Neuropathic (Charcot) diabetic arthropathy is a well recognized condition that affects mainly the ankle and the foot joints of many diabetic patients. Deformities of the foot and ankle cause difficulty with shoe-fitting and abnormal loads during weight-bearing; leading to an increased propensity for ulceration in the pressure areas resulting in superficial or deep infection. Infected diabetic Charcot ankle joint is a real surgical challenge because of the resistance of infection, presence of deformity and instability (due to joint dislocation / sublaxation) that – in many instances - makes amputation inevitable.
Patients and methods: Twenty patients (44 – 69 y.) with actively draining sinus(es) (over than 1y. duration) from unstable, deformed (moderate to severe) diabetic Charcot ankle joints; were operated upon. All were giving a history of previous multiple drainage or soft tissue debridement procedures 2 to 5 times (3 in average). All patients were treated by a one stage intervention in the form of radical debridement of the infected ankle bone and soft tissues followed by ankle compression arthrodesis by a modified Charnley's device.
Results: Twelve patients (60%) showed solid (bone) union, with infection eradication in 9 (45%) of them. Five patients (25%) had stable (fibrous) nonunion with infection eradication in only 3 (15%) of them. Two patients (10%) showed complete failure of the procedure in the form of unstable nonunion with persistence of infection. The remaining one patient (5%) had no residual infection but still with unstable nonunion. Average time for bone healing was 14w. (12-23w.). Surgical wound (& sinuses) closure time was 4w. in average (3-8w.). Residual average limb length discrepancy was 2.5 cm. There was no late reactivation of infection after a follow up of 10 years (4.5 - 6.5 y.).
Conclusion: Combined joint debridement and compression arthrodesis is a successful method of limb salvage in infected diabetic Charcot ankle joints; obtaining a total satisfactory stable ankle in 85% of patients (with 60% solid union); and infection eradication rate of 65%.
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