Open vs Arthroscopic Tibiotalar Arthrodesis: A Comparative Cohort Study from an Asian Tertiary Center

Tibiotalar arthrodesis remains the standard surgical treatment for end-stage ankle arthritis. Although arthroscopic techniques are increasingly used, differences in operative time, complication profiles, and union rates between arthroscopic and open techniques remain inconsistently reported. In Asian populations, degenerative ankle arthritis is frequently associated with varus coronal deformity, which may influence surgical approach selection and outcomes. This study compared perioperative outcomes, radiographic union, postoperative complications, and patient-reported outcomes between open and arthroscopic tibiotalar arthrodesis.

This study included 83 adult patients who underwent isolated tibiotalar arthrodesis at a single tertiary institution between January 2004 and December 2024 using either an open (n = 30) or arthroscopic (n = 53) approach. Perioperative outcomes, radiographic time to union, postoperative complications, and 6-month patient-reported outcomes were compared.

With the numbers available, no significant difference could be detected in the primary outcome of time to radiographic union between the arthroscopic and open cohorts (120.0 ± 99.5 vs 113.1 ± 73.0 days, respectively; P = .734), and no significant difference could be detected in overall complication rates between groups (18.9% vs 23.3%, respectively; P = .778). Patients undergoing open arthrodesis demonstrated greater preoperative coronal deformity compared with those treated arthroscopically (15.6° ± 10.8 vs 8.2° ± 7.4; P = .002). Arthroscopic arthrodesis was associated with longer operative time (154.7 ± 44.0 vs 130.1 ± 49.5 minutes; P = .028), whereas fewer reoperations were observed during follow-up (3.8% vs 20.0%; P = .024).

In this comparative cohort, with the numbers available, no significant differences were detected in radiographic union, early functional outcomes, or overall complication rates between arthroscopic and open tibiotalar arthrodesis. Fewer reoperations were observed in the arthroscopic cohort, which was generally composed of patients with less severe deformity. Both arthroscopic and open tibiotalar arthrodesis remain reasonable treatment options when selected according to patient characteristics, deformity severity, and surgical requirements.

Level III, retrospective comparative cohort study.