Arthroscopic Versus Open Ankle Arthrodesis: A Multicenter Comparative Case Series

SLR- January 2014- Ryan J. Rogers

Reference: Townshen, D, Di Silvestro M, Krause F, Penner M, Younger A, Glazebrook M, WingK. The Journal of Bone and Joint Surgery. 16 January 2013. pp 98-102.

 

Scientific Literature Review

Reviewed By: Ryan J. Rogers, DPM
Residency Program: St. John Hospital and Medical Center

Podiatric Relevance: Open ankle arthrodesis has been the mainstay for treatment of end-stage ankle arthritis. Arthroscopic ankle arthrodesis, however, has gained popularity as it has the added advantages of decreased hospital stay and quicker time to arthrodesis. The purpose of the study was to compare clinical outcome, morbidity, and length of hospital stay inpatients receiving open versus arthroscopic ankle arthrodesis.
 

Methods: Open arthrodeses were performed via transfibular approach with afibular-sparing Z-osteotomy. Arthroscopic arthrodeses were performed with noninvasive distraction and antermedial and anterolateral portals. Osseouscontours were preserved and fixation was achieved with two or three compression screws. Patients were kept non-weightbearing for six weeks with progression to weightbearing during the second six weeks. The primary outcome measure was based on Ankle Osteoarthritis Scale (AOS), ranging from 0-100 with a lower score indicating normal function. Secondary outcome measures included ShortForm-36 health survey, radiographic alignment, operative time, and length of hospital stay.

Results: There were thirty open and thirty arthroscopic arthrodeses with a mean age of 54.7 and 59.4, respectively. Both groups showed significant improvement in AOS scores at twelve and twenty-four months, in favor of the arthroscopic group atone and two years (p=0.01 and p=0.05). Improvement of SF-36 PCS scores showed no difference between the two groups at two years, however did show significant difference at one year, in favor of the arthroscopic group. The hospital stay was significantly shorter in the arthroscopic group (2.5 days versus 3.7 days). Mean tourniquet time was 99 minutes for the arthroscopic group and 107 for the open group. Ankle alignment was improved in both groups.
 

Conclusions: Previous studies have lacked control groups and avalid outcome measure, preventing useful comparison between arthroscopic andopen technique. Hospital stay was shown to be shorter and the degree of improvement in the AOS score was greater and more rapid in the arthroscopic group. This study has shown that both open and arthroscopic techniques provide good clinical outcome with equivalent deformity correction and nonunion rates. The main limitation of this study is lack of randomization, with the authors utilizing open technique for more difficult cases initially.