Year 2022 Vol. 30 No 6




Federal State Budgetary Institution National Ilizarov Medical Research Centre for Traumatology and Orthopaedics of the RF Ministry of Health, Kurgan,
Russian Federation

Objective. Purpose of this article to study the charateristic features of the structural rearrangement of the main components of the ankle joint in diabetic neuroosteoarthropathy complicated by chronic osteomyelitis using histopathological semi-quantitative assessment of osteomyelitis.
Methods. Analysis of the data of pathohistological studies of the operating material (bone-and-cartilaginous fragments of the ankle with adjacent soft tissues) of 30 patients with the established diagnosis of diabetic neroosteoarthropathy complicated by chronic osteomyelitis. Light microscopy of paraffin-embedded sections using immunohistochemical evaluation of marker of neutrophilic granulocytes CD15 was performed.
Results. The pronounced destruction of the articular cartilage and subchondral bone was revealed in all the patients. The articular cartilage structure disturbance was noted both on the side of the articular surface (synovial pannus, active chondroclasts), and on the side of the subchondral zone (destruction of the basophilic section, the calcified cartilage zone). Fragments of cartilage and bone were distributed in the articular cavity and in the synovium. The synovium was hypertrophied, hypervascularized with inflammatory infiltration. The histopathological semi-quantitative assessment of osteomyelitis and the immunohistochemical detection of CD15-positive neutrophils made it possible to identify signs of the active stage of chronic osteomyelitis in 8 patients, those of subacute course in 16 patients, weakened chronic osteomyelitis (remission) in 6 patients. An increased number of osteoclasts, intense destruction of the subchondral bone plate and a pronounced inflammatory infiltrate with the content of 5 or more neutrophils were observed in patients with an active inflammatory stage of chronic osteomyelitis. A positive correlation was found between the inflammatory stage of chronic osteomyelitis and the severity of inflammatory infiltration and osteonecrosis.
Conclusion. The combination of signs pronounced destruction of the articular cartilage, subchondral bone, hypertrophy of the synovial membrane, bone and cartilaginous fragments in the joint cavity and in the synovial membrane, fragments of bone tissue in the cartilage is a diagnostic histological criterion for the chronic stage of diabetic neroosteoarthropathy. The histopathological semi-quantitative assessment of osteomyelitis and the immunohistochemical determination of CD15 increase the accuracy of the pathological diagnostics of the inflammatory phases of chronic osteomyelitis in diabetic foot syndrome.

Keywords: histology, the ankle (joint), diabetic neroosteoarthropathy, osteomyelitis, diagnostics
p. 562-571 of the original issue
  1. Harris A, Violand M. Charcot Neuropathic Osteoarthropathy. [Updated 2021 Jul 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021.
  2. Sinacore DR, Bohnert KL, Smith KE, Hastings MK, Commean PK, Gutekunst DJ, Johnson JE, Prior FW. Persistent inflammation with pedal osteolysis 1year after Charcot neuropathic osteoarthropathy. J Diabetes Complications. 2017;31(6):1014-20. doi: 10.1016/j.jdiacomp.2017.02.005
  3. Sybenga AB, Jupiter DC, Speights VO, Rao A. Diagnosing Osteomyelitis: A Histology Guide for Pathologists. J Foot Ankle Surg. 2020;59(1):75-85. doi: 10.1053/j.jfas.2019.06.007.
  4. Faglia E, Clerici G, Caminiti M, Curci V, Somalvico F. Influence of osteomyelitis location in the foot of diabetic patients with transtibial amputation. Foot Ankle Int. 2013;34:222-27. doi: 10.1177/1071100712467436
  5. Tsvetkov VO, Kolovanova OV, Frolova OE, Gusarova TA, Ezhova LG. Informativnost bakteriologicheskogo issledovaniia kostnoi tkani v diagnostike osteomielita pri sindrome diabeticheskoi stopy. Sakharnyi diabet. 2019;22(5):428-435. doi: 10.14341/DM10048. (In Russ.)
  6. Tiemann A, Hofmann GO, Krukemeyer MG, Krenn V, Langwald S. Histopathological Osteomyelitis Evaluation Score (HOES) an innovative approach to histopathological diagnostics and scoring of osteomyelitis. GMS Interdiscip Plast Reconstr Surg DGPW. 2014;3:Doc08. doi: 10.3205/iprs000049.
  7. Dmitrienko AA, Anichkin VV, Kurek MF, Bugakov VA, Konovkov VV, Kushne AO. Differentiated surgical tactics at purulent complications of diabetic charcot osteoarthropathy. Novosti Khirurgii. 2013 Nov-Dec; Vol 21 (6): 47-56. doi: 10.18484/2305-0047.2013.6.47 (In Russ.)
  8. La Fontaine J, Shibuya N, Sampson HW, Valderrama P. Trabecular quality and cellular characteristics of normal, diabetic, and charcot bone. J Foot Ankle Surg. 2011;50(6):648-53. doi: 10.1053/j.jfas.2011.05.005.
  9. Dharmadas S, Kumar H, Pillay M, Jojo A, Pj T, Mangalanandan TS, Vivek L, Praveen VP, Bal A. Microscopic study of chronic charcot arthropathy foot bones contributes to understanding pathogenesis - A preliminary report. Histol Histopathol. 2020 May;35(5):443-48. doi: 10.14670/HH-18-162
  10. Berli MC, Higashigaito K, Götschi T, Pfirrmann CWA, Sutter R, Rosskopf AB. The Balgrist Score for evaluation of Charcot foot: a predictive value for duration of off-loading treatment. Skeletal Radiol. 2021;50(2):311-20. doi: 10.1007/s00256-020-03541-6.
  11. Donegan R, Sumpio B, Blume PA. Charcot foot and ankle with osteomyelitis. Diabet Foot Ankle. 2013;4:10. doi: 10.3402/dfa.v4i0.21361
  12. Alpert SW, Koval KJ, Zuckerman JD. Neuropathic Arthropathy: Review of Current Knowledge. J Am Acad Orthop Surg. 1996;4(2):100-108.
  13. Petrova NL, Petrov PK, Edmonds ME, Shanahan CM. Inhibition of TNF-α Reverses the Pathological Resorption Pit Profile of Osteoclasts from Patients with Acute Charcot Osteoarthropathy. Journal of Diabetes Research. 2015; . doi: 10.1155/2015/917945 (In Russ.)
  14. Diachkova GV, Diachkov KA, Kliushin NM, Larionova TA, Shastov AL. A multifaceted osteomyelitis: radiological diagnosis. Genii ortopedii. 2020;26(3):385-391. doi: 10.18019/1028-4427-2020-26-3-385-391 (In Russ.)
  15. Stupina TA, Migalkin NS, Sudnitsyn AS. Structural reorganization of the cartilage tissue in chronic osteomyelitis of the foot bones. Genii ortopedii. 2019;25(4):523-27. doi: 10.18019/1028-4427-2019-25-4-523-527 (In Russ.)
Address for correspondence:
640014, Russian Federation,
Kurgan, st. M. Ulyanova, 6,
National Medical Research Center
for Traumatology and Orthopedics
Named after Academician G.A. Ilizarov,
tel. +7 905 850-67-89,
Stupina Tatyana A.
Information about the authors:
Stupina Tatyana A., MD (Biol), Senior Researcher, Laboratory of Morphology, Ilizarov National Medical Research Centre for Traumatology and Orthopedics, Kurgan, Russian Federation.
Migalkin Nikolai S., Researcher. Laboratory of Morphology, Ilizarov National Medical Research Centre for Traumatology and Orthopedics, Kurgan, Russian Federation.
Mezentsev Igor N., Pathologist, Ilizarov National Medical Research Centre for Traumatology and Orthopedics, Kurgan, Russian Federation.
Sudnitsyn Anatoly S., PhD, Orthopedic Surgion, Ilizarov National Medical Research Centre for Traumatology and Orthopedics, Kurgan, Russian Federation.
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