|
Year |
2005 |
|---|---|
|
Question Number |
84. |
|
Category |
Hip and Knee Reconstruction |
Question
A 51-year-old woman with diabetes mellitus has progressive difficulty in walking. Radiographs are shown in Figures 24a and 24b. What is the most likely diagnosis?
1- Septic arthritis
2- Rheumatoid arthritis
3- Severe osteoarthritis
4- Charcot arthropathy
5- Gout
Figures
Answer (click for answer)
PREFERRED RESPONSE: 4
The figures show AP and lateral views of the knees with significant degenerative changes, including subluxation in the right knee, in a diabetic patient. This should automatically make you think of Charcot arthropathy. Charcot arthropathy most often develops in weight-bearing joints and is predominately caused by diabetes mellitus. Charcot arthropathy is generally believed to be related to the destruction of afferent proprioceptive fibers and subsequent unrecognized trauma to the joint. The loss of sensation to the joint is followed by severe degenerative changes, osteophyte formation, articular and subchondral fractures, and often calcification in the surrounding soft tissues. The progression of Charcot arthropathy is extremely variable.
Reference: RECOMMENDED READINGS: Parvizi J, Marrs J, Morrey BF: Total knee arthroplasty for neuropathic (Charcot) joints. Clin Orthop 2003;416:145-150.
Kim YH, Kim JS, Oh SW: Total knee arthroplasty in neuropathic arthropathy. J Bone Joint Surg Br 2002;84:216-219.
