SLR - January 2021 - Weldon G. Murry

Arthroscopic Ankle Arthrodesis Provides Similarly Satisfactory Surgical Outcomes in Ankles with Severe Deformity Compared With Mild Deformity in Elderly Patients

Reference: Yang TC, Tzeng YH, Wang CS, Chang MC, Chiang CC. Arthroscopic Ankle Arthrodesis Provides Similarly Satisfactory Surgical Outcomes in Ankles With Severe Deformity Compared With Mild Deformity in Elderly Patients. Arthroscopy. 2020 Oct;36(10):2738-2747. doi: 10.1016/j.arthro.2020.05.036. Epub 2020 Jun 1. PMID: 32497657.

Level of Evidence: Level III, retrospective comparative study

Scientific Literature Review

Reviewed By: Weldon G.  Murry, DPM
Residency Program: St. Vincent Hospital – Worcester, MA

Podiatric Relevance: Ankle arthrodesis is a well proven procedure for the treatment of end-stage ankle arthritis within the foot and ankle surgery community. Open ankle arthrodesis has been associated with complications that include wound healing problems, infection and neurovascular injury. Arthroscopic ankle arthrodesis has become more popular due to the quest for lower complications and faster rehabilitation. There is concern that arthroscopic procedures are not of choice for correcting severe deformities. Also, there are few studies that address the impact of age in ankle arthrodesis. This study aims to evaluate these two concerns in the area of arthroscopic ankle arthrodesis. 

Methods: Patients were retrospectively reviewed between January 2008 and December 2017 who underwent arthroscopic ankle arthrodesis with three cannulated screws. The patients were followed for at least 24 months postoperatively. All patients in the study were 60 years of age or older. The patients were divided into two groups. Patients with coronal deformity of less than 15 degrees were placed in group I and patients with a deformity equal to or greater than 15 degrees were placed in group II. Demographic data and radiographic and functional outcomes were compared between the two groups. 

Results: There were 26 patients in group I and 15 patients in group II that had follow-up of a mean of 51.4 months. The mean age of all patients was 70.6 years. There was significantly more severe preoperative coronal deformity of tibiotalar angle in group II than group I. Both groups achieved near normal tibiotalar alignment postoperatively. Union was achieved in 39 patients (95.1 percent). There were two cases in group I that experienced non-union. All patients in group II achieved union. No significant difference was noted between the two groups when evaluating union rate, mean American Orthopaedic Foot and Ankle Society ankle-hindfoot scale and visual analog scale pain scores.   

Conclusions: This study concluded that arthroscopic ankle arthrodesis, even in the setting of severe preoperative deformity, can provide high union rates, encouraging radiographic and functional outcomes, and low complication rates for end stage ankle arthritis in patients that are 60 years of age or older. Another conclusion extracted from this study was that arthroscopic intra-articular malleolar osteotomy was a useful technique for correcting severe coronal deformity. The results of this study are promising in that it may provide improved patient selection for arthroscopic ankle arthrodesis and likely lead to better outcomes and fewer complications.     

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