Charcot Arthropathy Limb Salvage with 3D Custom Cage and Dynamic Hindfoot Fusion Nail Combination Fixation: A Case-Series

CATEGORY: Diabetes; Ankle; Hindfoot INTRODUCTION/PURPOSE: Patients with Charcot arthropathy with hindfoot collapse present a difficult challenge for foot and ankle surgeons. While traditional limb salvage options include tibiotalocalcaneal (TTC) arthrodesis with accepted shortening, thin wire external fixation, or TTC arthrodesis with bulk femoral head allograft, new 3-dimensional (3D) custom patient specific implants offer a new treatment modality for limb salvage for this difficult issue. The purpose of this case-series is to offer one surgeon's experience with this new treatment technique for limb salvage. METHODS: All patients undergoing limb salvage procedures for hindfoot collapse between 2018 and 2022 with a custom 3D hindfoot cage with TTC hindfoot fusion intramedullary nail were included for analysis. Along with patient demographics and length of follow up, patients were asked a series of questions on a telephone survey in order to measure patient reported outcomes including current ambulatory status and whether they would have elected to undergo the same treatment modality again. Complications were also tracked. Finally, radiographs were analyzed to evaluate the degree of deformity correction on both coronal and sagittal planes as well as degree of deformity correction maintenance at last radiographic follow up. RESULTS: 13 patients were included in the analysis. 10 of the 13 patients had Charcot arthropathy. 2 patients had deep infections that ultimately required below knee amputation. 11 out of 13 patients had successful limb salvage as defined by the maintenance of a functional limb without need for amputation. Interestingly, both patients who failed limb salvage and required below knee amputations reported that they would prefer to have undergone the same attempt at limb salvage even with the resulting amputation. Radiographically, the average amount of coronal plane deformity correction was 25 degrees while the average amount of sagittal plane deformity correction was 6 degrees. The average amount of deformity correction maintenance seen at last radiographic follow up was high with a loss of only 0.5 degrees in coronal plane deformity correction loss throughout the time period and an average of 2 degrees of sagittal plane deformity correction loss. CONCLUSION: While still a challenging pathology to treat, custom patient specific 3D implants combined with TTC hindfoot fusion nail is a viable construct for patients with Charcot arthropathy undergoing limb salvage for hindfoot collapse.