Division of Orthopedic Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.
Division of Distal Extremities, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada.
J Bone Joint Surg Am. 2022 Jul 6;104(13):1197-1203. doi: 10.2106/JBJS.21.01088. Epub 2022 May 23.
End-stage ankle arthritis has long been managed surgically with open ankle arthrodesis (OAA). Since the first published report in 1983, arthroscopic ankle arthrodesis (AAA) has been thought to be associated with improved patient-reported outcome measures (PROMs) and fewer complications. The purpose of the present study was to compare the long-term PROMs, major complications, and reoperations for these 2 approaches at up to 15 years of follow-up.
This longitudinal cohort study included patients at our institution who underwent primary ankle arthrodesis for the treatment of end-stage arthritis. Demographic data and preoperative COFAS (Canadian Orthopaedic Foot and Ankle Society) ankle arthritis type were collected for all patients. PROMs were completed preoperatively, at 6 months, and annually thereafter to 5 years. PROMs were compared at all time points with use of a mixed-effects regression model that adjusted for preoperative variables and scores. Major complications and reoperations at the site of the ankle arthrodesis were also compared.
Of 1,294 patients who were screened for inclusion, 351 who had undergone ankle arthrodesis between 2003 and 2019 were eligible for the study. Of those, 223 had undergone AAA and 128 had undergone OAA. The 2 groups were similar preoperatively with respect to demographics, but COFAS Type-4 arthritis was relatively more common in the OAA group and Type-1 arthritis was relatively more common in the AAA group. In addition, the Ankle Osteoarthritis Scale (AOS) score and Ankle Arthritis Score (AAS) were better in the AAA group. In the mixed-effects model analysis, the differences in postoperative outcome scores between the groups were not significant. The risk of revision due to malunion or nonunion was similar in both groups (6% in the AAA group, compared with 4% in the OAA group). Deep infection and wound complications did not occur in the arthroscopic group but occurred in 4% of the patients in the OAA group.
After adjustment for baseline patient characteristics, there were no differences in PROMs between the 2 techniques. Ankle arthrodeses done arthroscopically had a similar revision rate but lower infection rate compared with those done with the open technique.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
晚期踝关节关节炎长期以来一直通过开放式踝关节融合术（OAA）进行手术治疗。自 1983 年首次报道以来，关节镜下踝关节融合术（AAA）被认为与改善患者报告的结果测量（PROM）和减少并发症有关。本研究的目的是比较这两种方法在长达 15 年的随访中远期的 PROM、主要并发症和再手术。
这项纵向队列研究纳入了我们机构接受初次踝关节融合术治疗终末期关节炎的患者。所有患者均采集人口统计学数据和术前 COFAS（加拿大矫形足踝协会）踝关节关节炎类型。所有患者均在术前、术后 6 个月以及此后每年进行 PROM 评估，直至 5 年。使用混合效应回归模型，对术前变量和评分进行调整，比较各时间点的 PROM。还比较了踝关节融合部位的主要并发症和再手术。
在筛选出的 1294 名符合条件的患者中，有 351 名在 2003 年至 2019 年期间接受了踝关节融合术，符合研究条件。其中 223 例接受了 AAA，128 例接受了 OAA。两组患者在术前人口统计学方面相似，但 OAA 组中 COFAS 4 型关节炎相对更为常见，AAA 组中 COFAS 1 型关节炎相对更为常见。此外，AAA 组的踝关节骨关节炎量表（AOS）评分和踝关节关节炎评分（AAS）更好。在混合效应模型分析中，两组术后结果评分的差异无统计学意义。两组的翻修风险因愈合不良或不愈合而相似（AAA 组 6%，OAA 组 4%）。关节镜组未发生深部感染和伤口并发症，但 OAA 组有 4%的患者发生了这些并发症。
在调整了基线患者特征后，两种技术之间的 PROM 没有差异。关节镜下踝关节融合术的翻修率与开放式技术相似，但感染率较低。
治疗性三级。有关证据等级的完整描述，请参见作者说明。
