Perioperative Factors Associated With Postoperative Failure-Free Survival After Arthrodesis for Diabetic Charcot Neuroarthropathy of the Foot or Ankle

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Abstract
Background: Evidence on perioperative factors associated with postoperative outcomes for diabetic Charcot neuroarthropathy (DCN) of the foot and ankle remains limited. We evaluated whether routinely available clinical, laboratory, and surgery-related variables were associated with postoperative failure-free survival (po-FFS) after arthrodesis. Methods: This single-center retrospective exploratory prognostic factor study screened consecutive surgically treated patients with DCN between June 2017 and October 2025. The final cohort included 83 patients with Eichenholtz stage III DCN of the foot or ankle treated with arthrodesis and follow-up sufficient for early endpoint ascertainment. The primary endpoint was early po-FFS. Kaplan-Meier analyses, Cox regression, sensitivity analyses, and supplementary analyses of anatomic variables and prior ulcer history were performed. Results: Thirty-five of 83 patients (42.2%) experienced postoperative failure, and 48 (57.8%) remained stable during follow-up. The estimated overall po-FFS was 96.0% (95% CI, 88.1%-98.7%) at 6 months and 45.3% (95% CI, 31.2%-58.5%) at 12 months. In the primary multivariable model, longer duration of diabetes (adjusted hazard ratio [HR] 1.091, 95% CI 1.034-1.150; P = .001) and smoking (adjusted HR 2.579, 95% CI 1.119-5.946; P = .026) were associated with worse po-FFS. Glycated hemoglobin (HbA1c) was not independently associated with po-FFS (adjusted HR 1.229, 95% CI 0.972-1.555; P = .085). In sensitivity analyses, duration of diabetes and smoking remained the most consistent factors. Fasting blood glucose was associated with worse po-FFS only in the alternative model replacing HbA1c. Brodsky classification and prior ulcer history were not independently associated with po-FFS after adjustment. Conclusion: Among patients with Eichenholtz stage III DCN of the foot or ankle treated with arthrodesis, diabetes duration and smoking showed the most consistent associations with early po-FFS. Glycemic markers may add information, but findings were marker-dependent. These exploratory findings require validation in larger prospective cohorts with longer follow-up. Level of Evidence: Level III, retrospective prognostic cohort study.
Funding Information
  • Xi'an Municipal Health Commission (No. 2025ms10)
  • Natural Science Foundation of Shaanxi Province (2025JC-YBMS-927)

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