Background: 

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.

Methods: 

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.

Results: 

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.

Conclusions: 

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.

Level of Evidence: 

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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关节镜与开放式踝关节融合术：5 年随访

背景： 

终末期踝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 年首次发表报告以来，关节镜下踝关节融合术 (AAA) 一直被认为与改善患者报告结果测量 (PROM) 和减少并发症有关。本研究的目的是在长达 15 年的随访中比较这两种方法的长期 PROM、主要并发症和再次手术。

方法： 

这项纵向队列研究包括在我们机构接受原发性踝关节融合术治疗终末期关节炎的患者。收集所有患者的人口统计学数据和术前 COFAS（加拿大骨科足踝协会）踝关节炎类型。PROMs 在术前、6 个月时完成，之后每年完成至 5 年。使用针对术前变量和评分进行调整的混合效应回归模型在所有时间点对 PROM 进行比较。还比较了踝关节融合术部位的主要并发症和再次手术。

结果： 

在筛选纳入的 1,294 名患者中，351 名在 2003 年至 2019 年期间接受过踝关节融合术的患者符合研究条件。其中，223 人接受了 AAA，128 人接受了 OAA。两组术前人口统计学相似，但 COFAS 4 型关节炎在 OAA 组中相对更常见，而 1 型关节炎在 AAA 组中相对更常见。此外，AAA 组的踝关节骨关节炎评分（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，组间术后结局评分差异不显着。两组因畸形愈合或骨不连而翻修的风险相似（AAA 组为 6%，OAA 组为 4%）。

结论： 

在对基线患者特征进行调整后，两种技术之间的 PROM 没有差异。与开放技术相比，通过关节镜完成的踝关节固定术具有相似的翻修率，但感染率较低。

证据等级： 

治疗三级。有关证据级别的完整描述，请参见作者说明。