Total knee arthroplasty in Charcot and Charcot-like joints.

Nine total knee arthroplasties were performed in seven patients with the diagnosis of neuropathic arthropathy. The patients were divided into two groups, classical Charcot and Charcot-like. The histopathological findings in all of the knees, however, were essentially the same. These included hyperplastic synovium with bone and/or cartilage detritus, severe disorganization of the articular cartilage with invasion by a fibrous pannus, and hemosiderin deposits in synovial macrophages. Chronic inflammatory synovitis was noted in all cases. The results of total knee arthroplasty an average of three years after surgery (range, two to 4.25 years) were excellent in eight knees in six patients and good in one knee. Neuropathic knees can be treated by total joint arthroplasty if severe bone loss is corrected by either bone grafting or a custom-augmented prosthesis and if ligamentous balancing is adequately secured.