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Key Features

  • Joint destruction resulting from loss or diminution of proprioception, pain, and temperature perception

  • As normal muscle tone and protective reflexes are lost, secondary degenerative joint disease ensues

  • Although initially described in the knees of patients with tabes dorsalis, it is now more frequently seen in association with diabetic neuropathy (foot and ankle) or syringomyelia (shoulder)

Clinical Findings

  • An enlarged, boggy, relatively painless joint with extensive cartilage erosion, osteophyte formation, and multiple loose-joint bodies

Diagnosis

  • Radiographs can reveal striking osteolysis that mimics osteomyelitis or dramatic destruction of the joint with subluxation, fragmentation of bone, and bony sclerosis

  • Differential diagnosis

    • Repeated trauma (causing degenerative joint disease)

    • Rheumatoid arthritis

    • Chronic hemarthrosis (bleed)

    • Chondrocalcinosis (eg, pseudogout, hemochromatosis, Wilson disease)

Treatment

  • Directed toward the primary disease

  • Mechanical devices are used to assist in weight bearing and prevention of further trauma

  • In some instances, amputation becomes unavoidable

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