Arthroscopic versus open ankle arthrodesis

Background and purpose — Arthrodesis is the most common treatment of severe ankle arthritis. Large studies on the occurrence of re-arthrodesis are few, especially with information in terms of risk. We used the National Swedish Ankle Registry to assess incidence and risk factors for re-arthrodesis.Patients and methods — In the Registry, we examined the occurrence of re-arthrodesis in 1,716 patients with a primary ankle arthrodesis. We also analyzed associations between the re-arthrodesis risk and sex, diagnosis, and surgical method.Results — The risk of first re-arthrodesis at 2.5 years was 7.4% and the rate at 9 years 7.8%. The risk following arthroscopic surgery with fixation by screws was 15%, which is statistically significantly higher than the 8% following the gold standard technique with open screw fixation, the 5% following fixation by intramedullary nailing, and the 3% following fixation by plate and screws. Patients with either idiopathic osteoarthritis or posttraumatic arthritis had a higher risk of re-arthrodesis than patients with rheumatoid arthritis. We could not find that the risk of re-arthrodesis was associated with sex.Interpretation — In Sweden, the re-arthrodesis risk varied by primary technique and was especially high after arthroscopic surgery. Reasons are unknown but poor surgical technique and/or surgeon inexperience may contribute, as may patient selection.

show abstract

“…( 2008 ), and Quayle et al. ( 2018 ). They found non-union rates of 2–6% with the arthroscopic technique and of 0–17% with the open technique.…”

Section: Discussionmentioning

confidence: 96%

“…Quayle et al. ( 2018 ) reported a re-arthrodesis rate of 3% with open technique and 0% with arthroscopic technique.…”

Section: Discussionmentioning

confidence: 99%

Re-arthrodesis after primary ankle fusion: 134/1,716 cases from the Swedish Ankle Registry

et al. 2018

View full text Add to dashboard Cite

show abstract

“…These complications of open ankle fusion resulted in the development of less invasive techniques such as arthroscopic ankle fusion [9]. A great deal of research suggests that arthroscopic ankle fusion has advantages over open operation such as faster time to union, lower morbidity, lower blood loss, faster rehabilitation, and shorter hospital stay [10][11][12][13][14]. Many scholars believe that the reason of these advantages by arthroscopic ankle fusion probably because periosteal stripping is not necessary, and the local circulation remains intact, creating a more favourable environment for fusion to occur [15].…”

Section: Introductionmentioning

confidence: 99%

Arthroscopic ankle fusion only has a limited advantage over the open operation if osseous operation type is the same: a retrospective comparative study

Wang

et al. 2020

J Orthop Surg Res

View full text Add to dashboard Cite

Background: A great deal of research suggests that arthroscopic ankle fusion (AAF) has advantages over open ankle fusion (OAF), but these outcomes would be imprecise because of a selection bias. The purpose of this study is to verify which is better for ankle fusion, AAF or OAF. We regrouped the OAF group into two subgroups according to whether the osseous operation type is the same as AAF group. The goal is to minimize the impact of disease severity, thereby reducing selection bias to some extent. Methods: We retrospectively analyzed the data of ankle fusion in our hospital between July 2015 and October 2018. Forty-three patients were enrolled and divided into AAF group (n = 17) and OAF group (n = 26). In order to eliminate selection bias, we divided OAF group into complex osseous operation subgroup (COO subgroup) (n = 15) and simple osseous operation subgroup (SOO subgroup) (n = 11). The osseous operation type of SOO subgroup is the same as AAF group. Then, we compared the differences between these groups. All patients were followed up at least 1 year after operation. We analyzed data, including etiology composition, surgical time, intra-op blood loss, reduction of albumin, total hospital stays, union time, fusion situation, complications, radiological examination, functional score, and questionnaire survey. Then we performed statistical analyses. Results: We found that the etiological components of AAF group and OAF group were different; the etiological components of AAF group and SOO subgroup were similar. We found that AAF group has advantages over OAF group and COO subgroup in general. However, except in terms of surgical trauma, hospital stays, and short-term complications occurred, the AAF group has not obvious advantages over SOO subgroup, including intra-op blood loss, fusion condition, postoperative function score, and postoperative patient satisfaction; and AAF group need more surgical time than the SOO subgroup. Conclusions: The arthroscopic ankle fusion can bring a good curative effect; however, if the osseous operation type is the same, the arthroscopic ankle fusion only has a limited advantage over the traditional open operation in perioperative soft tissue protection and enhanced recovery after surgery.

show abstract

“…xation fusion. In recent years, AAA has become increasingly popular with foot and ankle surgeons due to its advantages, such as being minimally invasive, having fewer complications (especially skin complications), and its rapid recovery [2][3][4]. A recent systematic review found that AAA has higher clinical scores, fewer complications, shorter hospital stays, and less bleeding than open ankle fusion, while the overall fusion and reoperation rates of these methods are similar [5].…”

Section: Introductionmentioning

confidence: 99%

Finite element analysis of the initial stability of arthroscopic ankle arthrodesis with three-screw fixation: posteromedial versus posterolateral home-run screw

Wang

Zhao

et al. 2020

Preprint

View full text Add to dashboard Cite

Objective: Arthroscopic ankle arthrodesis (AAA) is a standard surgical method for the treatment of advanced traumatic ankle arthritis and has become more popular due to its advantages. To fix the tibiotalar joint, the use of three percutaneous screws is considered to have better mechanical stability than the use of two screws. However, it is sometimes difficult to insert three screws because they might block each other due to the small area of the tibiotalar joint surface and the large diameter of the screws; few articles illustrate how to insert three screws without the screws disturbing each other. The purpose of this study is to explore possible screw configurations of tripod fixation in arthroscopic ankle arthrodesis that avoid the collision of screws and yield better biomechanical performance.Methods: We used the finite element method to examine the impact of different screw positions and orientations on the biomechanical characteristics of a three-dimensional (3D) ankle model. Maximum and average micromotion, pressure on the articular surface, and von Mises stress values of the tibia and the talus were used to evaluate the initial stability of the ankle.Results: Five kinds of three-screw configurations were identified, and finite element analysis results suggested that configurations with the posteromedial home-run screw presented lower micromotion (maximum: 17.96 ± 7.49 μm versus 22.52 ± 12.8 μm; mean: 4.88 ± 1.89 μm versus 5.19 ± 1.92 μm) (especially configuration 3) and better screw distributions on the articular surface than those with the posterolateral home-run screw.Conclusion: Screw configurations with the posteromedial home-run screw avoid collision and are more biomechanically stable than those with the posterolateral home-run screw. Thus, inserting the home-run screw through the posteromedial approach is recommended for clinical practice.

show abstract

Arthroscopic versus open ankle arthrodesis

Cited by 61 publications

References 7 publications

Re-arthrodesis after primary ankle fusion: 134/1,716 cases from the Swedish Ankle Registry

Re-arthrodesis after primary ankle fusion: 134/1,716 cases from the Swedish Ankle Registry

Arthroscopic ankle fusion only has a limited advantage over the open operation if osseous operation type is the same: a retrospective comparative study

Finite element analysis of the initial stability of arthroscopic ankle arthrodesis with three-screw fixation: posteromedial versus posterolateral home-run screw

Contact Info

Product

Resources

About