Lower-Extremity Amputation Risk Following Charcot Arthropathy and Diabetic Foot Ulcer
- Min-Woong Sohn, PhD. (Min-Woong.Sohn{at}va.gov)1,2,
- Rodney M. Stuck, DPM3,4,
- Michael Pinzur, MD4,
- Todd A. Lee, PharmD, PhD.1,5 and
- Elly Budiman-Mak, MD, MPH1,6
- 1 Center for Management of Complex Chronic Care, Hines VA Hospital, Hines, IL
- 2 Institute for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL
- 3 Surgical Service, Hines VA Hospital, Hines, IL
- 4 Department of Orthopaedic Surgery, Loyola University Stritch School of Medicine, Maywood, IL
- 5 Center for Pharmacoeconomic Research, Departments of Pharmacy Practice and Pharmacy Administration, College of Pharmacy, University of Illinois at Chicago, Chicago, IL
- 6 Department of Medicine, Loyola University Stritch School of Medicine, Maywood, IL
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 five 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 seven times higher for patients with ulcer alone and twelve times higher for patients with Charcot and ulcer.
Conclusions: Charcot arthropathy by itself does not pose a serious amputation risk, but ulcer complication multiplicatively increased the risk. Early surgical intervention for Charcot patients in the absence of deformity or ulceration may not be advisable.
Footnotes
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- Received August 11, 2009.
- Accepted September 28, 2009.
- Copyright © American Diabetes Association
