I am looking at putting an end to my chronically cranky and very painful ankle. The surgeons says according to the X-rays and CT scan I have end-stage osteoarthritis. She is recommending an ankle fusion using the newer arthroscopic method. Call me old-school but I'm not always convinced new is better. In this case, is it?
In this case, the term "new" may not be exactly the right word to use. Arthroscopic ankle arthrodesis (fusion) has been around for 30 years. That's long enough to have gathered enough data from studies to track short-, mid-, and long-term results.
What we don't always have are comparative studies where one group of patients is treated one way and a second group is treated differently. For example, in the case of ankle arthrodesis, there aren't oodles of studies comparing the results when the procedure is performed arthroscopically versus using an open incision approach.
Surgeons from Canada recently published the results of their two-year study of 60 patients in a comparative case series. They treated 30 adults (men and women) with ankle osteoarthritis using the arthroscopic arthrodesis and compared the results to 30 adults (similar in age, sex, weight, and diagnosis) treated for the same problem using an open approach. Everyone was re-evaluated at one and two years after the procedure.
They assessed which technique worked better when measured by improvement in pain levels, function, and costs (hospital stay). A special self-reported survey designed to measure disability and pain from ankle osteoarthritis was used as the main outcome measure. This tool is known as the Ankle Osteoarthritis Scale or AOS.
They found that all the patients in both groups improved significantly both at the end of one year and at the end of the second year of follow-up. But the arthroscopic group did show even greater improvement (statistically better) compared with the open incision group. And the arthroscopic group was in the hospital on average 1.2 fewer days.
There was no difference between the groups in terms of length of time (number of minutes) to do the surgery or quality of alignment of the bones (as viewed on X-ray). The number and type of complications (e.g., nonunion of the bone, delayed wound healing, painful hardware that had to be removed) were also the same between the two groups.
The authors concluded that surgical treatment for end-stage osteoarthritis of the ankle can be safely done arthroscopically. Compared with open incision procedures, arthroscopic arthrodesis provides better overall results faster and without an increase in postoperative problems or complications.
David Townshend, MBBS, FRCS(Orth), et al. Arthroscopic Versus Open Ankle Arthrodesis: A Multicenter Comparative Case Series. In The Journal of Bone and Joint Surgery. January 16, 2013. Vol. 95A. No. 2. Pp. 98-102.
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