Die Charcot Neuroarthropathie des Kniegelenkes

Zusammenfassung

Hintergrund Während die Charcot Neuroarthropathie (CN) des Fußes immer mehr Aufmerksamkeit gewinnt, wird die CN des Knies kaum beachtet. Zwar erschienen in den letzten Jahren einige Publikationen zu CN des Knies, es handelte sich aber fast ausschließlich um Einzelfallbeschreibungen und meist dann auch nur zur endoprothetischen Versorgung. Es existieren nur 2 systematische Beschreibungen der Erkrankung.

Ergebnisse Es wird an Hand eines Patienten nun der Krankheitsverlauf und die Charakteristika der CN am Knie detailiert sowie die Therapieoptionen dargestellt und in den Kontext einer vorangegangenen Publikation mit 3 Patienten mit CN des Kniegelenkes gesetzt. Die CN des Kniegelenkes zeigte die gleiche schubartige und stadienhafte Klinik analog zur CN des Fußes. Die Anwendung derselben Therapieprinzipien wie bei der CN des Fußes (sofortige Immobilisierung und Offloading) führte in allen Fällen zu einer schnellen Überführung in ein inaktives Stadium mit Konsolidierung des Befundes, sodass alle Patienten mittels Orthesen und ohne Operation wieder gehfähig wurden. Es handelte sich bei allen Patienten um Diabetiker mit multiplen Komplikationen (3x Diabetes Typ I, 1x Diabetes Typ 2), alle litten an einer stark fortgeschrittenen Polyneuropathie der unteren Extremität.

Schlußfolgerung Die CN des Kniegelenkes stellt eine schwere Komplikation bei Polyneuropathie dar und darf nicht übersehen werden. Dieselben Diagnose- und Behandlungskriterien wie bei der CN des Fußes führten zum Erhalt von Knie und Gehfähigkeit.

Abstract

Background In contrast to CN of the foot, which is gaining increasing interest, CN of the knee is hardly recognised. There have been publications about CN of the knee in recent years, but nearly all of them are only case reports and deal with endoprosthetics. There are only 2 systematic descriptions of CN of the knee.

Results Based on one patient, the clinical course, characteristics and treatment options are detailed and set into the context of a previous publication of three cases of CN of the knee. CN of the knee and CN of the foot have the same episodic course with flares. In all cases, the same treatment principals as in CN of the foot (immediate immobilisation und offloading) led to an inactive stage with consolidation, so that all patients were able to walk again with orthoses but without surgery. All patients had diabetes mellitus with multiple complications (3 x type 1 diabetes, 1 x type 2 diabetes), and all patients suffered from advanced polyneuropathy of the lower extremity.

Conclusion CN of the knee is a severe complication of polyneuropathy and should not be overlooked. The same criteria for diagnosis and treatment as in CN of the foot proved to be successful.

Schlüsselwörter

Charcot Neuroathropathie - Diabetes mellitus - Knie - Polyneuropathie - DNOAP

Key words

Charcot neuroarthropathy - diabetes mellitus - Knee - polyneuropathy - DNOAP

Publication History

Article published online:
18 June 2020

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