Use of implantable bone growth stimulation in Charcot ankle arthrodesis

Background: The purpose of this study was to review the results of arthrodesis of the Charcot hindfoot when an implantable bone growth stimulator was added to the procedure. Arthrodesis of the Charcot hindfoot has a high nonunion and complication rate. Methods: Ten patients (ages 50 to 69 years) with Charcot neuroarthropathy of the ankle, hindfoot, or both had arthrodesis with use of rigid internal fixation and an implantable bone growth stimulator. There were six tibiotalo-calcaneal, two pantalar, and two tibiocalcaneal arthrodeses. An intramedullary nail was used in nine patients and a blade plate was used in one patient. All but one patient was diabetic. Four of the ten patients had preoperative osteomyelitis or postoperative infection. Another patient had purulent drainage, although cultures were negative. Four patients had a preoperative ulceration. Five patients had a two-stage procedure for debridement of infected bone, removal of hardware, and placement of antibiotic beads. Autogenous bone graft from the distal fibula or proximal tibia was used in all patients. Results: One patient with a preoperative osteomyelitis developed a stable ankle pseudarthrosis. The other nine patients fused at an average of 3.7 months after surgery for a fusion rate of 90%. There were two major complications and eight minor complications. There were no amputations. All patients were ambulatory in a double upright brace or shoes for diabetic patients and were free of ulceration at the time of followup. Average American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score improved from 21 preoperatively to 59 postoperatively. Conclusions: The adjunctive use of an implantable bone growth stimulator in conjunction with rigid internal fixation, autogenous bone grafting, and sound operative technique may enhance the outcome and fusion rate in patients undergoing arthrodesis for Charcot neuroarthropathy of the ankle and hindfoot.