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.
Similar content being viewed by others
References
Eichenholtz SN (1966) Charcot joints. Charles C Thomas, Springfield
Lü HS, Wang YW, Li H (2009) Total knee arthroplasty in Charcot arthritis patients. Zhonghua Wai Ke Za Zhi 47:385–388
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
Parvizi J, Marrs J, Morrey BF (2003) Total knee arthroplasty for neuropathic (Charcot) joints. Clin Orthop Relat Res 416:145–150
Lambert AP, Close CF (2002) Charcot neuroarthropathy of the knee in Type 1 diabetes: treatment with total knee arthroplasty. Diabet Med 19:338–341
Kim YH, Kim JS, Oh SW (2002) Total knee arthroplasty in neuropathic arthropathy. J Bone Joint Surg Br 84:216–219
Fullerton BD, Browngoehl LA (1997) Total knee arthroplasty in a patient with bilateral Charcot knees. Arch Phys Med Rehabil 78:780–782
Chong A, Bruce W, Goldberg J (1995) Treatment of the neuropathic knee by arthroplasty. Aust N Z J Surg 65:370–371
Yoshino S, Fujimori J, Kajino A, Kiowa M, Uchida S (1993) Total knee arthroplasty in Charcot's joint. J Arthroplasty 8:335–340
Troyer J, Levine BR (2009) Proximal tibia reconstruction with a porous tantalum cone in a patient with Charcot arthropathy. Orthopedics 32:358
Arlecchini S, Busanelli L, Masetti C (1992) Neurogenic arthropathy. Differential diagnosis. Chir Organi Mov 77:317–320
Cassidy RC, Shaffer WO (2008) Charcot arthropathy because of congenital insensitivity to pain in an adult. Spine J 8:691–695
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
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
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
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
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
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
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
Jeffcoate W (2008) The causes of the Charcot syndrome. Clin Podiatr Med Surg 25:29–42
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
Dogan BE, Satin G, Yagmurhu B, Eiden I (2003) Neuroarthropathy of the extremities: magnetic resonance imaging features. Curr Probl Radiol 32:227–232
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
Frykberg RG, Belczyk R (2008) Epidemiology of the Charcot foot. Clin Podiatr Med Surg 25:17–28
Nielson DL, Armstrong DG (2008) The natural history of Charcot's neuroarthropathy. Clin Podiatr Med Surg 25:53–62
Jostel A, Jude EB (2008) Medical treatment of Charcot neuroosteoarthropathy. Clin Podiatr Med Surg 25:63–69
Disclosures
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
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
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10067-010-1617-x