Open vs Arthroscopic Fusion of the Ankle or Subtalar Joint: A Comparison and Analysis of Long-term Results

Objective To compare patient-reported outcomes and reintervention rates after open vs arthroscopic fusion of the ankle (TT—tibiotalar) or subtalar (ST) joint over a 10-year period in a cohort of patients from a single center. Methods In total, 129 patients (142 joints) underwent surgery for isolated TT or ST osteoarthritis between 2010 and 2020: 40 TT fusions (11 arthroscopic, 29 open) and 102 ST fusions (25 arthroscopic, 77 open). The course of treatment was followed clinically using patient-reported outcome measures (PROMs) for ankle function: Foot and Ankle Outcome Score—FAOS, general quality of life (European Quality of Life in Five Dimensions 3-level time-trade-off—EQ-5D 3L-TTO) and activity level (Tegner Activity Scale—TAS), and by tracking revision procedures. Results The median follow-up time was 8 (3–13) years. The mean age at the time of surgery was 52 (14) years. Most subjective scores showed significant improvement; cumulative FAOS improved from 41 to 57 in the TT group and from 41 to 67 in the ST group and EQ-5D from 0.40 to 0.55 (TT group) and from 0.38 to 0.60 (ST group), while TAS remained at 2. The ST fusion patients had better subjective outcomes than TT fusion patients. There were no significant differences in PROMs between arthroscopic and open procedures. Older age and preoperative FAOS pain were found to be negative predictors for the postoperative FAOS subscales. Overall, there was an 18% revision rate: 17 non-unions and 8 infections. In addition, 20 hardware removals were performed. Conclusion Isolated TT or ST fusions performed open or arthroscopically were safe and significantly improved function and quality of life and reduced joint-related pain but did not increase patients’ activity levels. Patients with ST fusion had a better subjective outcome. Older age and lower preoperative FAOS pain were associated with a worse postoperative subjective outcome.