Outcomes Following Total Hip Arthroplasty in Patients Who Have Charcot Neuroarthropathy of the Hip

Zhichang Zhang; Jialun Chi; Jon Raso; Haibin Xu; Quanjun Cui

doi:10.1016/j.arth.2023.05.088

Outcomes Following Total Hip Arthroplasty in Patients Who Have Charcot Neuroarthropathy of the Hip

J Arthroplasty. 2023 Dec;38(12):2650-2654. doi: 10.1016/j.arth.2023.05.088. Epub 2023 Jun 8.

Authors

Zhichang Zhang¹, Jialun Chi², Jon Raso², Haibin Xu³, Quanjun Cui²

Affiliations

¹ Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia; Department of Orthopaedic Surgery, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan, China.
² Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia.
³ Department of Orthopaedic Surgery, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan, China.

PMID: 37295623
DOI: 10.1016/j.arth.2023.05.088

Abstract

Background: Historically, Charcot neuroarthropathy hip (CNH) was deemed a contraindication for total hip arthroplasty (THA). However, as implant design and surgical techniques advance, THA for CNH has been performed and documented in literature. Information regarding the outcomes of THA for CNH is limited. The objective of the study was to assess outcomes following THA in patients who have CNH.

Methods: Patients who have CNH underwent primary THA and had at least 2 years of follow-up were identified in a national insurance database. For comparison, a 1:10 matched control cohort of patients who did not have CNH was created based on age, sex, and relevant comorbidities. Eight hundred and ninety-five CNH patients who underwent primary THA were compared to 8,785 controls. Medical outcomes, emergency department visits, hospital readmissions, and surgical outcomes including revisions between cohorts were evaluated using multivariate logistic regressions.

Results: The CNH patients were found to have higher risks of 90-day wound complications (P = .014), periprosthetic joint infection (P = .013) (P = .021), dislocation (P < .001) (P < .001), aseptic loosening (P = .040) (P = .002), periprosthetic fracture (P = .003) (P < .001), and revision (P < .001) (P < .001) at 1-year and 2-year follow-up, respectively.

Conclusion: While patients who have CNH are at a higher risk of wound and implant-related complications, they are comparatively lower than previously reported in literature. Orthopaedic surgeons should be cognizant of the increased risk in this population to provide appropriate preoperative counseling and enhanced perioperative medical management.

Keywords: Charcot neuroarthropathy; dislocation; hip; revision; total hip arthroplasty.

MeSH terms

Arthroplasty, Replacement, Hip* / adverse effects
Hip Prosthesis* / adverse effects
Humans
Patient Readmission
Periprosthetic Fractures* / etiology
Postoperative Complications / epidemiology
Postoperative Complications / etiology
Reoperation / adverse effects
Retrospective Studies
Risk Factors