SLR - September 2022 - Trey Edwards, DPM
Reference: Abuhantash M, Veljkovic A, Wing K, Gagne O, Qian H, Wong H, Sadr H, Penner M, Younger A. Arthroscopic Versus Open Ankle Arthrodesis: A 5-Year Follow Up. J Bone Joint Surg Am. 2022 Jul 6;104(13):1197-1203. doi: 10.2106/JBJS.21.01088. Epub 2022 May 23. PMID: 35793798.Level of Evidence: 3
Scientific Literature Review
Reviewed By: Trey Edwards, DPM
Residency Program: The Jewish Hospital – Mercy Health, Cincinnati, OH
Podiatric Relevance: End stage ankle arthritis is a challenging pathology encountered by foot and ankle surgeons and has traditionally been surgically managed with open ankle arthrodesis. Since being first published in 1983, arthroscopic ankle arthrodesis has been associated with improved patient reported outcomes and fewer complications. This study reviews long-term patient reported outcomes, major complications, and reoperations for patients treated with open versus arthroscopic ankle arthrodesis.
Methods: A retrospective cohort study was performed for patients who underwent primary ankle arthrodesis for the treatment of end stage ankle arthritis. A total of 351 patients who underwent either arthroscopic (223 patients) or open (128 patients) ankle arthrodesis were included in the present study. Relative patient reported outcome measures (PROMs) were collected for all patients including the Ankle Osteoarthritis Scale (AOS), Ankle Arthritis Score (AAS), and The Short Form-36 (SF-36). These PROMs were collected preoperatively, at 6 moths postoperatively, and annually thereafter up to five years. Patients requiring revisional surgery due to a major complication such as malunion, nonunion, infections, or amputations were also recorded.
Results: The mean preoperative AOS and AAS scores were lower for the arthroscopic ankle arthrodesis (AAA) group compared to the open ankle arthrodesis (OAA) group. From preoperative, to six months postoperative, the difference between the AAA and OAA groups in terms of AOS score improvement was not significant. The mean difference in AOS scores between the two groups from six months to five years postoperative was also not significant. Nine percent of patients in the AAA group and 18 percent of patients in the OAA group underwent major reoperation. Five patients in the OAA group experienced postoperative infection or wound complication whereas no infection or wound complications occurred in the AAA group. Revision for malunion and nonunion were similar between the two groups.
Conclusions: This study compared the long-term results of arthroscopic versus open ankle arthrodesis in terms of patient reports outcome measures, major complications, and reoperation. Both groups reported similar improvement after surgical intervention. Reoperation secondary to deep infection or wound complications only occurred in the open ankle arthrodesis group. The present study supports that both arthroscopic versus open ankle arthrodesis remain viable treatment options with comparable outcomes for the management of end stage ankle arthritis depending on the capability of the surgeon at the time of the procedure.