J S R G Saran, Department of Orthopaedics, M S Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India. E-mail: jsaran868@gmail.com
Abstract
Background: Charcot neuroarthropathy is a progressive destructive joint disorder resulting from loss of protective sensation, most frequently associated with diabetes mellitus but rarely affecting the knee. Diagnosis is often delayed because Charcot knee can mimic septic arthritis, particularly in critically ill patients with elevated inflammatory markers. Advanced cases may present with severe instability, pseudoarthrosis, or joint collapse, complicating management.
Case Report: An 83-year-old man with hydrocephalus, encephalopathy and Type 2 diabetes mellitus was admitted to the intensive care unit with sepsis. During physiotherapy, he was found to have a painful, immobile and swollen right knee, raising concern for septic arthritis. Aspiration yielded blood-tinged fluid with negative Gram stain and cultures. Radiographs and computed tomography demonstrated a neglected distal femoral fracture with non-union, condylar collapse, pseudoarthrosis, patellar fragmentation, and tibial plateau erosion. Magnetic resonance imaging showed complete cruciate ligament tears, meniscal destruction and medial collateral ligament attenuation. History revealed several years of recurrent falls and 7 months of non-ambulation, consistent with neuropathic joint neglect.
Results: Given extensive joint destruction, knee arthrodesis with an Ilizarov fixator was considered the only viable salvage procedure; however, severe comorbidities and high anesthetic risk led to family refusal. The patient was managed conservatively with bracing, analgesia, physiotherapy and pneumatic compression, stabilizing systemically before discharge. Long-term outcomes could not be assessed due to loss to follow-up.
Conclusion: This case illustrates an uncommon presentation of Charcot knee arising from combined central and peripheral neurological impairment, emphasizing diagnostic challenges and the necessity of individualized, risk-sensitive management in medically fragile patients.
Keywords: Charcot joint, neuroarthropathy, knee joint, diabetes mellitus, hydrocephalus, conservative treatment.
References
- 1. Cardile C, Cazzaniga C, Manzini B, Bongiovanni M, Marasco R, Ragni P. The Charcot knee arthropaty: The diagnostic and surgical challenge. A case of syphilis arthropaty and a review of literature. Arch Bone Jt Surg 2021;9:461-6. [Google Scholar]
- 2. Kucera T, Urban K, Sponer P. Charcot arthropathy of the knee. A case-based review. Clin Rheumatol 2011;30:425-8. [Google Scholar]
- 3. Chan RL, Chan CH, Chan HF, Pan NY. The many facets of neuropathic arthropathy. BJR Open 2019;1:20180039. [Google Scholar]
- 4. Rosenbaum AJ, DiPreta JA. Classifications in brief: Eichenholtz classification of Charcot arthropathy. Clin Orthop Relat Res 2015;473:1168-71. [Google Scholar]
- 5. Lu V, Zhang J, Thahir A, Zhou A, Krkovic M. Charcot knee – presentation, diagnosis, management – a scoping review. Clin Rheumatol 2021;40:4445-56. [Google Scholar]
- 6. Lim W, Barras CD, Zadow S. Radiologic mimics of osteomyelitis and septic arthritis: A pictorial essay. Radiol Res Pract 2021;2021:9912257. [Google Scholar]
- 7. Long B, Koyfman A, Gottlieb M. Evaluation and management of septic arthritis and its mimics in the emergency department. West J Emerg Med 2019;20:331-41. [Google Scholar]
- 8. Berzenji AI, Rasul DN, Alany AM. Effectiveness of the Ilizarov method in treating complex nonunions of the lower limb long bones. J Int Med Res 2025;53:3000605251337911. [Google Scholar]
- 9. Kumar H, Kamble RS, Kamble SL. Knee Arthodesis, as a salvage procedure for Non-union of floating knee after ilizarov fixation-A case report. J Orthop Case Rep 2025;15:239-43. [Google Scholar]
- 10. Gooday C, Hardeman W, Poland F, Woodburn J, Dhatariya K. Controversies in the management of active Charcot neuroarthropathy. Ther Adv Endocrinol Metab 2023;14:20420188231160406. [Google Scholar]