Medium-term clinical outcomes and prosthetic survivorship of total knee arthroplasty for charcot arthropathy of the knee: a single-center retrospective case series

This study aimed to analyze the medium-term clinical outcomes, prosthetic survivorship, and complications of total knee arthroplasty (TKA) for Charcot knee arthropathy. We retrospectively analyzed 34 patients (36 knees) with Charcot arthropathy who underwent primary TKA at our institution between January 2014 and December 2025. Demographic data, etiology, Koshino stage, prosthesis constraint type, bone defect management (stems, cones, sleeves, augmentation, and screws), preoperative and latest follow-up Knee Society Score (KSS), range of motion (ROM), complications, and revisions were recorded. Paired t-tests were used to compare functional scores before and after surgery, and the Kaplan–Meier method was used to calculate prosthetic survival. The median follow-up was 42.70 months (IQR: 23.10–56.87 months). Preoperatively, Koshino stage 2 accounted for 38.89% (14 knees). The rotating hinge knee prosthesis (RHK) was the most frequently used (36.11%, 13 knees), followed by posterior-stabilized (PS) (25.00%, 9 knees) and legacy constrained condylar knee prosthesis (LCCK) (19.44%, 7 knees). The utilization rate of combined femoral and tibial stems was 58.33% (21 knees). The total KSS improved significantly from 85.94 ± 26.15 preoperatively to 134.39 ± 21.13 at the 18- to 30-month follow-up ( P < 0.001). Flexion ROM improved from 99.31 ± 13.17° to 108.78 ± 9.12° ( P < 0.001). The complication rate was 30.56% (11/36 knees), including deep vein thrombosis (DVT) in six knees (16.67%), periprosthetic joint infection (PJI) in three knees (8.33%), and periprosthetic fracture in one knee (2.78%). 4 knees (11.11%) underwent revision during follow-up, with infection being the primary cause. The 5-year survivorship rates were 96.7% (95% CI: 90.5–100%) free of aseptic revision, 91.2% (95% CI: 82.1–100%) free of revision for infection, and 88.1% (95% CI: 77.9–99.8%) free of any revision. In this selected single-center cohort, TKA using constrained prostheses and stem fixation was associated with significant functional improvement and favorable prosthetic survival at medium-term follow-up. PJI remained the primary cause of revision.