Primary Open vs. Arthroscopic Ankle Arthrodesis

Abstract

Category: Ankle Arthritis Introduction/Purpose: Ankle arthrodesis is the gold-standard treatment option for patients with end-stage ankle osteoarthritis resulting in measurable improvements in postoperative pain relief. Arthroscopic ankle arthrodesis has gained increasing popularity, however there remains a lack of comparative data with open ankle arthrodesis. The objectives of this retrospective study were to compare (1) demographics, (2) surgical technique, (3) postoperative fusion rates, and (4) postoperative complication rates in patients with primary open vs. arthroscopic tibiotalar arthrodesis. Methods: Between March 2002 and November 2014, 385 primary ankle arthrodeses were performed at our institution. There were 212 male and 173 female patients with a mean age of 56 ± 14.7 years (18.0-88.8). The mean weight, height, and body mass index (BMI) were 89.4 ± 19.7 kg (46-168), 172.9 ± 11.1 cm (147-208), and 29.9 ± 5.8 kg/m2 (18.9-54.9), respectively. There were 322, and 63 patients with primary open and arthroscopic arthrodesis, respectively. Both patient groups were compared with regard to demographics including gender, weight, height, BMI, ASA classification, smoking, alcohol use, and comorbidities. The surgical technique was analyzed in both groups including approach, main fixation type, and allograft/autograft use. Finally, fusion rates and time to complete union were analyzed. Complication rates including wound complications, deep vein thrombosis/pulmonary embolism, and any secondary procedures were described in both groups. The mean time to final follow-up was 37.9 ± 27.0 months (12.0-150.4). Results: Demographics and comorbidities were comparable in both groups. All but one arthroscopy were performed using anterior portals. All arthroscopic ankle arthrodeses were performed using screw fixation, while fixation types varied in open arthrodesis (P < 0.001). Autograft use was higher in open arthrodesis at 84.2% vs. 6.3% (P < 0.001), while allograft was favored for arthroscopic arthrodesis at 66.7% vs. 20.2% (P = 0.101).Osseous union was with 92.2% and 90.5% in patients with open and arthroscopic arthrodesis, respectively (P = 0.529). However, the time to complete osseous fusion was significantly shorter in patients with arthroscopic ankle fusion, at 4.3 vs. 5.1 months (P = 0.034). Wound and thrombembolic complications occurred significantly more often in patients with open ankle arthrodesis. Conclusion: Osseous union rates were comparable in both patient groups,however union time was significantly shorter in the arthroscopic group. Wound healing problems and thrombembolic complications were more common in patients who underwent open ankle arthrodesis.