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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Neuropathic arthritis is a destructive arthropathy frequently associated with loss of proprioception. A third of patients, however, may have no demonstrable neurological deficit. Patients with diabetes, syphilis, syringomyelia and other neuropathies are particularly prone to developing this joint disease. The diagnosis of Charcot's joints should be considered in anyone who develops what appears to be a severe osteoarthritis or a transverse fracture of the tibia or fibula after minor trauma. Scoliosis with particularly destructive changes on radiography should prompt a search for syringomyelia or syphilis. The most common radiographic abnormalities are those of distension in 3D (Dislocation, Destruction and Degeneration). An atrophic form with resorption of the proximal humerus, most frequently described in syringomyelia, has been observed in diabetes. Loss of the distal end of the clavicle has not been described before in the neuropathies. These changes coupled with speckled calcification or shards of bone in the periarticular soft tissue confirm the diagnosis. Infection and CPPD crystal disease can be difficult to exclude. The joint fluid may be inflammatory and infection may be a complication. Treatment includes anti-inflammatories and splinting. Indications for surgery are limited.
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PMID:The neuropathic joint. 807 Jan 70

Neuropathic arthritis, or Charcot arthropathy, is a rapidly destructive process associated with nerve damage and periarticular insensitivity. Most commonly it is associated with diabetes mellitus, tabes dorsalis, syringomyelia, or other peripheral nerve disorders. Clinical manifestations of this disorder classically include gross deformity, crepitus, lack of proprioception, joint effusion, calor, and decreased awareness of pain in the affected joint. Often the clinical picture is difficult to distinguish from septic arthritis. Radiographic findings are typically worse than portrayed during clinical examination. Rapid destruction of the articular surface with bony fragmentation is commonly found. The incidence of neuropathic arthritis among all diabetic patients is relatively small, ranging between 0.15% and 0.4%. Historically, there have been conflicting reports as to the efficacy of total knee arthroplasty (TKA) in patients with neuropathic arthritis. However, recent literature on the use of modern implants has been more optimistic as to the success of TKA. Difficulties associated with severe bone loss, poor bone quality, and ligamentous laxity may necessitate the use of structural allografts/augments, as well as stemmed and/or constrained TKA components. This article presents a case of a patient with Charcot arthropathy of the knee secondary to diabetes mellitus (type 2) treated successfully with a minimally constrained TKA and a porous tantalum cone (Zimmer, Warsaw, Indiana) as an "internal plate," for reconstruction of a combined segmental/cavitary defect of the proximal tibia. At 2-year follow-up, radiographs revealed stable TKA components with reconstitution of the fragmented proximal tibia around an osseointegrated porous cone.
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PMID:Proximal tibia reconstruction with a porous tantalum cone in a patient with Charcot arthropathy. 1947 57