Charcot foot reconstruction—how do hardware failure and non-union affect the clinical outcomes?
Ingvild Kummen, Ngwe Phyo, Venu Kavarthapu
Abstract
Background: Surgical reconstruction of severe Charcot foot deformities using internal fixation technique carries a high risk of major hardware failure. Our aim of this study was to look at the demographics of hardware failure, and the radiological and clinical outcomes in this group. Methods: We studied 78 patients that have undergone Charcot foot reconstruction. The patients’ demographics, radiological and clinical outcomes were recorded within a follow-up period of minimum of 12 months with a mean duration of 31.8 months (12–91 months). Results: Nineteen patients had hardware failure. Only 7/19 of these patients developed full bone fusion radiologically, compared to 49/59 of the non-hardware failure group (P<0.001). Patients with a body mass index (BMI) of greater than 30 kg/m 2 are at higher risk of hardware failure (P=0.038). Hindfoot and midfoot combination carries 12 times the risk of metal breakage compared to single segment reconstruction alone (P<0.001). In the hardware-failure group 9/19 were able to weight-bear in shoes, in comparison to 43/59 in the non-hardware failure patients (P=0.040). Limb salvage was achieved in all patients. Conclusions: Hardware failure is common following Charcot deformity corrections. However, the clinical and radiological outcomes are still satisfactory in this group. Further developments of the internal fixation devices may reduce the risk of hardware failure.