Reviving the debate: Articular cartilage preservation during disarticulation at the lower limb? A systematic review

Abstract

Background: The need for preservation(P) or removal(R) of articular cartilage during disarticulations remains unanswered.

Methods: Medline database was used to conduct a systematic review regarding all types of minor disarticulations and some types of major disarticulations in patients with diabetes mellitus, peripheral arterial disease or trauma related disarticulations. Fisher-exact statistical test was used to perform calculations for the entire group as for subgroups.

Results: A total of 444 disarticulations at the Chopart joint, ankle and knee were included (P = 255 vs. R = 189). There was no difference in wound healing, functionality and mortality. Reamputation rate was lower in the P-group (9.4% vs. 16.9%). Infection rate was not significantly different. Differences in reamputations (R = 10.6% vs. P = 1.0%) and infections (R = 4.4% vs. P = 22.6%) were only present for the ankle subgroup.

Conclusions: There is no difference in wound healing, functionality and mortality between the preservation and removal of articular cartilage in the lower limb.

Keywords: Amputation; Cartilage; Diabetes mellitus; Disarticulation; Lower limb.