Kaissar Yammine1, Anthony El-Alam2, Chahine Assi3. 1. Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, School of Medicine, Lebanon; Diabetic Foot Clinic, Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon; Center for Evidence-Based Anatomy, Sport & Orthopedics Research, Lebanon. Electronic address: cesaryam@gmail.com. 2. Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, School of Medicine, Lebanon; Center for Evidence-Based Anatomy, Sport & Orthopedics Research, Lebanon. 3. Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, School of Medicine, Lebanon; Diabetic Foot Clinic, Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon.
Abstract
BACKGROUND: Infected diabetic foot ulcers (DFU) complicated with calcaneal osteomyelitis are a real challenge for limb preservation. Very few alternatives to amputation are available, mainly the resection of a part or the totality of the calcaneal bone. Calcanectomies were advanced as limb-sparing procedures in patients with heel osteomyelitis. However, there is a lack of pooled quantitative evidence on their efficacy and complications. OBJECTIVES: The present systematic review and meta-analysis was conducted to determine the primary outcome of healing rates following partial (PC) and total calcanectomies (TC) in treating calcaneal osteomyelitis due to diabetic heel ulcers. Additionally, secondary outcomes such as secondary TC following PC, secondary below knee amputation (BKA), mortality and the change in the ambulation status were analyzed. METHODS: Medline, Scopus, Web of science, Cochrane Library and Google Scholar were searched since inception. All types of study design were included. Single case report studies and studies reporting osteomyelitis due to other etiologies than DFU were excluded. RESULTS: Twenty studies met the inclusion criteria comprising 295 patients with 300 calcanectomies (270 PC and 30 TC). With a mean follow-up period of 29.3±17.7 months, the weighted results were as follows: a) the osteomyelitis healing rate was of 80% (95% CI=0.728 to 0.861, I2=48.3%), b) the rate of secondary total calcanectomy was of 5.4% (95% CI=0.022 to 0.097, I2=7.5%), c) the rate of secondary BKA was of 17.1% (95% CI=0.111 to 0.241, I2=50.6%) with no difference between subgroups of TC and PC, and d) the combined mortality rate of both calcanectomies was of 13.4% (95% CI=0.064 to 0.224, I2=73.6%); however, significant higher mortality was found following TC compared to PC (p<0.0001). CONCLUSION: Partial and total calcanectomies were found to yield very good healing rates with acceptable complication frequencies. When compared to the reported outcomes of below and above-knee amputations in the literature, calcanectomies could be fairly considered as good alternatives to above ankle amputations.
BACKGROUND: Infected diabetic foot ulcers (DFU) complicated with calcaneal osteomyelitis are a real challenge for limb preservation. Very few alternatives to amputation are available, mainly the resection of a part or the totality of the calcaneal bone. Calcanectomies were advanced as limb-sparing procedures in patients with heel osteomyelitis. However, there is a lack of pooled quantitative evidence on their efficacy and complications. OBJECTIVES: The present systematic review and meta-analysis was conducted to determine the primary outcome of healing rates following partial (PC) and total calcanectomies (TC) in treating calcaneal osteomyelitis due to diabetic heel ulcers. Additionally, secondary outcomes such as secondary TC following PC, secondary below knee amputation (BKA), mortality and the change in the ambulation status were analyzed. METHODS: Medline, Scopus, Web of science, Cochrane Library and Google Scholar were searched since inception. All types of study design were included. Single case report studies and studies reporting osteomyelitis due to other etiologies than DFU were excluded. RESULTS: Twenty studies met the inclusion criteria comprising 295 patients with 300 calcanectomies (270 PC and 30 TC). With a mean follow-up period of 29.3±17.7 months, the weighted results were as follows: a) the osteomyelitis healing rate was of 80% (95% CI=0.728 to 0.861, I2=48.3%), b) the rate of secondary total calcanectomy was of 5.4% (95% CI=0.022 to 0.097, I2=7.5%), c) the rate of secondary BKA was of 17.1% (95% CI=0.111 to 0.241, I2=50.6%) with no difference between subgroups of TC and PC, and d) the combined mortality rate of both calcanectomies was of 13.4% (95% CI=0.064 to 0.224, I2=73.6%); however, significant higher mortality was found following TC compared to PC (p<0.0001). CONCLUSION: Partial and total calcanectomies were found to yield very good healing rates with acceptable complication frequencies. When compared to the reported outcomes of below and above-knee amputations in the literature, calcanectomies could be fairly considered as good alternatives to above ankle amputations.
Authors: Mauricio Esteban Ghioldi; Eric Daniel Dealbera; Lucas Nicolás Chemes; Gustavo Alejandro Caballero; Jorge Javier Del Vecchio Journal: SAGE Open Med Case Rep Date: 2021-07-17