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Charcot arthropathy of the knee. A case-based review

Clinical Rheumatology volume 30, pages 425–428 (2011)Cite this article

Abstract

The diagnosis of Charcot arthropathy in the knee is rare. However, there is an increasing number of diabetic patients, and they are living longer due to improvements in treatment. Because neuropathic arthropathy is a late effect of peripheral neuropathy, we can expect an increasing incidence of neuropathic arthropathy. Total knee arthroplasty is the preferred choice of treatment by patients, although it may also be associated with a high incidence of serious complications. This case report presents a young female with diabetes mellitus and Charcot arthropathy of the knee managed by total knee arthroplasty and a literature review. The report encompasses a 5-year follow-up of the patient, from the first contact after knee distortion through diagnosis of Charcot arthropathy and the performance of total knee arthroplasty with outpatient controls. The diagnosis was established on the basis of the rapid destruction of the medial tibial condyle after knee distortion in a patient with neuropathy. Neuropathic arthropathy was confirmed by histology. The patient refused knee fusion and total knee arthroplasty was performed. The patient quickly achieved a painless, stable knee with a 130-degree range of motion. However, a radiolucent line appeared under the tibial component due to premature weight-bearing. The patient was ordered to refrain from weight-bearing for the next 3 months, and the knee was healed. While the management of Charcot arthropathy in the knee remains controversial, total knee arthroplasty is not a contraindication. Early diagnosis, appropriate choice of implant and operative technique, and long-term weight protection are essential.

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References

  1. Eichenholtz SN (1966) Charcot joints. Charles C Thomas, Springfield

    Google Scholar 

  2. Lü HS, Wang YW, Li H (2009) Total knee arthroplasty in Charcot arthritis patients. Zhonghua Wai Ke Za Zhi 47:385–388

    PubMed  Google Scholar 

  3. Bae DK, Song SJ, Yoon KH, Noh JH (2009) Long-term outcome of total knee arthroplasty in Charcot joint: a 10- to 22-year follow-up. J Arthroplasty 24:1152–1156

    PubMed  Article  Google Scholar 

  4. Parvizi J, Marrs J, Morrey BF (2003) Total knee arthroplasty for neuropathic (Charcot) joints. Clin Orthop Relat Res 416:145–150

    PubMed  Article  Google Scholar 

  5. Lambert AP, Close CF (2002) Charcot neuroarthropathy of the knee in Type 1 diabetes: treatment with total knee arthroplasty. Diabet Med 19:338–341

    PubMed  Article  CAS  Google Scholar 

  6. Kim YH, Kim JS, Oh SW (2002) Total knee arthroplasty in neuropathic arthropathy. J Bone Joint Surg Br 84:216–219

    PubMed  Article  CAS  Google Scholar 

  7. Fullerton BD, Browngoehl LA (1997) Total knee arthroplasty in a patient with bilateral Charcot knees. Arch Phys Med Rehabil 78:780–782

    PubMed  Article  CAS  Google Scholar 

  8. Chong A, Bruce W, Goldberg J (1995) Treatment of the neuropathic knee by arthroplasty. Aust N Z J Surg 65:370–371

    PubMed  Article  CAS  Google Scholar 

  9. Yoshino S, Fujimori J, Kajino A, Kiowa M, Uchida S (1993) Total knee arthroplasty in Charcot's joint. J Arthroplasty 8:335–340

    PubMed  Article  CAS  Google Scholar 

  10. Troyer J, Levine BR (2009) Proximal tibia reconstruction with a porous tantalum cone in a patient with Charcot arthropathy. Orthopedics 32:358

    PubMed  Article  Google Scholar 

  11. Arlecchini S, Busanelli L, Masetti C (1992) Neurogenic arthropathy. Differential diagnosis. Chir Organi Mov 77:317–320

    PubMed  CAS  Google Scholar 

  12. Cassidy RC, Shaffer WO (2008) Charcot arthropathy because of congenital insensitivity to pain in an adult. Spine J 8:691–695

    PubMed  Article  Google Scholar 

  13. Nakajima H, Uchida K, Oki H et al (2009) Rapidly progressive neuropathic arthropathy of the knee in possible assocition with a huge extruded cervical intervertebral disc herniation. Rheumatol Int 30:811–815

    PubMed  Article  Google Scholar 

  14. Biotti D, Fuerea R, Deschamps G, Durupt S (2009) Neurogenic osteoarthropathy of the knee associated with spina bifida: a diagnosis not to be missed. Rev Méd Interne 30:985–987

    PubMed  Article  CAS  Google Scholar 

  15. Feldman DS, Ruchelsman DE, Spencer DB, Straight JJ, Schweitzer ME, Axelrod FB (2009) Peripheral arthropathy in hereditary sensory and autonomic neuropathy types III and IV. J Pediatr Orthop 29:91–97

    PubMed  Google Scholar 

  16. Sudanese A, Paderni S, Guerra E, Bertoni F (2003) Neurogenic arthropathy of the knee due to chronic alcoholism: two case reports. Chir Organi Mov 88:427–434

    PubMed  CAS  Google Scholar 

  17. Lokiec F, Arbel R, Isakov J, Wientroub S (1998) Neuropathic arthropathy of the knee associated with an intra-articular neurofibroma in a child. J Bone Joint Surg Br 80:468–470

    PubMed  Article  CAS  Google Scholar 

  18. Aoshima H, Kushida K, Okada M, Kageyama Y, Inoue T, Tomita H (1997) Neuropathic arthropathy caused by paraneoplastic sensory neuropathy. A case report. Clin Orthop Relat Res 339:185–189

    PubMed  Article  Google Scholar 

  19. Shiraishi M, Ando Y, Mizuta H, Nakamura E, Takagi K, Ando M (1997) Charcot knee arthropathy with articular amyloid deposition in familial amyloidotic polyneuropathy. Scand J Rheumatol 26:61–64

    PubMed  Article  CAS  Google Scholar 

  20. Jeffcoate W (2008) The causes of the Charcot syndrome. Clin Podiatr Med Surg 25:29–42

    PubMed  Article  Google Scholar 

  21. Palestro CJ, Mehta HH, Patel M et al (1998) Marrow versus infection in the Charcot joint: indium-111 leukocyte and technetium-99 m sulfur colloid scintigraphy. J Nucl Med 39:346–350

    PubMed  CAS  Google Scholar 

  22. Dogan BE, Satin G, Yagmurhu B, Eiden I (2003) Neuroarthropathy of the extremities: magnetic resonance imaging features. Curr Probl Radiol 32:227–232

    Article  Google Scholar 

  23. Slowman-Kovacs SD, Braunstein EM, Brandt KD (1990) Rapidly progressive charcot arthropathy following minor joint trauma in patients with diabetic neuropathy. A&R 33:412–417

    CAS  Google Scholar 

  24. Frykberg RG, Belczyk R (2008) Epidemiology of the Charcot foot. Clin Podiatr Med Surg 25:17–28

    PubMed  Article  Google Scholar 

  25. Nielson DL, Armstrong DG (2008) The natural history of Charcot's neuroarthropathy. Clin Podiatr Med Surg 25:53–62

    PubMed  Article  Google Scholar 

  26. Jostel A, Jude EB (2008) Medical treatment of Charcot neuroosteoarthropathy. Clin Podiatr Med Surg 25:63–69

    PubMed  Article  Google Scholar 

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Affiliations

  1. Department of Orthopedic Surgery, University Hospital and Medical Faculty of the Charles University, Sokolska 581, 500 05, Hradec Kralove, Czech Republic

    Tomas Kucera, Karel Urban & Pavel Sponer

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  1. Tomas Kucera
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  2. Karel Urban
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  3. Pavel Sponer
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Correspondence to Tomas Kucera.

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Kucera, T., Urban, K. & Sponer, P. Charcot arthropathy of the knee. A case-based review. Clin Rheumatol 30, 425–428 (2011). https://doi.org/10.1007/s10067-010-1617-x

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  • DOI: https://doi.org/10.1007/s10067-010-1617-x

Keywords

  • Diabetes mellitus
  • Knee fusion
  • Neuropathic arthropathy
  • Total knee arthroplasty