Stephan H Wirth1, Arnd F Viehöfer1, Timo Tondelli1, Rebecca Hartmann1, Martin C Berli2, Thomas Böni2, Felix W A Waibel3,4. 1. Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland. 2. Divison of Technical Orthopaedics, Department of Orthopaedic Surgery, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland. 3. Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland. felix.waibel@balgrist.ch. 4. Divison of Technical Orthopaedics, Department of Orthopaedic Surgery, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland. felix.waibel@balgrist.ch.
Abstract
BACKGROUND: Failed conservative treatment and complications are indications for foot reconstruction in Charcot arthropathy. External fixation using the Ilizarov principles offers a one-stage procedure for deformity correction and resection of osteomyelitic bone. The aim of this study was to determine whether external fixation with an Ilizarov ring fixator leads reliably to walking ability. MATERIALS AND METHODS: 29 patients treated with an Ilizarov ring fixator for Charcot arthropathy were retrospectively analyzed. Radiologic fusion at final follow up was assessed separately on conventional X-rays by two authors. The association between walking ability and the presence of osteomyelitis at the time of reconstruction, and the presence of fusion at final follow up was investigated using Fisher's exact test. RESULTS: Mean follow up was 35 months (range 5.3-107) months; mean time of external fixation was 113 days. Ten patients (34.5%) reached fusion, but 19 did not (65.5%). Two patients needed below knee amputation. 26 of the remaining 27 patients maintained walking ability, 23 of those without assistive devices. Walking ability was independent from the presence of osteomyelitis at the time of reconstruction and from the presence of fusion. CONCLUSION: Foot reconstruction with an Ilizarov ring fixator led to limb salvage in 93%. The vast majority (96.3%) of patients with successful limb salvage was ambulatory, independent from radiologic fusion, and presence of osteomyelitis at the time of reconstruction. These findings encourage limb salvage and deformity correction in this difficult-to-treat disease, even with underlying osteomyelitis.
BACKGROUND: Failed conservative treatment and complications are indications for foot reconstruction in Charcot arthropathy. External fixation using the Ilizarov principles offers a one-stage procedure for deformity correction and resection of osteomyelitic bone. The aim of this study was to determine whether external fixation with an Ilizarov ring fixator leads reliably to walking ability. MATERIALS AND METHODS: 29 patients treated with an Ilizarov ring fixator for Charcot arthropathy were retrospectively analyzed. Radiologic fusion at final follow up was assessed separately on conventional X-rays by two authors. The association between walking ability and the presence of osteomyelitis at the time of reconstruction, and the presence of fusion at final follow up was investigated using Fisher's exact test. RESULTS: Mean follow up was 35 months (range 5.3-107) months; mean time of external fixation was 113 days. Ten patients (34.5%) reached fusion, but 19 did not (65.5%). Two patients needed below knee amputation. 26 of the remaining 27 patients maintained walking ability, 23 of those without assistive devices. Walking ability was independent from the presence of osteomyelitis at the time of reconstruction and from the presence of fusion. CONCLUSION: Foot reconstruction with an Ilizarov ring fixator led to limb salvage in 93%. The vast majority (96.3%) of patients with successful limb salvage was ambulatory, independent from radiologic fusion, and presence of osteomyelitis at the time of reconstruction. These findings encourage limb salvage and deformity correction in this difficult-to-treat disease, even with underlying osteomyelitis.
Authors: Felix W A Waibel; Martin C Berli; Viviane Gratwohl; Kati Sairanen; Dominik Kaiser; Laura Shin; David G Armstrong; Madlaina Schöni Journal: Foot Ankle Int Date: 2020-07-22 Impact factor: 2.827
Authors: Charlotte Reinke; Sebastian Lotzien; Emre Yilmaz; Yannik Hanusrichter; Christopher Ull; Hinnerk Baecker; Thomas A Schildhauer; Jan Geßmann Journal: Arch Orthop Trauma Surg Date: 2021-01-23 Impact factor: 2.928
Authors: Viviane Gratwohl; Thorsten Jentzsch; Madlaina Schöni; Dominik Kaiser; Martin C Berli; Thomas Böni; Felix W A Waibel Journal: Arch Orthop Trauma Surg Date: 2021-04-07 Impact factor: 2.928