Abstract
Regarding the treatment of ankle arthritis, the choice of arthroscopic ankle arthrodesis
(AAA) or open ankle arthrodesis (OAA) remains controversial. To guide clinical decision-making,
we conducted a meta-analysis on the optimal treatment of ankle arthrodesis. We identified
eligible studies published from June 1, 1969 to June 1, 2020 using the Cochrane Library,
PubMed, OVID, Embase, and Medline searched the references of relevant studies. Randomized
and non-randomized studies that compared outcomes of AAA and OAA were included. After
the methodologic assessment, available data were extracted and statistically reviewed.
The primary outcomes were overall complications rate, tourniquet time, length of the
hospital stay, non-union rate, and rate to fusion. The secondary outcomes were delayed
union and postoperative infection rate. We included 9 studies comparing arthroscopic
and open in patients with ankle arthrodesis, comprising 467 participants. AAA had
the advantage of demonstrating a lower overall complication rate (odds ratio [OR],
0.44 [95% confidence interval [CI], 0.26-0.73]; p = .002), shorter intraoperative tourniquet time (mean difference [MD], -16.49 [95%
CI, -23.51 to -9.46]; p < .001), shorter length of the hospital stay (MD -1.75, 95% CI -1.94 to -1.2, p < .001),lower non-union rate (OR, -0.07 [95% CI, -0.13 to -0.02]; p <.01) and higher rate to fusion (OR, 4.2 [95% CI, 1.96-8.99]; p < .001) in comparison with OAA. Yet, no significant differences were found in delayed
union (OR, 0.46 [95% CI, 0.10-2.04]; p = .30) and postoperative infection rate (OR, 0.45 [95% CI, 0.17-1.15]; p = .09) between the groups. Our results suggest that arthroscopic ankle arthrodesis
is superior to open ankle arthrodesis alone in the treatment of ankle arthritis based
on the overall complication rate, intraoperative tourniquet time, length of the hospital
stay, non-union rate and rate to fusion. However, further high-quality randomized
controlled trials with appropriate blinding methods are needed to confirm the findings.
Level of Clinical Evidence
Keywords
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References
- Total ankle arthroplasty versus ankle arthrodesis. Comparison of sports, recreational activities and functional outcome.Int Orthop. 2012; 36: 1207-1214
- Is elevated contact stress predictive of post-traumatic osteoarthritis for imprecisely reduced tibial plafond fractures?.J Orthop Res. 2011; 29: 33-39
- Ankle arthrodesis: a long term review of the literature.J Orthop. 2019; 16: 430-433
- Outcomes after standardized screw fixation technique of ankle arthrodesis.Clin Orthop Relat Res. 2006; 447: 112-118
- Is end-stage ankle arthrosis best managed with total ankle replacement or arthrodesis? A systematic review.Adv Orthop. 2014; 2014986285
- Arthroscopic ankle arthrodesis.Foot Ankle Clin. 2006; 11: 361-368
- Evidence-based indications for ankle arthroscopy.Arthroscopy. 2009; 25: 1478-1490
Chapter 8: Assessing risk of bias in included studies. In: Higgins DG, Altman JP, eds. Cochrane Handbook for Systematic Reviews of Interventions. Version 5.0.1.Updated September 2008]. Available at: http://hiv.cochrane.org/sites/hiv.cochrane.org/files/uploads/Ch08_Bias.pdf. Accessed May 15.
- Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses[J].Eur. J. Epidemiol. 2010; 25: 603-605
- The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration.J Clin Epidemiol. 2009; 62: e15-e34
- Arthroscopic versus open ankle arthrodesis: a multicenter comparative case series.J Bone Joint Surg Am. 2013; 95: 98-102
- Primary vs. revision ankle arthrodesis: comparison of fusion and complication rates.Foot Ankle Orthop. 2016; 1: 100-101
- Arthroscopic versus open ankle arthrodesis: a retrospective cost analysis.J Foot Ankle Surg. 2010; 49: 242-247
- Open versus arthroscopic ankle arthrodesis: a comparison of subsequent procedures in a large database.J Foot Ankle Surg. 2016; 55: 777-781
- Open versus arthroscopic ankle arthrodesis: a comparative study.Foot Ankle Int. 1999; 20: 368-374
- The outcome of arthroscopic and open surgery ankle arthrodesis: a comparative retrospective study on 107 patients.Foot Ankle Surg. 2008; 14: 153-157
- Ankle arthrodesis. A comparison of an arthroscopic and an open method of treatment.Clin Orthop Relat Res. 1991; : 84-95
- Effectiveness comparison between arthroscopic and open ankle arthrodeses.Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2013; 27: 288-289
- Arthroscopic versus open ankle arthrodesis.Foot Ankle Surg. 2018; 24: 137-142
- Prospective comparison of open and arthroscopic ankle arthrodesis using validated outcome score with two-year minimum follow-up (SS-55).Arthroscopy. 2011, e59; 27
- A comparison of open and arthroscopic ankle fusion.Foot Ankle Surg. 2003; 9: 169-172
- Ankle arthrodesis—Open versus arthroscopic: a systematic review and meta-analysis.J Clin Orthop Trauma. 2017; 8: S71-S77
- Arthroscopic versus open ankle arthrodesis: a systematic review.Arthroscopy. 2018; 34: 988-997
- Ankle arthrodesis using an arthroscopic method: long-term follow-up of 34 cases.Arthroscopy. 1996; 12: 428-434
- Long term results of tibiotalar arthrodesis.J. Bone Joint Surg. 1985; 67A: 546-549
- Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes.Foot Ankle Int. 1994; 15: 349-353
- Reliability and validity of the subjective component of the American Orthopaedic Foot and Ankle Society clinical rating scales.J Foot Ankle Surg. 2007; 46: 65-74
Article info
Publication history
Published online: December 16, 2022
Footnotes
Financial Disclosure: No funding was received for this study.
Conflict of Interest: The authors declare that they have no competing interests.
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