Arthroscopic ankle fusion only has a limited advantage over the open operation if osseous operation type is the same: a retrospective comparative study

Abstract

Background: A great deal of research suggests that arthroscopic ankle fusion (AAF) has advantages over open ankle fusion (OAF), but these outcomes would be imprecise because of a selection bias. The purpose of this study is to verify which is better for ankle fusion, AAF or OAF. We regrouped the OAF group into two subgroups according to whether the osseous operation type is the same as AAF group. The goal is to minimize the impact of disease severity, thereby reducing selection bias to some extent. Methods: We retrospectively analyzed the data of ankle fusion in our hospital between July 2015 and October 2018. Forty-three patients were enrolled and divided into AAF group (n = 17) and OAF group (n = 26). In order to eliminate selection bias, we divided OAF group into complex osseous operation subgroup (COO subgroup) (n = 15) and simple osseous operation subgroup (SOO subgroup) (n = 11). The osseous operation type of SOO subgroup is the same as AAF group. Then, we compared the differences between these groups. All patients were followed up at least 1 year after operation. We analyzed data, including etiology composition, surgical time, intra-op blood loss, reduction of albumin, total hospital stays, union time, fusion situation, complications, radiological examination, functional score, and questionnaire survey. Then we performed statistical analyses. Results: We found that the etiological components of AAF group and OAF group were different; the etiological components of AAF group and SOO subgroup were similar. We found that AAF group has advantages over OAF group and COO subgroup in general. However, except in terms of surgical trauma, hospital stays, and short-term complications occurred, the AAF group has not obvious advantages over SOO subgroup, including intra-op blood loss, fusion condition, postoperative function score, and postoperative patient satisfaction; and AAF group need more surgical time than the SOO subgroup. Conclusions: The arthroscopic ankle fusion can bring a good curative effect; however, if the osseous operation type is the same, the arthroscopic ankle fusion only has a limited advantage over the traditional open operation in perioperative soft tissue protection and enhanced recovery after surgery.

Arthroscopic vs. Open-Ankle Arthrodesis on Fusion Rate in Ankle Osteoarthritis Patients: A Systematic Review and Meta-Analysis

“…After the elimination of duplicates (n = 32), another 343 studies were excluded based on abstract and another 10 studies based on full-text assessment (see Supplementary File S4 for more information regarding excluding studies). A total of 13 studies [11,[14][15][16][28][29][30][31][32][33][34][35][36] were therefore included in the present review on the effectiveness of open-ankle arthrodesis vs. arthroscopy on our primary outcome (i.e., fusion rate).…”

“…The risk-of-bias scores of included studies are reported in Figure 2 both traffic light and summary plots. A total of 13 studies were analyzed [11,[14][15][16][28][29][30][31][32][33][34][35][36]. Figure 2A,B summarizes the risk of bias on fusion rate outcome.…”

“…On the other hand, non-union, malunion, deep infection, and delayed wound healing were reported for the arthroscopy group. [11,14,16,[28][29][30]33,35,36].…”

“…On the other hand, the ankle arthroscopic technique represents a valid alternative to open surgery for patients with ankle arthrosis. Although open surgery is the traditional option for ankle osteoarthritis, there are some reports in the literature regarding the use of the arthroscopy procedure with outstanding results, including shorter operative time [14] and hospital stay [15], as well as comparable fusion rates between open vs. arthroscopic interventions [16]. For these reasons, there is still an open debate about the adequacy of which surgical technique (i.e., open vs. arthroscopic) yields better responses in patient outcomes.…”

Management of Elderly Traumatic Ankle Arthritis with Ilizarov External Fixation

“… 6 , 10 Despite the many technologies proposed for ankle arthrodesis, it is frequently associated with comorbidities including hindfoot arthritis, delayed or nonunion, tibial stress fractures, infection, and compromised wound healing, which can subsequently result in a prolonged period of hospitalization and rehabilitation. 11 , 12 …”