2007 Volume 26 Issue 4 Pages 449-454
Severe joint destruction found in patients suffering from nerve disorders such as tabes dorsalis was called“Charcot joint”. Fracture near the joint was thought to be important as an initial lesion of Charcot joint and was named “Charcot fracture”. We present a case of Charcot fracture of a tibial plateau, in a patient who had received a total knee arthroplasty (TKA) .
A 53-year-old woman, who was in our hospital for treatment of diabetic retinopathy, complained of gait disturbance. Although there was severe instability in her left knee, she had little knee pain. Tibial plateau fracture was found on X-ray, and moreover it seemed to be old. Stress X-ray confirmed that the instability was caused at the fracture site .We diagnose this situation as Charcot fracture in the diabetic patient. Granulation was found between fragments, and intensity change was found in the proximal fragment by MRI. We considered bone union difficult and performed TKA using bone graft, metal augmentation, and stem extension. Now, 1 year after operation, she can walk without help and has no complaints.
When Charcot fracture is diagnosed early, it can be treated as a usual fracture, namely bone union can be hoped for. However, if diagnosis is delayed, bone union becomes difficult and the fracture should be treated as a Charcot joint is. Charcot joint of a knee used to be treated by arthrodesis, and TKA was thought to be contraindicated. However, good results of TKA for Charcot joints have recently been reported. When appropriate techniques such as good ligament balancing, bone defect compensation with bone graft or metal augmentation, and implant stabilization by stem extension are performed, good results can be gained even in Charcot joints.
