Hinged total knee arthroplasty in two female patients with type 1 diabetes-associated charcot neuroarthropathy: case reports and a review of the literature series

Abstract

Background: Charcot neuroarthropathy (CN) is a rare musculoskeletal disorder caused by peripheral neuropathy, predominantly affecting the forefoot and ankle joints in diabetic patients. While more common in type 2 diabetes, type 1 diabetes-associated CN carries high risks of disability and mortality due to delayed diagnosis and nonspecific pathophysiology. Knee joint CN in type 1 diabetes remains exceptionally rare, with limited reports on standardized management—particularly regarding knee arthroplasty outcomes. Case Presentation: We report two female type 1 diabetes patients with knee joint CN. Both presented with poorly controlled hyperglycemia (blood glucose > 20 mmol/L) and elevated HbA1c. Each underwent total knee arthroplasty (TKA); one patient additionally received autologous bone grafting with titanium mesh screw fixation for severe bone defects, Intraoperative pathological examination was performed in all cases to rule out infection. Conclusion: These cases highlight the complexity of managing knee CN in type 1 diabetes. TKA represents a viable intervention, though outcomes may vary based on surgical adjuncts like bone grafting. This report, contextualized with a literature review, underscores the need for individualized approaches in this high-risk population.