SLR - October 2023 - Smith
Title: Arthroscopic vs open-ankle arthrodesis on fusion rates in ankle osteoarthritis patients: a systemic review and meta-analysisReference: Aljandro, L et al. Arthroscopic vs open-ankle arthrodesis on fusion rates in ankle osteoarthritis patients: a systemic review and meta-analysis. J Clin. Med. 2023 May; 12(10): 3574
Level of Evidence: Level 3, System review and meta-analysis
Reviewed By: Brooke Smith, DPM
Residency: Montefiore Medical Center, Bronx, NY
Podiatric Relevance: To analyze the effect of open vs arthroscopic surgical technique for ankle fusion with patients with osteoarthritis of the ankle, which is an issue that podiatric physicians treat. Arthroscopic procedures are growing in popularity as it is minimally invasive and has less post-operative complications. The primary objective was to analyze fusion rate with both procedures. Secondarily, they looked at operation time, hospital stay and overall complications.
Methods: PICO strategy used to build search criteria for electronic databases through Pubmed, web of science, and Scopus using terms “open-ankle arthrodesis, arthroscopy, fusion rate, blood loss” in April 2023. Methodological quality assessed using modified version of the RoB 2 Cochrane bias assessment tool. GRADE system used for interpreting results. Data was extracted by 2 researchers. Sample size, standard deviation and confidence intervals were extracted. Mean differences were calculated for hospital stay and operation time. Variance calculations were used for fusion rates and overall complications. Odds ratios and 95% confidence ratios were calculated for nominal variables. Heterogeneity tests, small study bias assessment and random-effects models were used for statistical analysis.
Results: A total of 13 studies were reviewed. Arthroscopy had a non-statistically significant advantage in fusion rates compared to open surgery however the overall quality of the evidence was low. Operation time did not significantly differ between techniques but open procedures had a longer hospital stay. Arthroscopy was associated with a lower risk of complications.
Conclusions: In this study, there is evidence to suggest that ankle arthroscopic fusion vs ankle arthrodesis may offer similar, or better outcomes compared to open surgery with potentially fewer complications. The observed differences in fusion rates was not statistically significant. The evidence had low quality in terms of comparing fusion rates as some were not randomized controlled studies. Operation time did not differ significantly, but hospital stay did. Arthroscopy showed lower complications. Overall, the choice whether to do a fusion open vs arthroscopically should be based on the surgeons’ experience, preference as well as the patient condition. This study proves that one is not necessarily superior to the other, especially when it comes to fusion rates, therefore those who are not as skilled in arthroscopy can rest assured that the open procedure is still very successful. The patient who is at risk for surgical site complications would potentially benefit from an arthroscopic approach if the surgeon has the experience. More studies with higher level of clinical evidence including more randomized control trials will be needed to substantiate these claims.