The clinical and radiographic results of 40 modern design condylar total knee
arthroplasties (TKAs) in 29 patients with a confirmed diagnosis of
Charcot joint were reviewed. The followup averaged 7.9 years (range, 2-15 years) for clinical and 6.4 years (range, 2-15) for radiographic surveillance. There was a significant improvement in Knee Society
pain and function scores and ROM after
knee arthroplasty. Extensive bone fragmentation and bone defect was present in 38 knees (95%).
Metal wedge augments (10 knees, eight patient), autologous
bone grafting (17 knees, 13 patients), and bone allografts (two knees, two patients) were used to reinforce the bony defects. Ligamentous instability necessitated the use of long stem components in 27 knees and rotating hinge
prostheses in five knees. There were six reoperations for
periprosthetic fracture (two knees, two patients), aseptic loosening (two knees, two patients), instability (one knee, one patient), and deep
infection (one knee, one patient).
Total knee arthroplasty may be offered to a select group of patients with end-stage neuropathic
arthropathy. The basic principles of
knee arthroplasty in restoring limb alignment, reinforcing bony defects by
bone grafting or augmented
prostheses, careful ligamentous balancing, and appropriate selection of constrained
prostheses particularly are important in these patients. The technical challenges encountered during TKA in patients with neuropathic
arthropathy, particularly in those with significant
deformities, can require skills, implant systems, and methods usually reserved for complex revision
arthroplasty.