Treatment Failures in Diabetic Foot Osteomyelitis Associated with Concomitant Charcot Arthropathy - The Role of Underlying Arteriopathy.

OBJECTIVE Therapy of diabetic foot osteomyelitis (DFO) with Charcot neuroosteoarthropathy is challenging. In patients with diabetic Charcot osteomyelitis (DCO), both the anatomic deformity and infection must be addressed. We assessed the outcomes of DCO therapy and variables associated with treatment failure and compared them to outcomes of DFO cases. METHODS Single-center, retrospective, case-control study, comparing 93 DCO episodes with 530 DFO episodes, using Kaplan-Meier survival curves and multivariate Cox regression analyses. RESULTS Clinical failure occurred in 21.5% of DCO compared to 22.3% in DFO episodes (p=0.89) and was associated with peripheral arterial disease (PAD) stages 3 or 4 (HR 6.1; CI 2.0-18.1) and chronic treatment with immunosuppressives (HR 7.4; CI 2.0-27.1). Major amputations were significantly more frequent in DCO (28% versus 13.6%; p<0.01) and associated with PAD, stages 3 and 4 (HR 8.0, CI 2.2-29.4), smoking (HR 5.4; CI 1.2-24.6), alcohol abuse (HR 3.5; CI 1.1-10.6) and renal dialysis (HR 4.9; CI 1.3-18.9). CONCLUSIONS Clinical treatment failures did not differ between DCO and DFO. However, patients with DCO underwent major amputation twice as often as those with DFO. Unlike widespread beliefs, treatment failure in DCO patients may, similar to DFO, be associated with a striking epidemiological link to severe PAD.