Abstract
Surgical treatments in neuropathic arthropathy have been studied on the basis of a follow-up study of 24 joints of 23 cases (13 males and 10 females) . The post-operative follow-up period varied from 2 months to 19 years (average, 5 years) .
Joint debridement was performed in 1 shoulder, 1 elbow, 1 hip, 5 knees, and 2 ankles. Debridement in the upper extremities had favorable results at follow-up, whereas that in the lower extremities, especially in the knees, was not found to prevent the affected joint from progressive destruction. Among the 3 cases which received total knee replacement (TKR, hinge type), 1 had femoral shaft fracture after TKR, 1 received arthrodesis on account of persisting postoperative hydrops, and 1 knee was revised due to loosening a year and a half after TKR. Arthrodesis was performed in 13 knees and 1 ankle. Bony fusion was attained in 7 of 13 knees, but arthrodesis of the ankle was not successful.
Surgical treatment is not necessarily required in the upper extremities on account of their well-developed substitutive functions. Arthrodesis is recommended to obtain joint stability in the lower extremities. As bony fusion is likely to be delayed in neuropathic joints, firm fixation using an external fixator and bone graft as well as meticulous resection of the joint capsule and synovium is required to promote successful fusion.
