J Korean Foot Ankle Soc.  2024 Sep;28(3):107-110. 10.14193/jkfas.2024.28.3.107.

Surgical Management of Neuropathic Arthropathy due to Rheumatoid Arthritis: A Case Report

• Yu H
• Kim J
• Lee S

• KMID: 2559640
• DOI: http://doi.org/10.14193/jkfas.2024.28.3.107

Abstract

Neuropathic arthropathy (Charcot arthropathy) is a progressive joint disease often associated with conditions such as diabetes, leading to severe joint deformity and pain. However, its occurrence in patients with rheumatoid arthritis (RA) is rare and not well documented. This case report describes a 48-year-old woman with a long history of RA who developed a severe deformity of her right ankle, identified as neuropathic arthropathy extending to the subtalar joint (Brodsky classification type 3A). After excluding other potential causes, the condition was determined to be secondary to RA-associated peripheral neuropathy. Surgery, including allograft and autograft fixation, was performed to correct the deformity. Post-operative complications, such as wound infection, were treated with negative pressure wound therapy and skin grafting. At the 18-month follow-up, the patient was able to walk without pain, demonstrating successful joint fusion.

Keyword

Neuropathic arthropathy; Charcot arthropathy; Rheumatoid arthritis

Figure

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  Figure 1 Preoperative plain radiograph of the right ankle showing severe deformity, joint space narrowing, and significant talar collapse, consistent with Brodsky classification type 3A neuropathic arthropathy.

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  Figure 2 Preoperative computed tomography scan of the right ankle demonstrating severe talar collapse and erosion, leading to significant deformity, indicative of Brodsky classification type 3A neuropathic arthropathy.

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  Figure 3 Postoperative plain radiographic follow-up, femoral head allograft and additional fixation with a semitubular plate, autograft were performed.

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  Figure 4 On the 7th postoperative day, there was inflammation and exudate in the surgical wound on the medial (Med) and lateral (Lat) sides, so a continuous debridement was performed after wound opening, and the metal plate was removed for wound improvement at the 3rd postoperative week, and negative pressure wound therapy was performed at the 4th postoperative week, and the wound showed improvement, and a split thickness skin graft was performed on the medial side at the 10th postoperative week.

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  Figure 5 Simple radiograph follow-up, 1.5 year after surgery.

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