Arthroscopic Versus Open Ankle Arthrodesis

Abstract

Background:End-stage ankle arthritis has long been managed surgically with open ankle arthrodesis (OAA). Since the first published report in 1983, arthroscopic ankle arthrodesis (AAA) has been thought to be associated with improved patient-reported outcome measures (PROMs) and fewer complications. The purpose of the present study was to compare the long-term PROMs, major complications, and reoperations for these 2 approaches at up to 15 years of follow-up.Methods:This longitudinal cohort study included patients at our institution who underwent primary ankle arthrodesis for the treatment of end-stage arthritis. Demographic data and preoperative COFAS (Canadian Orthopaedic Foot and Ankle Society) ankle arthritis type were collected for all patients. PROMs were completed preoperatively, at 6 months, and annually thereafter to 5 years. PROMs were compared at all time points with use of a mixed-effects regression model that adjusted for preoperative variables and scores. Major complications and reoperations at the site of the ankle arthrodesis were also compared.Results:Of 1,294 patients who were screened for inclusion, 351 who had undergone ankle arthrodesis between 2003 and 2019 were eligible for the study. Of those, 223 had undergone AAA and 128 had undergone OAA. The 2 groups were similar preoperatively with respect to demographics, but COFAS Type-4 arthritis was relatively more common in the OAA group and Type-1 arthritis was relatively more common in the AAA group. In addition, the Ankle Osteoarthritis Scale (AOS) score and Ankle Arthritis Score (AAS) were better in the AAA group. In the mixed-effects model analysis, the differences in postoperative outcome scores between the groups were not significant. The risk of revision due to malunion or nonunion was similar in both groups (6% in the AAA group, compared with 4% in the OAA group). Deep infection and wound complications did not occur in the arthroscopic group but occurred in 4% of the patients in the OAA group.Conclusions:After adjustment for baseline patient characteristics, there were no differences in PROMs between the 2 techniques. Ankle arthrodeses done arthroscopically had a similar revision rate but lower infection rate compared with those done with the open technique.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Clinical Outcomes Following Percutaneous Ankle Fusion With Bone Graft Substitute

“…7 Complications in arthroscopic ankle fusion have been reported with varying results as some authors present a decrease in all complications and infections with others finding no differences in infection or overall complication rate when comparing arthroscopic vs open ankle fusion. 1,2,7 Theoretically it is likely arthroscopic technique benefits from less insult to soft tissues and copious amounts of irrigation that help reduce infection rate and wound-related complications, which the current study technique benefits from as well with even smaller portals and continuous irrigation throughout the procedure. Complications after arthroscopic ankle fusion that have been reported include nonunion, deep infections, lymphedema, neuropraxias, and adjacent joint degeneration.…”

“…7 Complications in arthroscopic ankle fusion have been reported with varying results as some authors present a decrease in all complications and infections with others finding no differences in infection or overall complication rate when comparing arthroscopic vs open ankle fusion. 1,2,7…”

Complex Ankle Fusion With Circular Frames: Factors Influencing Outcomes, Complications, and Patient Satisfaction

“…The most widespread approach for ankle fusion remains open or arthroscopic ankle fusion with internal fixation, which has demonstrated excellent, reliable, and reproducible results. 2,5,8,56 Circular frames are typically reserved for complex clinical scenarios such as severe deformity, ongoing infection, poor soft tissue envelope, bone defects that are not reconstructable with conventional means, and complex revision surgery. 21,27,28,41,48,54,57 The benefits of a circular frame include early weightbearing, the ability to gradually correct severe deformity, the avoidance of internal fixation, preservation of the soft tissue envelope, and a reduction in wound complications related to large extensile surgical exposures.…”

“…The most widespread approach for ankle fusion remains open or arthroscopic ankle fusion with internal fixation, which has demonstrated excellent, reliable, and reproducible results. 2,5,8,56 Circular frames are typically reserved for complex clinical scenarios such as severe deformity, ongoing infection, poor soft tissue envelope, bone defects that are not reconstructable with conventional means, and complex revision surgery. 21,27,28,41,48,54,57…”

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

“…According to the definition of terms in medical subject headings, the surgical fixation of a joint by a procedure designated to accomplish the fusion of the joint surface by promoting the proliferation of the bone cell is called arthrodesis. In this regard, open-surgery arthrodesis represents the traditional option for the treatment of ankle osteoarthritis and related pathologies (i.e., chronic instability and degenerative deformity) due to its effect on pain relief and functional improvements [11]. In recent years, however, ankle replacement has gained more consideration, becoming the preferred treatment for this pathology.…”