Alexander T Mehlhorn1,2,3, Ulrich Illgner4, Stefan Lemperle5, Verena Huber5, Hubert Hoerterer5,6, Oliver Gottschalk5,6, Maria Anna Legrand7, Veit Krenn8, Markus Walther5. 1. Zentrum für Fuß- und Sprunggelenkschirurgie, Schönklinik München-Harlaching, München, Deutschland. amehlhorn@schoen-klinik.de. 2. Klinik für Orthopädie und Unfallchirurgie, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland. amehlhorn@schoen-klinik.de. 3. Sektion für Diabetische und Neuropathische Fußerkrankungen, Zentrum für Fuß- und Sprunggelenkschirurgie, Schönklinik München-Harlaching, Harlachinger Straße 51, 81547, München, Deutschland. amehlhorn@schoen-klinik.de. 4. Orthopädische Privatpraxis Seintsch Illgner, Koblenz, Deutschland. 5. Zentrum für Fuß- und Sprunggelenkschirurgie, Schönklinik München-Harlaching, München, Deutschland. 6. Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Universitätsklinikum der LMU München, München, Deutschland. 7. Zentrum für Anästhesiologie und Intensivmedizin, Schönklinik München-Harlaching, München, Deutschland. 8. MVZ-Zentrum für Histologie, Zytologie und Molekulare Diagnostik GmbH, Trier, Deutschland.
Abstract
BACKGROUND: Neuro-osteoarthropathy of the foot (CN) is divided into an active and inactive stage, with impact on the further treatment. The histopathological Charcot score (HCS) can be used, to grade the inflammatory activity in tissue samples. RESEARCH QUESTION: This study aims to clarify whether successful bony healing after arthrodesis is related to inflammatory activity of the disease. MATERIAL AND METHOD: N = 80 patients underwent corrective arthrodesis of the midfoot (group 1) or hindfoot/ankle (group 2). A distinction was made between patients with/without diabetes mellitus and with/without pain perception. Intraoperative samples were taken to determine HCS. The osseous healing of the arthrodesis was determined by computed tomography 12 weeks postoperatively. RESULTS: There was an indirect correlation between bony consolidation and HCS. In group 2, there was a significantly worse bony healing in patients without pain sensation. There seems to be a tendency for HCS to be increased in patients without diabetes/no pain sensation. DISCUSSION: The present study confirms the assumption that corrective arthrodesis should be performed in the inactive stage of CN only. High activity levels obviously impede bony healing. HCS represents a relevant prognostic tool for surgical treatment.
BACKGROUND: Neuro-osteoarthropathy of the foot (CN) is divided into an active and inactive stage, with impact on the further treatment. The histopathological Charcot score (HCS) can be used, to grade the inflammatory activity in tissue samples. RESEARCH QUESTION: This study aims to clarify whether successful bony healing after arthrodesis is related to inflammatory activity of the disease. MATERIAL AND METHOD: N = 80 patients underwent corrective arthrodesis of the midfoot (group 1) or hindfoot/ankle (group 2). A distinction was made between patients with/without diabetes mellitus and with/without pain perception. Intraoperative samples were taken to determine HCS. The osseous healing of the arthrodesis was determined by computed tomography 12 weeks postoperatively. RESULTS: There was an indirect correlation between bony consolidation and HCS. In group 2, there was a significantly worse bony healing in patients without pain sensation. There seems to be a tendency for HCS to be increased in patients without diabetes/no pain sensation. DISCUSSION: The present study confirms the assumption that corrective arthrodesis should be performed in the inactive stage of CN only. High activity levels obviously impede bony healing. HCS represents a relevant prognostic tool for surgical treatment.