Ankle Arthrodesis Revisited: A Systematic Review of Techniques, Outcomes, and Complications

Ankle arthrodesis is a widely accepted treatment for managing end-stage ankle arthritis and various other conditions, including post-traumatic, inflammatory, congenital, and neurogenic deformities. Several surgical techniques for ankle arthrodesis have been developed, such as open ankle fusion, arthroscopic ankle fusion, and mini-open ankle arthrodesis. The purpose of this study was to explore the range of surgical approaches and techniques used in ankle arthrodesis, with particular emphasis on comparing their outcomes in terms of complications, hospital stay duration, pain relief, and functional improvement.

This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review included comparative studies, including randomized controlled trials, non-randomized controlled trials, and observational studies, that assessed patients undergoing ankle arthrodesis.

The study analyzed various surgical techniques, including the anterior versus transfibular approach, Ilizarov versus internal fixation, and open versus arthroscopic techniques. The results indicated that the visual analogue scale (VAS) scores did not show a statistically significant difference between the anterior and transfibular approaches or between the Ilizarov and internal stability methods. However, the length of hospital stay was statistically significant (p = 0.05) when comparing the arthroscopic technique (mean 2.5 days) to the open technique (mean 3.7 days). The comparison between the Ilizarov and internal stability techniques did not show a significant difference in length of stay. A statistically significant difference in postoperative alignment was observed between the anterior and transfibular approaches, with the transfibular approach resulting in an average valgus alignment of 2.4°. Different studies employed various scoring systems to evaluate clinical outcomes, including the American Orthopaedic Foot & Ankle Society Score (AOFAS), ankle osteoarthritis scale (AOS), foot and ankle ability measure (FAAM), and short form (36) (SF-36) scores. No significant differences were found between the techniques, except for the comparison between open and arthroscopic approaches. The arthroscopic technique demonstrated significantly better outcomes in terms of the AOS score (p = 0.05) and the physical component of the SF-36 (p = 0.01).

Further research is necessary in this field, and it is essential for surgeons to reach a consensus on the most effective techniques for ankle arthrodesis, rather than employing a variety of approaches.