JAAOS - 2026-07-15 - Journal Article; Systematic Review
Clinical Outcomes and Complication Profile of Open and Arthroscopic Ankle Arthrodesis: A Systematic Review.
Encinas R, Kiriluk SH, Kosko B, Vulcano E, Jackson JB, Gonzalez T
Topics
Key Takeaway
Arthroscopic ankle arthrodesis yields a significantly lower infection rate (1.1% vs 8.5%) and shorter hospital stay (3.3 vs 5.4 days) compared to open arthrodesis across 1,554 procedures.
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Summary
This systematic review compared clinical outcomes and complications between open and arthroscopic ankle arthrodesis using PRISMA and Cochrane methodology with MINORS quality scoring. Arthroscopic arthrodesis demonstrated significantly lower infection rates (1.1% vs 8.5%, P=0.05), shorter length of stay (3.3 vs 5.4 days, P=0.05), lower revision rate (3.5% vs 5.9%), lower additional surgery rate (6.9% vs 13.2%), and lower total complication rate (20.4% vs 41%). Union rates were comparable at 94.9% arthroscopic vs 91.2% open.
Key Limitation
The included studies are predominantly non-randomized with no standardized deformity grading, meaning the arthroscopic cohort likely represents less severe or less deformed ankles, confounding the complication and union rate comparisons.
Original Abstract
BACKGROUND
One of the main surgical treatments for ankle arthritis is arthrodesis. Mixed results are reported in the literature regarding which technique is superior: open arthrodesis or arthroscopic arthrodesis. This systematic review aims to report and summarize all available literature on this topic.
METHODS
Two independent authors performed a systematic literature search using the following databases: PubMed, Embase, and the Cochrane Library. The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) protocol and the Cochrane Handbook guidelines were followed. The search criteria were for open and arthroscopic ankle arthrodesis. The MINORS score criteria were used to evaluate the strength and quality of the selected studies.
RESULTS
A total of 19 studies including 719 open and 835 arthroscopic arthrodesis were included. Average age and BMI for the open and arthroscopic groups were 56.6 and 56.8 years and 29.3 and 28.8 kg/m 2 , respectively. A statistically significant lower infection rate 8.5% vs. 1.1% and length of stay 5.4 vs. 3.3 days was found in the arthroscopic group ( P = 0.05, 0.05). The union rate was 656 (91.2%) and 793 (94.9%) for the open and arthroscopic groups. Revision procedures were required in 40 open procedures (5.9%) and 28 arthroscopic procedures (3.5%); additional revision surgery (excluding revisions) was required after 89 open (13.2%) and 55 arthroscopic (6.9%) arthrodesis surgeries. A total complication rate of 41% and 20.4% was reported among the open and arthroscopic groups, respectively.
CONCLUSION
Both open and arthroscopic ankle arthrodesis surgeries are safe and effective treatments for ankle arthritis. This systematic review found with significance a lower infection rate and length of stay for the arthroscopic group. We hope the current review will help surgeons' when planning surgical management for patients with severe ankle arthritis.