JOA - 2026-06-18 - Journal Article
Use of Zonal Fixation Therapy and Metal Augmentation for Rotating-Hinge Knee Arthroplasty in Charcot Arthropathy: A Comparative Study.
Zheng W, Tang J, Xiao W, Wang X, Wang J
Topics
Key Takeaway
RHK-pTKA guided by zonal fixation theory achieved 94.44% 5-year prosthesis survival in Charcot knee arthropathy, equivalent to non-Charcot controls (94.29%), despite greater bone defect burden and more frequent metal augmentation requirements.
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Summary
This study evaluated whether zonal fixation theory could guide RHK-pTKA in Charcot knee arthropathy and compared outcomes against non-Charcot RHK-pTKA controls. Preoperative planning used a square zoning method targeting fixation in at least two zones; metal augmentation was used more frequently in the Charcot group (P<0.05). At 60 months, prosthesis survival was 94.44% vs 94.29%, and final patient-reported outcomes were equivalent between groups despite lower Charcot baseline scores.
Key Limitation
The Charcot cohort is heterogeneous in etiology (diabetic neuropathy prevalence noted but underlying causes not stratified), preventing conclusions about whether survivorship and complication rates differ by neuropathic etiology.
Original Abstract
BACKGROUND
Charcot knee arthropathy requiring primary total knee arthroplasty (pTKA) with a rotating-hinge knee (RHK) is rare, with no established reconstructive guidelines. Bone defect management in these cases is technically challenging. This study evaluated the zonal fixation theory for guiding RHK-pTKA, compared outcomes between Charcot and non-Charcot arthropathy, and assessed bone defect reconstruction methods.
METHODS
We retrospectively analyzed 51 patients (53 knees) undergoing RHK-pTKA. Preoperative planning followed the zonal fixation theory using a square zoning method. The mean follow-up was 87.0 months (range, 61 to 108). The cohort comprised 16 Charcot patients (18 knees) and 35 non-Charcot patients (35 knees). Demographic data, surgical parameters, clinical outcomes, radiographic indicators, prosthesis survival, and complications were compared between groups. Metal augmentation for bone defect reconstruction in Charcot knees was specifically evaluated.
RESULTS
Postoperative imaging confirmed reliable prosthesis fixation in at least two zones, with significant limb alignment improvement. Overall, patient-reported outcomes improved significantly. Prosthesis survival at 60 months was 94.34% overall, 94.44% in the Charcot group, and 94.29% in the non-Charcot group. Compared to non-Charcot patients, the Charcot group was older, had more diabetes, and exhibited lower preoperative patient-reported outcomes (P < 0.05). The Charcot group also required more frequent metal augmentation (P < 0.05). During follow-up, one Charcot and two non-Charcot patients underwent revision. At final follow-up, no significant differences existed between groups in postoperative patient-reported outcomes or prosthesis survival (P > 0.05).
CONCLUSION
The zonal fixation theory effectively guides RHK-pTKA, achieving favorable outcomes and prosthesis survival. RHK-pTKA is effective for severe Charcot knee arthropathy, with metal augmentation offering a viable option for bone defect management.