Arthroscopic Ankle Arthrodesis is Associated with Fewer Adverse Events Compared to Open Ankle Arthrodesis

Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: Ankle arthrodesis (AA) is a common treatment for end-stage ankle arthritis, chronic instability, and degenerative deformity. The procedure can be performed via multiple approaches and employ internal or external fixation methods. The relative risks and benefits between open and arthroscopic techniques for arthrodesis remain debated. While minimally invasive arthroscopic techniques may reduce soft tissue disruption, postoperative pain, and related morbidity, open techniques may be beneficial for treatment of patients with aberrant anatomy, insufficient bone stock, or complex deformity. This study aimed to determine whether arthroscopic AA is associated with lower adverse event rates and improved complication profiles compared with the open AA techniques at 90 days and 2 years postoperative. Methods: We conducted a retrospective analysis using the TriNetX research network, which aggregates deidentified electronic medical records from 105 healthcare organizations. Patients undergoing AA were identified using CPT codes for arthroscopic (CPT 29899, n = 972) and open (CPT 27870, n = 11,835) procedures. Two cohorts were defined and propensity score–matched on age, sex, race, BMI, and type II diabetes mellitus (n = 961 each). Outcomes were evaluated 90 days and 2 years post–index event. The primary endpoint was a composite any adverse event. Complications with fewer than 10 events in either group were excluded. Rates, odds ratios (ORs), and p values were calculated for each endpoint. Results: At 90 days, the composite adverse event rate was significantly lower in the arthroscopic AA group (4.4% vs. 12.6%; p < 0.001). Statistically significant reductions were observed in dehiscence (1.4% vs. 4.6%; p < 0.001), surgical site infection [SSI] (1.1% vs. 4.9%; p < 0.001), emergency department (ED) visits (7.3% vs. 11.1%; p = 0.004), and cerebral infarct (1.0% vs. 2.4%; p = 0.022). No significant differences were found for pulmonary embolism (PE), acute myocardial infarction (MI), transfusion, deep vein thrombosis (DVT), hematoma, or sepsis at 90 days. At 2 years, adverse events remained lower in the arthroscopic group (9.9% vs. 20.0%; p < 0.001) with similar significant benefits for dehiscence and surgical site infection; other complications showed no significant differences. Conclusion: Arthroscopic AA was associated with significantly lower composite adverse event rates at both 90 days and 2 years, as well as reduced rates of dehiscence, SSI, ED visits, and cerebral infarct. Complications such as PE, acute MI, transfusion, DVT, hematoma, and sepsis did not differ significantly between approaches. These findings suggest that the arthroscopic technique may offer a safer complication profile compared with open AA. Further prospective studies are warranted to confirm these results and refine surgical protocols.