Background: Charcot neuroarthropathy is a non-infective, destructive process occurring in patients rendered insensate by peripheral neuropathy, which is caused mainly by diabetes. Repetitive trauma from standing and walking provides a neuro-traumatic stimulus that leads to dislocation, or peri-articular fracture, or both, within the ankle. This review concentrates on the management protocols regarding the ankle only. Methods: A Pubmed search for clinical trials performed to manage ankle Charcot neuroarthropathy and a systematic review of these articles were undertaken. Results: Twenty papers met the inclusion criteria: four of them describe non-surgical management, while the rest show different surgical management options of ankle Charcot neuroarthropathy. Conclusions: Surgical algorithms for the treatment of CN of the ankle are based almost entirely on level four. There is inconclusive evidence concerning the timing of treatment and the use of different fixation methods. Instability and ulceration are the main precursors for surgical interventions. Prospective series and randomized studies, albeit difficult to perform, are necessary to support and strengthen current practice.

Major joint arthroplasty is one of the most quality-of-life-enhancing operations. However, one of the devastating potential complications is prosthetic joint infection. The diagnosis of prosthetic joint infection (PJI) can be challenging. There has been a growing interest in synovial fluid biomarkers for this purpose. Alpha defensin (AD) is an available biomarker to help clinicians diagnose PJI. Prompt accurate diagnosis of PJI is crucial for successful treatment. However, there is no single gold standard diagnostic test. Instead, clinicians use a battery of tests collectively to draw a diagnosis. One of the quickest and promising available synovial biomarkers is the AD test. AD is a small peptide that is secreted by neutrophils in response to infection and has lethal effects on infecting organisms. There are two current techniques for detecting alpha defensin in synovial fluid; enzyme-linked immunosorbent assay (ELISA) and the lateral flow test. This review highlights the benefits and limitations of the use of AD as a diagnostic tool for PJI.