into account the type and scope of the planned orthopedic reconstruction.

Material and methods. The results of treatment of 12 patients with type 2 diabetes mellitus and DNOAP with indications for orthopedic correction of foot deformity, and hemodynamically significant steno-occlusive lesions of the limb arteries were analyzed. Endovascular revascularization was performed at the first stage, orthopedic correction of deformity was performed at the second stage.

Results. At the first stage, a total of 30 arterial segments were recanalized (an average of 2.71±1.7 segments per patient), the technical success of the endovascular stage was achieved in 100% of cases. At the second stage, orthopedic correction of limb deformities was performed. There were no clinical manifestations associated with an exacerbation of DNOAP after revascularization in the inter-stage period. The healing of soft tissues by primary tension, as well as the preservation of the limb, was observed in all clinical cases during the observation period.

Discussion. In contrast to the previously existing concept of “good” peripheral blood flow in patients with DNOAP, recent accumulated data show a significantly higher than expected incidence of PAD in such patients. The presence of atherosclerotic lesion of the arteries of the lower extremities is associated with unfavorable outcomes of surgical treatment of Charcot’s DNOAP in the form of impaired healing of soft tissues, attachment of infection and, as a consequence, high amputation of the limb.

Conclusion. In some cases, step-by-step approach “revascularization and then orthopedic reconstruction” in the treatment of DNOAP can be considered as the optimal tactic for restoring the supporting function of the foot, significantly reducing the risk of amputation.

Keywords:diabetic neuroosteoarthropathy Charcot; peripheral artery diseases; endovascular revascularization; orthopedic correction

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