Arthroscopic vs open tibiotalocalcaneal and pantalar arthrodesis: Do minimally invasive techniques reduce...

Arthrodesis of the hindfoot can be performed using either open or arthroscopic techniques. A retrospective comparative study was conducted including 38 patients, 41 feet, who underwent tibiotalocalcaneal (TTC) and pantalararthrodesis between 1/2012 and 12/2024. Feet were divided into two groups: 21 treated arthroscopically (15 TTC and 6 pantalar fusions) and 20 treated with open techniques (14 TTC and 6 pantalar fusions) All patients had minimum follow up of 12 months. TTC arthrodesis: Two feet (2/15; 13%) in the arthroscopic group, vs. seven (7/14; 50%) in the open group had significant deformity. Clinical union of all joints was achieved in 14 out of 15 (93.3%) arthroscopic and 13 out of 14 open procedures (92.8%) (p = 1.0, Fischer's exact test), whilst mean time to union was similar (p = 0.42, T-test). Two asymptomatic (radiographic) nonunions were observed in the arthroscopic group, and one in the open group, not requiring additional surgery. Thus, total radiographic union rates were 80% (12 out of 15) in the arthroscopic and 85.7% (12 out of 14) in the open groups (p = 1.0, Fischer's exact test). Pantalar arthrodesis: 11 out of 12 feet had significant deformity. Union was achieved in all six cases in the open, and in five out of six in the arthroscopic group, whilst, time to union was shorter in the arthroscopic group (13.7 vs. 21.7 weeks), but not significantly (p = 0.13, T-test). Three patients (3/6; 50%) in the arthroscopic group experienced complications, two (2/6; 33%) requiring revision arthrodesis due to nonunion and malunion. Whilst arthroscopic arthrodesis has a trend towards shorter union time and fewer wound complications, in our study there was an increased rate of nonunion and malunion, though these differences were not significant. However, one malunion requiring revision surgery, was observed in the arthroscopic group. Minimally invasive approaches may be preferable for selected patients, but should be used with caution if deformity is present, though larger prospective studies are required to confirm these findings.