Arthroscopic ankle arthrodesis for end-stage ankle osteoarthritis

Arthroscopic ankle arthrodesis (AAA) has been performed for 40 years for end-stage ankle osteoarthritis. Along with open ankle arthrodesis (OAA) and total ankle replacement (TAR), it forms one arm of the triumvirate of commonly performed procedures for this condition. The aim of this article is to review the state of the art for AAA and compare outcomes with OAA and TAR. This narrative review of the literature traces the development of this technique through case series and systematic reviews. Traditional OAA techniques carry a nonunion rate of 11%, necessitating revision surgery in most cases. As individual and communal experience of AAA has grown, the range of pathology and deformity successfully corrected by this technique has developed. There is evidence that AAA offers greater and more rapid union rates, with reduced hospital stay and better long-term outcomes. However, the technique requires mature surgical skills and still carries a significant complication rate. No single procedure is suitable for all patients. AAA can be seen as the new gold standard for patients with isolated ankle osteoarthritis and no/minimal deformity, either within the talocrural joint or hindfoot or patients with systemic and/or local comorbidities that would benefit from minimal disturbance to the soft-tissue envelope. However, in older patients, the presence of concomitant hindfoot osteoarthritis or significant deformity, TAR and OAA remain valuable procedures in the foot and ankle surgeon's armamentarium.