Lower-Extremity Amputation Risk After Charcot Arthropathy and Diabetic Foot Ulcer
- Min-Woong Sohn, PHD1,2,
- Rodney M. Stuck, DPM3,4,
- Michael Pinzur, MD4,
- Todd A. Lee, PHARMD, PHD1,5 and
- Elly Budiman-Mak, MD, MPH1,6
- 1Center for Management of Complex Chronic Care, Hines Veterans Affairs Hospital, Hines, Illinois;
- 2Institute for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, Illinois;
- 3Surgical Service, Hines Veterans Affairs Hospital, Hines, Illinois;
- 4Department of Orthopedic Surgery, Loyola University Stritch School of Medicine, Maywood, Illinois;
- 5Center for Pharmacoeconomic Research, Departments of Pharmacy Practice and Pharmacy Administration, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois;
- 6Department of Medicine, Loyola University Stritch School of Medicine, Maywood, Illinois.
- Corresponding author: Min-Woong Sohn, min-woong.sohn{at}va.gov.
Abstract
OBJECTIVE To compare risks of lower-extremity amputation between patients with Charcot arthropathy and those with diabetic foot ulcers.
RESEARCH DESIGN AND METHODS A retrospective cohort of patients with incident Charcot arthropathy or diabetic foot ulcers in 2003 was followed for 5 years for any major and minor amputations in the lower extremities.
RESULTS After a mean follow-up of 37 ± 20 and 43 ± 18 months, the Charcot and ulcer groups had 4.1 and 4.7 amputations per 100 person-years, respectively. Among patients <65 years old at the end of follow-up, amputation risk relative to patients with Charcot alone was 7 times higher for patients with ulcer alone and 12 times higher for patients with Charcot and ulcer.
CONCLUSIONS Charcot arthropathy by itself does not pose a serious amputation risk, but ulcer complication multiplicatively increases the risk. Early surgical intervention for Charcot patients in the absence of deformity or ulceration may not be advisable.
Footnotes
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This article presents the findings and conclusions of the authors; it does not necessarily represent the U.S. Department of Veterans Affairs or Health Services Research and Development Service.
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The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
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- Received August 11, 2009.
- Accepted September 28, 2009.
- © 2010 by the American Diabetes Association.
