Arthroscopic vs open ankle arthrodesis: A prospective case series with seven years follow-up

Abstract

BACKGROUND The osteoarthritis of the ankle, although less common than other joints, is associated with severe functional limitation. Surgical options are ankle arthroscopic debridement, osteotomies, ankle arthrodesis and ankle arthroplasty. Ankle arthroplasty is increasingly used thanks to the new implants design, but ankle arthrodesis still represents the most used technique and it can be performed arthroscopically or with an open procedure. AIM To compare mid-term results of arthroscopic vs open ankle arthrodesis of patients affected by end-stage ankle arthritis. METHODS This study enrolled 23 patients, which underwent ankle arthrodesis. The patients were divided into 2 groups: group A (open procedure; n = 11) and group B (arthroscopic procedure, n = 12), the two groups were homogeneous with regard to age and body mass index ( P = 0.347). The American Orthopaedic Foot and Ankle score (AOFAS), Freiburg Ankle score (FAS) and visual analogue scale for pain intensity were evaluated preoperatively, at six months and at final follow-up of 7.6 years in group A and 7.3 years in group B ( P = 0.364). RESULTS Patients in the arthroscopic group showed better results at six-month follow-up compared to the open group at the AOFAS (group A, 62.2; group B, 78.5; P < 0.05) and the FAS (group A, 61.1; group B, 70.3; P = 0.015) scores. Pain relief was achieved in both groups at six-month follow-up (group A, 1.4; group B, 0.9; P = 0.162). Both open and arthroscopic groups showed improved clinical outcomes from baseline to final follow-up ( P > 0.05). Hospital stay was shorter in group B than in group A ( P = 0.001). More complications were reported in the open group than in the arthroscopic group ( P = 0.459). CONCLUSION The arthroscopic and the open arthrodesis are valid and safe options for the treatment of ankle arthritis on the basis of clinical outcomes at 7 years follow-up. Moreover, the arthroscopic treatment shows faster improvement at six-month follow-up in comparison with the open group.

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].…”

“…Table 2 summarizes the GRADE evaluation system for the outcomes included in the present systematic review and meta-analysis. [11,14,16,[28][29][30]33,35,36].…”

“…This was confirmed analyzing Egger's test for both outcomes (fusion rate intercept = −0.031, CI 95% = −1.75 to −1.69, t = −0.036, p = 0.972, and overall complications intercept = −0.046, CI 95% = −1.30 to −1.21, t = −0.072, p = 0.944). [11,14,16,[28][29][30]33,35,36].…”