Charcot neuroarthropathy (CN) is a rare but serious sequela of diabetes and other diseases that cause peripheral neuropathy. It is most commonly characterized by degeneration of the foot and/or ankle joints leading to progressive deformity and altered weight-bearing. If left untreated, the deformities of CN lead to ulceration, infection, amputation, and even death. Because of the associated peripheral neuropathy and proprioception deficits that accompany CN, patients typically do not perceive the onset of joint destruction. Moreover, in the hands of the untrained clinician, the initial presentation of CN can easily be mistaken for infection, osteoarthritis, gout, or inflammatory arthropathy. Misdiagnosis can lead to the aforementioned serious sequelae of CN. Thus, an early accurate diagnosis and off-loading of the involved extremity, followed by prompt referral to a specialist trained in the care of CN are crucial to prevent the late-term sequelae of the disease. The purpose of this article was to create an opportunity for enhanced understanding between orthopedic surgeons and emergency physicians, to improve patient care through the optimization of diagnosis and early management of CN in the emergent setting. Keywords: Charcot neuroarthropathy; Charcot foot; diabetes mellitus; midfoot collapse; emergency.

Introduction: Launched in 2018 for revision total ankle arthroplasty (rTAA), the INVISION talar component addresses subsidence when poor talar bone stock is present. Due to the recency of the market-availability of the INVISION, studies evaluating its efficacy are lacking. This study presents the first analysis of early-term outcomes of patients undergoing rTAA with the INVISION talar component. Methods: This was a single-center, retrospective review of 28 patients undergoing rTAA with the INVISION talar component and INBONE II tibial component performed between 2018 and 2022. Data on preoperative characteristics, postoperative complications, secondary procedures, and survivorship were collected. The primary outcome measures were rates of major complications, re-operation, and implant failure. Secondary outcomes included post-operative changes in varus and valgus alignment of the tibia and talus. Results: The most common secondary procedures performed with rTAA were medial malleolus fixation (n = 22, 78.6%) and gastrocnemius recession (n = 14, 50%). Overall, 10.7% (n = 3) of patients underwent reoperation and 14.3% (n = 4) suffered major complications. Incidence of implant failure was 10.7% (n = 3). All reoperations were caused by infection. Mean varus alignment of the tibia and talus improved from 4.07 degrees and 4.83 degrees to 1.67 degrees and 1.23 degrees, respectively. Mean valgus alignment of the tibia and talus improved from 3.67 degrees and 4.22 degrees to 2.00 degrees and 2.32 degrees, respectively. Conclusions: In a series of 28 patients undergoing rTAA with the INVISION talar component, we discovered comparatively low rates of reoperation, major complication, and implant failure (10.7%, 14.3%, and 10.7%). The INVISION system appears to have a reasonable safety profile, but further studies evaluating long-term outcomes are required to assess the efficacy of the INVISION system.

Background/Objectives: Locally recurrent osteosarcoma is associated with high patient morbidity and mortality, yet the risk factors for local recurrence remain incompletely understood. Therefore, the objective of this study was to comprehensively assess the impact of tumor histology, patient demographics, surgical resection, and chemotherapy delivery on the risk of local recurrence, development of metastases, and overall patient survival in osteosarcoma. Methods: This single-center retrospective review included 102 patients with skeletal osteosarcoma who underwent primary surgical resection between August 2001 and August 2021. Primary outcomes included the development and timing of local recurrence following primary resection. Data was abstracted from the electronic medical record, and statistical analyses were performed to identify demographic, tumor, or management (surgical and chemotherapy) related factors associated with an increased risk of local recurrence. Results: Locally recurrent osteosarcoma developed in 13.7% (n = 14) of patients after primary resection. Patients with local recurrence were more likely to have the chondroblastic subtype (57.1% versus 19.3% in those without local recurrence, p = 0.005). The chondroblastic subtype was associated with shorter local recurrence-free survival and overall survival than other histologic subtypes (p < 0.001). Resection approach, surgical margin status, histologically assessed response to neoadjuvant chemotherapy, and type and dose intensity of chemotherapy delivered were not statistically associated with risk of local recurrence. Conclusions: Chondroblastic histology is a risk factor for local recurrence in osteosarcoma and is associated with poor overall survival in our patient cohort.