Open versus arthroscopic ankle arthrodesis: A systematic review and meta-analysis

Abstract

Background: Osteoarthritis (OA) is a growing health concern that affects approximately 27 million people in the USA and is associated with a $185 billion annual cost burden . Choosing between open surgery and arthroscopic arthrodesis for ankle arthritis is still controversial. This study compared arthroscopic arthrodesis and open surgery by performing a systematic review and meta-analysis. Methods: For the systematic review, a literature search was conducted in four English databases (PubMed, Embase, Medline and the Cochrane Library) from inception to February 2020. Two prospective cohort studies and 8 retrospective cohort studies, enrolling a total of 548 patients with ankle arthritis, were included. Result: For fusion rate, the pooled data showed a significantly higher rate of fusion during arthroscopic arthrodesis compared with open surgery (odds ratio 0.25, 95% CI 0.11 to 0.57, p = 0.0010). Regarding estimated blood loss, the pooled data showed significantly less blood loss during arthroscopic arthrodesis compared with open surgery (WMD 52.04, 95% CI 14.14 to 89.94, p = 0.007). For tourniquet time, the pooled data showed a shorter tourniquet time during arthroscopic arthrodesis compared with open surgery (WMD 22.68, 95% CI 1.92 to 43.43, p = 0.03). For length of hospital stay, the pooled data showed less hospitalisation time for patients undergoing arthroscopic arthrodesis compared with open surgery (WMD 1.62, 95% CI 0.97 to 2.26, p < 0.00001). The pooled data showed better recovery for the patients who underwent arthroscopic arthrodesis compared with open surgery at 1 year (WMD 14.73, 95% CI 6.66 to 22.80, p = 0.0003). Conclusion: In conclusion, arthroscopic arthrodesis was associated with a higher fusion rate, smaller estimated blood loss, shorter tourniquet time, shorter length of hospitalisation and better functional improvement at 1 year than open surgery.

Open Ankle Arthrodesis: A Retrospective Analysis Comparing Different Fixation Methods

“…They found an average union rate of 89% following OAA. In addition, Mok et al (39) found similar union rates in their study including more recently reported series (n = 187). Our union rate of 97.6% is largely comparable with these studies.…”

Two-Year Revision Rates in Total Ankle Replacement Versus Ankle Arthrodesis

“…Arthroscopic AA has been proposed as a procedure with fewer complications and quicker recovery compared with open AA 4 . Proponents argue that arthroscopic AA is associated with a shorter hospital stay, speedier recovery, and improved outcome 26-28 , although it is arguably more technically demanding. Our data indicate that arthroscopic AA has not been widely adopted in New York State and California, with <6% of AA procedures (84 of 1,468) being reported as arthroscopic, which is somewhat lower than the 9% reported by Lawton et al 3 .…”