Clinical effectiveness of arthroscopic vs open ankle arthrodesis for advanced ankle arthritis

Abstract

Background: Ankle fusion is the primary treatment for advanced ankle arthritis. With the advancement of arthroscopy technology, ankle arthroscopy fusion has shown many advantages over traditional surgery. However, there are few related studies globally, and evidence-based medicine is needed to verify the reliability and feasibility of ankle arthroscopy fusion. Objective: To compare the clinical efficacy and safety of arthroscopic ankle arthrodesis and open ankle arthrodesis. Methods: We searched the databases of PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure [CNKI], Wanfang Database, and VIP Database for published prospective or retrospective controlled studies of arthroscopic-assisted ankle fusion in the treatment of advanced ankle arthritis. The dates were limited from the construction of the library to June 30, 2019. Literature was included based on the principles and methods of evidence-based medicine. Literature retrieval, data extraction, and quality assessment were performed by 2 independent reviewers using the Cochrane 5.1 risk bias assessment tool. The methodological bias of the literature was evaluated, and a meta-analysis was using by RevMan 5.3 software. Results: A total of 18 studies and 1102 patients were included in the study, including 551 in the arthroscopic surgery group and 551 in the open surgery group. Arthroscopy-assisted surgery for advanced ankle arthritis was more effective than open surgery in terms of fusion rate (odd ratio[OR] = 3.32, 95% confidence interval[CI]:2.16, 5.10), fusion time (mean difference[MD] = −2.31, 95% CI:−4.63, −2.21), intraoperative blood loss (MD = −43.37, 95%CI: −48.49, −38.25), hospital stay (MD = −1.80, 95%CI: −2.28, −1.33), and visual analog scale score (MD = −1.75, 95%CI: −2.04, −1.46). In addition, rate of complications (OR = 0.33, 95%CI: 0.21, 0.52) was superior to open ankle fusion ( P < .00001). Conclusion: Arthroscopic ankle arthrodesis has more advantages than open ankle arthrodesis in improving the fusion rate and reducing complications, which is worthy of clinical application. PROSPERO registration number: CRD42020195727.

Ankle Arthroscopy Procedural Volume Is Low Among Graduating Orthopaedic Surgery Residents

“…A meta-analysis performed in 2021 found that patients undergoing arthroscopic ankle arthrodesis for the treatment of advanced tibiotalar osteoarthritis experienced a greater fusion rate, lower fusion time, lower intraoperative blood loss, decreased hospital length of stay, and an overall lower rate of postoperative complications when compared to those undergoing open surgery. 45 In addition, a separate meta-analysis performed in 2022 comparing outcomes of arthroscopic versus open Brostrom repair showed significantly less time to weight-bearing and decreased pain scores in the arthroscopic groups. 24 Perhaps the use of ankle arthroscopy within academic settings will rise overtime as the evidence supporting its indications continue to grow.…”

One-stage tibial deformity correction and ankle arthrodesis for ankle osteoarthritis and tibial malalignment after low tibial osteotomy

“…Second, placement of a long intramedullary nail in the subtalar joint via a plantar approach was an option. However, we consider it important to preserve an intact and flexible subtalar joint in a patient undergoing ankle arthrodesis in view of the study by Bai et al demonstrating that patients lose 74% of sagittal range of motion, 70% of rotational range of motion, and 77% of valgus range of motion after ankle fusion [35] . Third, there was a slight amount of residual lateral shift of the talus relative to the longitudinal axis of the tibia.…”

Association of Preexisting Triple Fusion and Arthroscopic Ankle Arthrodesis nonunion

“…Multiple studies have demonstrated that arthroscopic ankle arthrodesis (AAA) results in higher fusion rates, less blood loss, shorter tourniquet time, and shorter hospital stay compared to open ankle fusion. 3,25 Although many consider AAA superior to open fusion, reported complications of AAA include nonunion, malunion, delayed wound healing, and infection. Of these, nonunion is recognized as one of the most important 1171077F AIXXX10.1177/10711007231171077Foot & Ankle InternationalWoods et al research-article2023 1 Nuffield Orthopaedic Centre, Oxford, UK 2 Horton General Hospital, Banbury, UK complications, with rates of 8% to 13% reported in systematic reviews.…”