SLR - September 2017 - Sarah L. Hilton
Reference: Vaishya R, Azizi AT, Agarwal AK, Vijay V. Arthroscopic Assisted Ankle Arthrodesis: A Retrospective Study of 32 Cases. J Clin Orthop Trauma. 2017 Jan-Mar;8(1): 54–58Scientific Literature Review
Reviewed By: Sarah L. Hilton, DPM
Residency Program: Beaumont Hospital, Farmington Hills, MI
Podiatric Relevance: Ankle arthrodesis has long been considered the treatment of choice for patients with end-stage ankle osteoarthritis who have failed conservative treatments. Both open and arthroscopic assisted ankle arthrodesis (AAAA) techniques have been shown to have positive outcomes. However, the intention of this article is to demonstrate the benefits of performing arthroscopic assisted ankle arthrodesis over open procedures. Advantages of AAAA are proposed to be due to the minimally invasive nature of the technique, including low infection rate, minimal bone removal, faster union rates, minimal blood loss, decreased morbidity, fewer soft-tissue complications and shorter hospital stays.
Methods: This is a retrospective review performed on 32 patients who underwent AAAA from 2008 to 2015. The procedure included two parts: anteromedial and anterolateral. Fixation was performed in all cases with two crossing 7.0 cancellous screws. Ankle function for each patient was radiographically evaluated preoperatively, three months postoperatively and one year postoperatively using the Karlsson and Peterson’s Ankle function score. Secondary outcomes were also evaluated, including postop fusion rates, complications, average tourniquet time, mean hospital stay and clinical outcomes.
Results: Of the 32 patients, four were excluded due to incomplete follow-up. Fusion was achieved in all of the 28 remaining individuals, with the average union time of 14 weeks. Regarding complications, four of the 28 patients required screw removal at a later date due to prominence, and one patient experienced a superficial infection. Twenty (71.4 percent) patients were considered to have an excellent outcome, four (14.2 percent) with a good outcome, three (10.7 percent) with a fair outcome and one (3.5 percent) with a poor clinical outcome. The average tourniquet time for the procedure was 70 minutes (ranging from 60 to 100 minutes), with a mean hospital stay of two days (ranging from one to four days). The average calculated Karlsson and Peterson’s scores were 32.71 preoperatively, 74.10 at three months postop and 89.00 at one year postop.
Conclusions: The authors concluded that AAAA has numerous advantages over the open procedure and should be considered the technique of choice for ankle arthrodesis, especially for patients at an increased risk of soft-tissue complications and in younger individuals.
They demonstrated that AAAA achieved 100 percent union rate with minimal complications, short OR times, short hospital stays, good clinical outcomes and significantly increased postop ankle function scores. Overall, AAAA technique was shown to have numerous benefits. However, further studies are needed to directly compare open vs. AAAA outcomes to provide a complete assessment for selecting the appropriate technique for improved patient care.