Arthroscopic vs Open Ankle Arthrodesis: The Canadian Multi-Center Long Term Study

Category: Ankle Arthritis; Ankle Introduction/Purpose: This multi-center study aimed to compare complication rates, reoperation rates, and patient-reported outcome measures (PROMs) between open ankle arthrodesis (OAA) and arthroscopic ankle arthrodesis (AAA) in treating end-stage ankle arthritis. Methods: This was a prospectively collected retrospective study utilizing data from three medical centers in the Canadian Orthopaedic Foot and Ankle Society (COFAS) database. Primary ankle arthrodeses for the treatment of end-stage arthritis with a minimum of 2 years follow up and valid PROM scores were included. Preoperative COFAS ankle arthritis type, validated PROMs including the Ankle Osteoarthritis Scale (AOS), Short Form-36 (SF-36) with 2 components (the Physical Component Summary (PCS) and Mental Component Summary (MCS)), as well as major complications including malunion, nonunion, infection, amputations, and reoperations related to the arthrodesis were evaluated using CROCS (Canadian Reoperation Coding System). Results: 2,835 prospectively enrolled patients who underwent surgical treatment of end-stage ankle arthritis (COFAS Types 1-4) from 2001 to 2020 were screened. 447 ankle arthrodeses were included (178 AAA, 269 OAA) with 1-15 years of followup (7.13 yrs +/- 3.8). There was no difference between the two groups in demographics except more cases of type 1 and 4 arthritis in OAA group. There was a 6.9% incidence of major complications (3.79% related operations around the ankle, 0.67% deep infection, 1.78% revisions for nonunion/malunion, 0.67% amputations). For the 4 types of arthritis, AOS score improved significantly at 1 year, stabilized in type 1 group, but fluctuated in the remaining 3 types of arthritis after 8 years postoperatively. Average postoperative AOS score was better in the AAA group. Conclusion: Better outcomes were found for the arthroscopic cohort. However differences may be less after correction for confounding factors such as surgeon, site, and COFAS grade. Revision surgery is rare in both groups. AOS Treated Total Scores in Arthroscopic versus Open Ankle Arthrodesis Groups