Prospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Dec 18, 2021; 12(12): 1016-1025
Published online Dec 18, 2021. doi: 10.5312/wjo.v12.i12.1016
Arthroscopic vs open ankle arthrodesis: A prospective case series with seven years follow-up
Federico Morelli, Giorgio Princi, Matteo Romano Cantagalli, Marco Rossini, Ludovico Caperna, Daniele Mazza, Andrea Ferretti
Federico Morelli, Giorgio Princi, Matteo Romano Cantagalli, Marco Rossini, Ludovico Caperna, Daniele Mazza, Andrea Ferretti, Department of Trauma and Orthopaedics, Sapienza University of Rome, Roma 00189, Italy
Author contributions: Morelli F, Princi G did work design; Princi G, Cantagalli MR, and Rossini M did data acquisition; Princi G did data analysis; Princi G, Cantagalli MR, Rossini M, Caperna L and Mazza D drafted the work; Morelli F, Princi G, Caperna L, Mazza D and Ferretti A did critical revision for important intellectual content; All authors did final approval of the version to be published.
Institutional review board statement: The study was reviewed and approved by the Sant'Andrea Hospital-La Sapienza University of Rome Institutional Review Board (Approval No. 00172008).
Conflict-of-interest statement: On behalf of all the authors, there is no conflict of interest.
Data sharing statement: Participants gave informed consent for the publication of the study; the presented data are anonymized and risk of identification is low.
CONSORT 2010 statement: The guidelines of the CONSORT 2010 statement have been adopted.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Giorgio Princi, MD, Doctor, Surgeon, Department of Trauma and Orthopaedics, Sapienza University of Rome, Via di Grottarossa 1035, Roma 00189, Italy. giorgioprinci@gmail.com
Received: March 28, 2021
Peer-review started: March 28, 2021
First decision: June 16, 2021
Revised: June 27, 2021
Accepted: December 10, 2021
Article in press: December 10, 2021
Published online: December 18, 2021
Abstract
BACKGROUND

The osteoarthritis of the ankle, although less common than other joints, is associated with severe functional limitation. Surgical options are ankle arthroscopic debridement, osteotomies, ankle arthrodesis and ankle arthroplasty. Ankle arthroplasty is increasingly used thanks to the new implants design, but ankle arthrodesis still represents the most used technique and it can be performed arthroscopically or with an open procedure.

AIM

To compare mid-term results of arthroscopic vs open ankle arthrodesis of patients affected by end-stage ankle arthritis.

METHODS

This study enrolled 23 patients, which underwent ankle arthrodesis. The patients were divided into 2 groups: group A (open procedure; n = 11) and group B (arthroscopic procedure, n = 12), the two groups were homogeneous with regard to age and body mass index (P = 0.347). The American Orthopaedic Foot and Ankle score (AOFAS), Freiburg Ankle score (FAS) and visual analogue scale for pain intensity were evaluated preoperatively, at six months and at final follow-up of 7.6 years in group A and 7.3 years in group B (P = 0.364).

RESULTS

Patients in the arthroscopic group showed better results at six-month follow-up compared to the open group at the AOFAS (group A, 62.2; group B, 78.5; P < 0.05) and the FAS (group A, 61.1; group B, 70.3; P = 0.015) scores. Pain relief was achieved in both groups at six-month follow-up (group A, 1.4; group B, 0.9; P = 0.162). Both open and arthroscopic groups showed improved clinical outcomes from baseline to final follow-up (P > 0.05). Hospital stay was shorter in group B than in group A (P = 0.001). More complications were reported in the open group than in the arthroscopic group (P = 0.459).

CONCLUSION

The arthroscopic and the open arthrodesis are valid and safe options for the treatment of ankle arthritis on the basis of clinical outcomes at 7 years follow-up. Moreover, the arthroscopic treatment shows faster improvement at six-month follow-up in comparison with the open group.

Keywords: Ankle, Osteoarthritis, Arthrodesis, Arthroscopy, Arthroplasty, Surgery

Core Tip: Purpose of this study is to evaluate arthrodesis as surgical treatment in patients with end-stage ankle osteoarthritis. The open procedure is compared with the arthroscopic procedure, evaluating the medium to long-term results through The American Orthopedic Foot and Ankle score, Freiburg Ankle score and visual analogue scale for pain intensity. Bone fusion timing is analyzed utilizing X-rays. The results suggest that both treatments are valid and safe, and that the arthroscopic procedure shows faster improvements in the medium term. It is also interesting to note that the group treated with arthroscopic procedure in the medium term control, has a shorter hospital stay and a better union rate.