Primary Total Hip Arthroplasty for Charcot Arthropathy is Associated With High Complications but Improved Clinical Outcomes

Brian P. Chalmers, Meagan E. Tibbo, Robert T. Trousdale, David G. Lewallen, Daniel J. Berry, Matthew Abdel

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Neuropathic (Charcot) arthropathy of the hip is rare but can lead to joint destruction, bone loss, and dysfunction. While total hip arthroplasty (THA) may be considered a treatment option, only very limited data in the form of case reports are available on the results of THA. The goal of this study was to analyze the outcomes of primary THA for Charcot arthropathy with emphasis on implant survivorship, complications, and clinical outcomes. Methods: Eleven patients undergoing 12 primary THAs for Charcot arthropathy from 2007 to 2014 were retrospectively reviewed. All patients had a severe underlying neuropathy and clear radiographic evidence of Charcot arthropathy. Mean age was 54 years with 4 patients being female. Mean follow-up was 5 years. Results: Survivorship free of any revision was 75% at both 2 and 5 years. Three THAs (3/12) were revised: 2 for recurrent instability and 1 for femoral component loosening. Survivorship free of any reoperation was 67% at both 2 and 5 years. One additional THA underwent open reduction and internal fixation of a Vancouver B 1 periprosthetic fracture. The overall complication rate (including revisions and reoperations) was high at 58% with 3 recurrent dislocations, 2 periprosthetic fractures, 1 femoral component loosening, and 1 delayed wound healing. Harris Hip Scores improved from a mean of 43 preoperatively to 81 postoperatively (P <.001). Conclusion: In this study, the largest to date, we found that patients undergoing primary THA for Charcot arthropathy have a significant improvement in clinical outcomes but that there was a high risk of early complications and revisions, mostly related to recurrent instability. Specific precautions to avoid early complications, namely utilization of components that provide robust fixation and strategies that provide enhanced hip stability, should be considered. Level of Evidence: Level IV.

Original languageEnglish (US)
Pages (from-to)2912-2918
Number of pages7
JournalJournal of Arthroplasty
Volume33
Issue number9
DOIs
StatePublished - Sep 1 2018

Fingerprint

Joint Diseases
Arthroplasty
Hip
Periprosthetic Fractures
Tacrine
Survival Rate
Thigh
Reoperation
Wound Healing
Joints
Bone and Bones

Keywords

  • Charcot arthropathy
  • complications
  • instability
  • neuropathic
  • total hip arthroplasty

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

Primary Total Hip Arthroplasty for Charcot Arthropathy is Associated With High Complications but Improved Clinical Outcomes. / Chalmers, Brian P.; Tibbo, Meagan E.; Trousdale, Robert T.; Lewallen, David G.; Berry, Daniel J.; Abdel, Matthew.

In: Journal of Arthroplasty, Vol. 33, No. 9, 01.09.2018, p. 2912-2918.

Research output: Contribution to journalArticle

Chalmers, Brian P. ; Tibbo, Meagan E. ; Trousdale, Robert T. ; Lewallen, David G. ; Berry, Daniel J. ; Abdel, Matthew. / Primary Total Hip Arthroplasty for Charcot Arthropathy is Associated With High Complications but Improved Clinical Outcomes. In: Journal of Arthroplasty. 2018 ; Vol. 33, No. 9. pp. 2912-2918.
@article{8374e02aea9f41568d634ab0eee1f106,
title = "Primary Total Hip Arthroplasty for Charcot Arthropathy is Associated With High Complications but Improved Clinical Outcomes",
abstract = "Background: Neuropathic (Charcot) arthropathy of the hip is rare but can lead to joint destruction, bone loss, and dysfunction. While total hip arthroplasty (THA) may be considered a treatment option, only very limited data in the form of case reports are available on the results of THA. The goal of this study was to analyze the outcomes of primary THA for Charcot arthropathy with emphasis on implant survivorship, complications, and clinical outcomes. Methods: Eleven patients undergoing 12 primary THAs for Charcot arthropathy from 2007 to 2014 were retrospectively reviewed. All patients had a severe underlying neuropathy and clear radiographic evidence of Charcot arthropathy. Mean age was 54 years with 4 patients being female. Mean follow-up was 5 years. Results: Survivorship free of any revision was 75{\%} at both 2 and 5 years. Three THAs (3/12) were revised: 2 for recurrent instability and 1 for femoral component loosening. Survivorship free of any reoperation was 67{\%} at both 2 and 5 years. One additional THA underwent open reduction and internal fixation of a Vancouver B 1 periprosthetic fracture. The overall complication rate (including revisions and reoperations) was high at 58{\%} with 3 recurrent dislocations, 2 periprosthetic fractures, 1 femoral component loosening, and 1 delayed wound healing. Harris Hip Scores improved from a mean of 43 preoperatively to 81 postoperatively (P <.001). Conclusion: In this study, the largest to date, we found that patients undergoing primary THA for Charcot arthropathy have a significant improvement in clinical outcomes but that there was a high risk of early complications and revisions, mostly related to recurrent instability. Specific precautions to avoid early complications, namely utilization of components that provide robust fixation and strategies that provide enhanced hip stability, should be considered. Level of Evidence: Level IV.",
keywords = "Charcot arthropathy, complications, instability, neuropathic, total hip arthroplasty",
author = "Chalmers, {Brian P.} and Tibbo, {Meagan E.} and Trousdale, {Robert T.} and Lewallen, {David G.} and Berry, {Daniel J.} and Matthew Abdel",
year = "2018",
month = "9",
day = "1",
doi = "10.1016/j.arth.2018.04.002",
language = "English (US)",
volume = "33",
pages = "2912--2918",
journal = "Journal of Arthroplasty",
issn = "0883-5403",
publisher = "Churchill Livingstone",
number = "9",

}

TY - JOUR

T1 - Primary Total Hip Arthroplasty for Charcot Arthropathy is Associated With High Complications but Improved Clinical Outcomes

AU - Chalmers, Brian P.

AU - Tibbo, Meagan E.

AU - Trousdale, Robert T.

AU - Lewallen, David G.

AU - Berry, Daniel J.

AU - Abdel, Matthew

PY - 2018/9/1

Y1 - 2018/9/1

N2 - Background: Neuropathic (Charcot) arthropathy of the hip is rare but can lead to joint destruction, bone loss, and dysfunction. While total hip arthroplasty (THA) may be considered a treatment option, only very limited data in the form of case reports are available on the results of THA. The goal of this study was to analyze the outcomes of primary THA for Charcot arthropathy with emphasis on implant survivorship, complications, and clinical outcomes. Methods: Eleven patients undergoing 12 primary THAs for Charcot arthropathy from 2007 to 2014 were retrospectively reviewed. All patients had a severe underlying neuropathy and clear radiographic evidence of Charcot arthropathy. Mean age was 54 years with 4 patients being female. Mean follow-up was 5 years. Results: Survivorship free of any revision was 75% at both 2 and 5 years. Three THAs (3/12) were revised: 2 for recurrent instability and 1 for femoral component loosening. Survivorship free of any reoperation was 67% at both 2 and 5 years. One additional THA underwent open reduction and internal fixation of a Vancouver B 1 periprosthetic fracture. The overall complication rate (including revisions and reoperations) was high at 58% with 3 recurrent dislocations, 2 periprosthetic fractures, 1 femoral component loosening, and 1 delayed wound healing. Harris Hip Scores improved from a mean of 43 preoperatively to 81 postoperatively (P <.001). Conclusion: In this study, the largest to date, we found that patients undergoing primary THA for Charcot arthropathy have a significant improvement in clinical outcomes but that there was a high risk of early complications and revisions, mostly related to recurrent instability. Specific precautions to avoid early complications, namely utilization of components that provide robust fixation and strategies that provide enhanced hip stability, should be considered. Level of Evidence: Level IV.

AB - Background: Neuropathic (Charcot) arthropathy of the hip is rare but can lead to joint destruction, bone loss, and dysfunction. While total hip arthroplasty (THA) may be considered a treatment option, only very limited data in the form of case reports are available on the results of THA. The goal of this study was to analyze the outcomes of primary THA for Charcot arthropathy with emphasis on implant survivorship, complications, and clinical outcomes. Methods: Eleven patients undergoing 12 primary THAs for Charcot arthropathy from 2007 to 2014 were retrospectively reviewed. All patients had a severe underlying neuropathy and clear radiographic evidence of Charcot arthropathy. Mean age was 54 years with 4 patients being female. Mean follow-up was 5 years. Results: Survivorship free of any revision was 75% at both 2 and 5 years. Three THAs (3/12) were revised: 2 for recurrent instability and 1 for femoral component loosening. Survivorship free of any reoperation was 67% at both 2 and 5 years. One additional THA underwent open reduction and internal fixation of a Vancouver B 1 periprosthetic fracture. The overall complication rate (including revisions and reoperations) was high at 58% with 3 recurrent dislocations, 2 periprosthetic fractures, 1 femoral component loosening, and 1 delayed wound healing. Harris Hip Scores improved from a mean of 43 preoperatively to 81 postoperatively (P <.001). Conclusion: In this study, the largest to date, we found that patients undergoing primary THA for Charcot arthropathy have a significant improvement in clinical outcomes but that there was a high risk of early complications and revisions, mostly related to recurrent instability. Specific precautions to avoid early complications, namely utilization of components that provide robust fixation and strategies that provide enhanced hip stability, should be considered. Level of Evidence: Level IV.

KW - Charcot arthropathy

KW - complications

KW - instability

KW - neuropathic

KW - total hip arthroplasty

UR - http://www.scopus.com/inward/record.url?scp=85046145313&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85046145313&partnerID=8YFLogxK

U2 - 10.1016/j.arth.2018.04.002

DO - 10.1016/j.arth.2018.04.002

M3 - Article

C2 - 29706256

AN - SCOPUS:85046145313

VL - 33

SP - 2912

EP - 2918

JO - Journal of Arthroplasty

JF - Journal of Arthroplasty

SN - 0883-5403

IS - 9

ER -