Development of Charcot neuroosteoarthropathy of the knee joint after reconstructive surgery for diabetic neuroosteoarthropathy of the ankle joint; [Шарко коленного сустава после реконструктивной операции по поводу диабетической нейроостеоартропатии голеностопного сустава]

We present the results of examination and treatment of a patient with the consecutive development of diabetic neuroosteoarthropathy (DNOAP) of the ankle joint and knee joint of the same limb. The patient 24 y.o. with type 1 diabetes mellitus since age of 13 and DNOAP of the ankle joint (Eichenholtz 2). A supra-malleolar minimally invasive osteotomy of the fibula and tibia was performed with correction of deformation and stabilization of bone fragments by an external fixation device (EFD). EFD was removed 6 months later. During the initiation of walking, the development of the DNOAP of knee joint of the operated limb, diagnosed at stage 0 using magnetic resonance imaging, occurred. Complete unloading (crutches) in combination with immobilization with total contact cast led to the relief of the process in the knee joint without deformity formation for 4 months, which was confirmed by the disappearance of the temperature gradient, as well as magnetic resonance imaging data. 2.5 months after the end of immobilization, the patient walks with a 50% load on the limb, there are no clinical signs of recurrence of arthropathy of both localizations. Supra-malleolar minimally invasive osteotomy in combination with EFD fixation was effective in the defeat of the ankle joint, but it provoked the development of DNOAP of the knee joint. Perhaps other factors contributing to this could be a combination of vitamin deficiency, prolonged diarrhea, as well as aggravation of sarcopenia and weakening of the ligamentous apparatus of the limb due to uncompensated diabetes mellitus and prolonged immobilization. © 2023 GEOTAR Media. All rights reserved.