Soft Tissue Reconstruction and Flap Coverage for Revision Total Knee Arthroplasty.

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Abstract

[Indexed for MEDLINE] 20. Clin Rheumatol. 2021 Nov;40(11):4445-4456. doi: 10.1007/s10067-021-05775-8. Epub 2021 May 24. Charcot knee - presentation, diagnosis, management - a scoping review. Lu V(1)(2), Zhang J(3), Thahir A(4), Zhou A(3), Krkovic M(4). Author information: (1)School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0SP, UK. victorluwawa@yahoo.com.hk. (2)Christ's College, St. Andrew's Street, Cambridge, CB2 3BU, UK. victorluwawa@yahoo.com.hk. (3)School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0SP, UK. (4)Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK. BACKGROUND: Charcot arthropathy is a progressive, non-infectious, destructive inflammatory process. Charcot arthropathy of the knee (CK) is rare and diagnosis is often delayed, resulting in detrimental outcomes. This scoping review aims to investigate the literature on CK, present the pathognomonic features of CK to aid early diagnosis, and suggest gaps in the literature for future research. METHODS: A systematic search of PubMed, EMBASE, Web of Science for literature relevant to CK was performed. Primary studies such as case reports, case series, retrospective studies were included. Review articles and animal studies were excluded. RESULTS: Of the 513 results, 58 were included in qualitative synthesis. Average time from symptom onset to CK diagnosis was 50.5 months. Eighteen and twenty-one studies included patients who had diabetes mellitus and syphilis, respectively. Twenty-one studies reported pain as a presenting complaint, but the degree of pain didn't correspond with the level of destruction. Oedema and joint effusion were noticed in 34 studies. Twenty-nine studies reported lower limb hypoesthesia and 17 studies reported decreased tendon reflex. Twenty-eight studies reported initial conservative treatment, often in a knee brace with minimal weight bearing, 9 of which needed subsequent surgical management. Twelve studies utilised arthrodesis, with fracture at the intramedullary nail entry site being the most common complication. Twenty-four studies utilised TKA. CONCLUSION: The literature on CK remains sparse, with most publications being case reports. Given that CK dramatically reduces quality of life, increases morbidity of patients, there is need for more literature on evidence-based options for early diagnoses and management. © 2021. The Author(s). DOI: 10.1007/s10067-021-05775-8 PMCID: PMC8143744