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Histopathological assessment of a two-stage reconstructive procedure of the infected Charcot foot

  • Orthopaedic Surgery
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Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Charcot neuropathic osteoarthropathy (CN) can be complicated by osteomyelitis (OM). Surgery is a standard procedure to treat OM including debridement and interposition of antibiotic-loaded cement (ABLC) spacer. The course of CN and OM was investigated on a histopathological level.

Materials and methods

Diabetic patients (n = 15) suffering from CN and midfoot OM underwent surgical debridement and interposition of ABLC was interposed. 6 weeks later, ABLC was removed and bone samples were taken again. Histopathological Charcot Score (HCS), Histopathological Osteomyelitis Evaluation Score (HOES) and microbiological assessment were used to evaluate osteomyelitic and neuroosteoarthropathic activity at both time points.

Results

Interposition of ABLC leads to microbiological/histopathological eradication of OM in 73%/87% of patients. CN activity—measured by HCS—could be reduced from moderate to low activity by ABLC spacer and correlated with HOES.

Conclusions

CN activity could be reduced by surgery. It can be suggested that neuroosteoarthropathic activity measured by HCS is triggered by OM.

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Funding

The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. Center of Foot and Ankle Surgery, Schönklinik München Harlaching, Harlachingerstrasse 55, 81549, Munich, Germany

    Alexander T. Mehlhorn, Stefan Lemperle, Hubert Hoerterer & Markus Walther

  2. MVZ-Zentrum Für Histologie, Zytologie Und Molekulare Diagnostik GmbH, Max-Planck-Str. 5, Trier, Germany

    Veith Krenn

  3. Orthopädische Privatpraxis Seintsch Illgner, Koblenz, Germany

    Ulrich Illgner

  4. Department of Orthopedics and Trauma Surgery, Medical Center, Albert-Ludwigs University of Freiburg, Freiburg, Germany

    Alexander T. Mehlhorn

  5. Department of General, Trauma, and Reconstructive Surgery, University Hospital Munich, Munich, Germany

    Hubert Hoerterer

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Mehlhorn, A.T., Illgner, U., Lemperle, S. et al. Histopathological assessment of a two-stage reconstructive procedure of the infected Charcot foot. Arch Orthop Trauma Surg 143, 1223–1230 (2023). https://doi.org/10.1007/s00402-021-04238-8

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  • DOI: https://doi.org/10.1007/s00402-021-04238-8

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