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Article: Is there a need for diabetic foot orthopaedic surgery as a sub-specialty?

Kavarthapu, Venu

Journal of clinical orthopaedics and trauma

2021 Volume 17, Page(s) 72–73

Language	English
Publishing date	2021-02-09
Publishing country	India
Document type	Editorial
ZDB-ID	2596956-0
ISSN	2213-3445 ; 0976-5662
ISSN (online)	2213-3445
ISSN	0976-5662
DOI	10.1016/j.jcot.2021.02.004
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Article ; Online: Managing Cavovarus Feet in Diabetic Patients.

Tiruveedhula, Madhu / Kavarthapu, Venu

Foot and ankle clinics

2023 Volume 28, Issue 4, Page(s) 873–887

Abstract: A cavovarus foot is characterized by exacerbated medial longitudinal arch (cavus), hindfoot varus, plantar flexed first ray, forefoot pronation (apparent supination), forefoot adduction, and claw toe deformities. It can be broadly divided as flexible and ...

Abstract	A cavovarus foot is characterized by exacerbated medial longitudinal arch (cavus), hindfoot varus, plantar flexed first ray, forefoot pronation (apparent supination), forefoot adduction, and claw toe deformities. It can be broadly divided as flexible and rigid and further classified based on the neurological and non-neurological causes. Diabetes associated peripheral neuropathy complicates individual bony deformities associated with cavovarus foot with early callus which can breakdown to ulceration rapidly. Based on the disease progression in neurological and non-neurological causes of cavovarus feet in patients with diabetic neuropathy, 3 stages of the disease and its management is described.
MeSH term(s)	Humans ; Talipes Cavus/complications ; Talipes Cavus/therapy ; Treatment Outcome ; Foot ; Foot Deformities/etiology ; Foot Deformities/surgery ; Diabetes Mellitus
Language	English
Publishing date	2023-06-17
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2051688-5
ISSN	1558-1934 ; 1083-7515
ISSN (online)	1558-1934
ISSN	1083-7515
DOI	10.1016/j.fcl.2023.05.006
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Zs.A 5780: Show issues

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Article ; Online: Etiology, Epidemiology, and Outcomes of Managing Charcot Arthropathy.

Hester, Thomas / Kavarthapu, Venu

Foot and ankle clinics

2022 Volume 27, Issue 3, Page(s) 583–594

Abstract: Surgical intervention for Charcot arthropathy is becoming more common; this is driven by an increased prevalence, better understanding of the cause, identifying patient risk factors that influence outcomes, and how to best optimize these. This article ... ...

Abstract	Surgical intervention for Charcot arthropathy is becoming more common; this is driven by an increased prevalence, better understanding of the cause, identifying patient risk factors that influence outcomes, and how to best optimize these. This article aims to summarize the cause of Charcot, look at the factors that influence the outcomes, and the financial cost of managing what is a very challenging condition.
MeSH term(s)	Arthropathy, Neurogenic/diagnosis ; Arthropathy, Neurogenic/epidemiology ; Arthropathy, Neurogenic/etiology ; Humans
Language	English
Publishing date	2022-08-10
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2051688-5
ISSN	1558-1934 ; 1083-7515
ISSN (online)	1558-1934
ISSN	1083-7515
DOI	10.1016/j.fcl.2022.03.002
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Article ; Online: Combined Charcot hindfoot and midfoot reconstruction using internal fixation method-surgical technique and single surgeon series.

Kavarthapu, Venu / Guduri, Venugopal / Hester, Thomas

Annals of joint

2023 Volume 8, Page(s) 10

Abstract: Isolated midfoot and hindfoot Charcot reconstruction using internal fixation is increasingly a common procedure in multidisciplinary diabetic foot units, and the surgical techniques using internal fixation have well been described. However, about a third ...

Abstract	Isolated midfoot and hindfoot Charcot reconstruction using internal fixation is increasingly a common procedure in multidisciplinary diabetic foot units, and the surgical techniques using internal fixation have well been described. However, about a third of Charcot deformities that require surgical limb salvage present with the involvement of midfoot and hindfoot. Surgical reconstruction of a combined hindfoot and midfoot deformity is an evolving technique and technically challenging. We present the surgical technique of deformity correction and stabilisation using internal fixation, developed by the senior author (VK), and present the outcomes. All patients that had undergone combined hindfoot and midfoot reconstruction to address a limb threatening deformity due to Charcot neuroarthropathy, performed by the senior author, with a minimum follow-up of 12 months, have been included in this study. The principles of surgical reconstruction included adequate pre-operative optimisation of the patient, sequential deformity correction and stabilisation of the hindfoot followed by midfoot using the principle of long-segment rigid internal fixation with optimal bone opposition. Standard post-operative regime, including offloading, has been used in all patients. A total of 34 patients (35 feet) had undergone combined midfoot and hindfoot Charcot reconstruction between January 2009 and December 2019. Active ulcers were noted in 13 feet at the time of the procedure. Eleven reconstructions were performed as two-stage procedures due to the presence of active infection. At a mean follow-up of 53 months, 11/13 ulcer healed, and 32 patients (33 feet) were full weightbearing in surgical shoes or a brace at the latest follow-up. Bone fusion was noted in 28 feet in the hindfoot region and 32 feet in the midfoot. Metal work failure was noted in 5 feet requiring removal in 3 feet. Revision procedures were required in 4 patients. Our newly described technique of combined hindfoot and midfoot Charcot has provided functional limb salvage in majority of presentations, with an acceptable level of complications, at a medium-term follow-up of 53 months.
Language	English
Publishing date	2023-01-15
Publishing country	China
Document type	Journal Article
ISSN	2415-6809
ISSN (online)	2415-6809
DOI	10.21037/aoj-22-23
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Article ; Online: Charcot neuroarthropathy in persons with diabetes: It's time for a paradigm shift in our thinking.

Wukich, Dane K / Frykberg, Robert G / Kavarthapu, Venu

Diabetes/metabolism research and reviews

2023 Volume 40, Issue 3, Page(s) e3754

Abstract: The aim of this paper is to review the recent literature regarding the epidemiology and surgical management of Charcot neuro-osteoarthropathy (CNO). We propose that a fundamental change in the approach and assumptions regarding the historical treatment ... ...

Abstract	The aim of this paper is to review the recent literature regarding the epidemiology and surgical management of Charcot neuro-osteoarthropathy (CNO). We propose that a fundamental change in the approach and assumptions regarding the historical treatment of active CNO should be considered. Although the true incidence and prevalence of CNO in the US population with diabetes are not known, we estimated the incidence to be 27,602 per year and the prevalence to be 208,880 persons. In persons with diabetes, the incidence of CNO is higher than that of prostate, lung, kidney, and thyroid cancer, and in the entire US population, the incidence of CNO is higher than that of multiple myeloma, soft tissue sarcoma, and primary bone sarcoma. In persons with diabetes, the incidence of CNO is higher than fractures of the femoral shaft, distal femur, tibia, talus, calcaneus and Lisfranc ligament injuries. Surgical techniques have evolved over the past half century, and surgery is the standard for treating displaced fractures and intra-articular injuries. Since CNO is a fracture, dislocation, or fracture dislocation in patients with neuropathy, why do we treat CNO differently? Elsewhere in the skeleton displaced osseous and ligament injuries are treated surgically. Based on the information presented in this manuscript, we suggest that it is time for a paradigm shift in the treatment of persons with CNO. While uncommon, CNO in persons with diabetes is not rare. Given the advances in surgical techniques, surgical intervention should be considered earlier in persons with CNO who are at risk for developing deformity related foot ulceration.
MeSH term(s)	Male ; Humans ; Diabetes Mellitus ; Fractures, Bone ; Foot ; Peripheral Nervous System Diseases ; Arthropathy, Neurogenic/complications ; Arthropathy, Neurogenic/epidemiology
Language	English
Publishing date	2023-12-08
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	1470192-3
ISSN	1520-7560 ; 1520-7552
ISSN (online)	1520-7560
ISSN	1520-7552
DOI	10.1002/dmrr.3754
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Zs.A 2119: Show issues

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ab Jg. 2022: Lesesaal (EG)

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Article: Surgical management of Charcot foot - The advancements over the past decade.

Khan, Omeair / Kavarthapu, Meghana / Edmonds, Michael / Kavarthapu, Venu

Journal of clinical orthopaedics and trauma

2023 Volume 47, Page(s) 102317

Abstract: Charcot neuroarthropathy is a progressive, destructive condition leading to deformity, dysfunction and, in some cases, amputation. Much evolution has occurred over the last couple of decades in the management of Charcot foot with a focus on developing ... ...

Abstract	Charcot neuroarthropathy is a progressive, destructive condition leading to deformity, dysfunction and, in some cases, amputation. Much evolution has occurred over the last couple of decades in the management of Charcot foot with a focus on developing limb salvage and reconstructive techniques. The aim has been to achieve a stable plantigrade foot that remains pain and ulcer-free whilst reducing amputation rates. Soft tissue and bony reconstructions have been explored, and various modalities of fixation, including internal, external, and combined techniques, have been described and their outcomes published. Currently, no strong evidence exists which supports a particular modality of treatment, nor have there been any randomised studies to this effect, but the results are nevertheless promising. Recent studies have reported on minimally invasive techniques, the use of super construct fixation, computer-navigated deformity correction, the efficacy of techniques such as subtalar arthrodesis or tendon balancing procedures and staged deformity corrections. There is a need for more controlled and comparative studies with consistent reporting of intended outcomes to create a stronger portfolio of evidence on the surgical management of Charcot foot.
Language	English
Publishing date	2023-12-14
Publishing country	India
Document type	Journal Article
ZDB-ID	2596956-0
ISSN	2213-3445 ; 0976-5662
ISSN (online)	2213-3445
ISSN	0976-5662
DOI	10.1016/j.jcot.2023.102317
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Article ; Online: Two-stage reconstruction of infected Charcot foot using internal fixation : a promising functional limb salvage technique.

Kavarthapu, Venu / Budair, Basil

The bone & joint journal

2021 Volume 103-B, Issue 10, Page(s) 1611–1618

Abstract: Aims: In our unit, we adopt a two-stage surgical reconstruction approach using internal fixation for the management of infected Charcot foot deformity. We evaluate our experience with this functional limb salvage method.: Methods: We conducted a ... ...

Abstract	Aims: In our unit, we adopt a two-stage surgical reconstruction approach using internal fixation for the management of infected Charcot foot deformity. We evaluate our experience with this functional limb salvage method. Methods: We conducted a retrospective analysis of prospectively collected data of all patients with infected Charcot foot deformity who underwent two-stage reconstruction with internal fixation between July 2011 and November 2019, with a minimum of 12 months' follow-up. Results: We identified 23 feet in 22 patients with a mean age of 56.7 years (33 to 70). The mean postoperative follow-up period was 44.7 months (14 to 99). Limb salvage was achieved in all patients. At one-year follow-up, all ulcers have healed and independent full weightbearing mobilization was achieved in all but one patient. Seven patients developed new mechanical skin breakdown; all went on to heal following further interventions. Fusion of the hindfoot was achieved in 15 of 18 feet (83.3%). Midfoot fusion was achieved in nine of 15 patients (60%) and six had stable and painless fibrous nonunion. Hardware failure occurred in five feet, all with broken dorsomedial locking plate. Six patients required further surgery, two underwent revision surgery for infected nonunion, two for removal of metalwork and exostectomy, and two for dynamization of the hindfoot nail. Conclusion: Two-stage reconstruction of the infected and deformed Charcot foot using internal fixation and following the principle of 'long-segment, rigid and durable internal fixation, with optimal bone opposition and local antibiotic elusion' is a good form of treatment provided a multidisciplinary care plan is delivered. Cite this article:
MeSH term(s)	Adult ; Aged ; Arthrodesis/methods ; Arthropathy, Neurogenic/complications ; Arthropathy, Neurogenic/surgery ; Diabetic Foot/complications ; Diabetic Foot/surgery ; Female ; Follow-Up Studies ; Humans ; Limb Salvage/methods ; Male ; Middle Aged ; Retrospective Studies ; Staphylococcal Infections/etiology ; Staphylococcal Infections/surgery ; Treatment Outcome
Language	English
Publishing date	2021-09-20
Publishing country	England
Document type	Evaluation Study ; Journal Article
ZDB-ID	2697156-2
ISSN	2049-4408 ; 2049-4394
ISSN (online)	2049-4408
ISSN	2049-4394
DOI	10.1302/0301-620X.103B10.BJJ-2021-0339.R2
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Zs.A 6989: Show issues

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Article: Charcot hindfoot deformity reconstruction using a hindfoot nail- surgical technique.

Kavarthapu, Venu / Hester, Thomas

Journal of clinical orthopaedics and trauma

2021 Volume 16, Page(s) 277–284

Abstract: Various techniques of reconstruction of deformed Charcot hindfoot using different internal fixation devices have been described in the literature. We present our surgical technique using specific principles that has resulted in improved outcomes to allow ...

Abstract	Various techniques of reconstruction of deformed Charcot hindfoot using different internal fixation devices have been described in the literature. We present our surgical technique using specific principles that has resulted in improved outcomes to allow correction of deformity, obtain stability and allow progression to weightbearing in orthotic shoes. We describe our preoperative evaluation, planning and surgical timing. We also hope to share some technical pearls and details on the finer points to achieve a satisfactory correction and reduce the learning curve.
Language	English
Publishing date	2021-02-23
Publishing country	India
Document type	Journal Article
ZDB-ID	2596956-0
ISSN	2213-3445 ; 0976-5662
ISSN (online)	2213-3445
ISSN	0976-5662
DOI	10.1016/j.jcot.2021.02.007
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Article: Investigation and management of diabetic foot osteomyelitis: An update for the foot and ankle orthopaedic surgeon.

Alkhalfan, Yousif / Lewis, Thomas Lorchan / Kavarthapu, Venu / Hester, Thomas

Journal of clinical orthopaedics and trauma

2023 Volume 48, Page(s) 102330

Abstract: Diabetic foot osteomyelitis (DFO) poses a significant challenge in the management of diabetic patients, often leading to severe complications and increased morbidity. Effective management of DFO requires a multidisciplinary approach, involving ... ...

Abstract	Diabetic foot osteomyelitis (DFO) poses a significant challenge in the management of diabetic patients, often leading to severe complications and increased morbidity. Effective management of DFO requires a multidisciplinary approach, involving endocrinologists, infectious disease specialists, vascular surgeons, orthopaedic surgeons, and wound care experts. Early diagnosis is paramount, facilitated by advanced imaging techniques such as magnetic resonance imaging (MRI) and bone scintigraphy. Once diagnosed, the treatment strategy hinges on a combination of medical and surgical interventions. Antibiotic therapy, guided by culture results, plays a central role in managing DFO. Tailored regimens targeting the specific pathogens involved are administered, often for prolonged durations. Surgical intervention becomes necessary when conservative measures fall short. Surgical approaches range from minimally invasive procedures, like percutaneous drainage, to more extensive interventions like debridement and bone resection. Prevention of DFO recurrence is equally vital, emphasising glycemic control, meticulous foot care, patient education, monitoring of at-risk signs, revascularization and early intervention when indicated. The management of diabetic foot osteomyelitis mandates a comprehensive strategy that addresses both the infectious and surgical aspects of the condition. A collaborative, interdisciplinary approach ensures timely diagnosis, tailored treatment, and holistic care. Further research into novel therapeutic modalities and long-term outcomes remains essential in refining the management of this complex and debilitating complication of diabetes.
Language	English
Publishing date	2023-12-31
Publishing country	India
Document type	Journal Article
ZDB-ID	2596956-0
ISSN	2213-3445 ; 0976-5662
ISSN (online)	2213-3445
ISSN	0976-5662
DOI	10.1016/j.jcot.2023.102330
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Article: The Expanding Role of Hip Arthroscopy in Modern Day Practice.

Massa, Edward / Kavarthapu, Venu

Indian journal of orthopaedics

2019 Volume 53, Issue 1, Page(s) 8–14

Abstract: Over the past decade, hip arthroscopy has become increasingly popular in managing hip conditions in a minimally invasive approach. The development of specialist equipment and training in this field has allowed indications for hip arthroscopy to be ... ...

Abstract	Over the past decade, hip arthroscopy has become increasingly popular in managing hip conditions in a minimally invasive approach. The development of specialist equipment and training in this field has allowed indications for hip arthroscopy to be extended to a range of conditions. However, the need for special equipment and training has also limited the use of hip arthroscopy to specialized centers. This article will outline the evolution of hip arthroscopy, the pathology of hip conditions, what it has been used for and how this technique has now been extended to help manage these conditions in a minimally invasive approach, limiting the complications of open surgery.
Language	English
Publishing date	2019-03-21
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	603194-8
ISSN	0019-5413
ISSN	0019-5413
DOI	10.4103/ortho.IJOrtho_12_18
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Zs.A 1720: Show issues

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