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Arthroscopic Versus Open Ankle Arthrodesis: A Multicenter Comparative Case Series
David Townshend, MBBS, FRCS(Orth)1; Matthew Di Silvestro, MSc, MD, FRCSC2; Fabian Krause, MD3; Murray Penner, MD, FRCSC4; Alastair Younger, MBChB, FRCSC4; Mark Glazebrook, MSc, PhD, MD, FRCSC, Dip Sports Med5; Kevin Wing, MD, FRCSC4
1 Department of Orthopaedics, North Tyneside General Hospital, Rake Lane, North Shields NE29 8NH, United Kingdom. E-mail address for D. Townshend: davetownshend@hotmail.com
2 Queensway Carleton Hospital, Suite 220, 770 Broadway Avenue, Ottawa, ON K2A 3Z3, Canada
3 Department of Orthopaedic Surgery, Inselspital, University of Berne, Freiburgstrasse, 3010 Berne, Switzerland
4 Department of Orthopaedics, University of British Columbia, 1144 Burrard Street, 5th Floor, Vancouver, BC V6Z 2A4, Canada
5 Queen Elizabeth II Health Sciences Center, Halifax Infirmary, 1796 Summer Street, Suite 4867, Halifax, NS, Canada
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Investigation performed at St Paul’s Hospital, Vancouver, British Columbia, and Halifax Infirmary, Halifax, Nova Scotia, Canada

This article was chosen to appear electronically on December 12, 2012, in advance of publication in a regularly scheduled issue.

A commentary by Eric Giza, MD, is linked to the online version of this article at jbjs.org.

Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Jan 16;95(2):98-102. doi: 10.2106/JBJS.K.01240
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Ankle arthrodesis results in measurable improvements in terms of pain and function in patients with end-stage ankle arthritis. Arthroscopic ankle arthrodesis has gained increasing popularity, with reports of shorter hospital stays, shorter time to solid fusion, and equivalent union rates when compared with open arthrodesis. However, there remains a lack of high-quality prospective data.


We evaluated the results of open and arthroscopic ankle arthrodesis in a comparative case series of patients who were managed at two institutions and followed for two years. The primary outcome was the Ankle Osteoarthritis Scale score, and secondary outcomes included the Short Form-36 physical and mental component scores, the length of hospital stay, and radiographic alignment. There were thirty patients in each group.


Both groups showed significant improvement in the Ankle Osteoarthritis Scale score and the Short Form-36 physical component score at one and two years. There was significantly greater improvement in the Ankle Osteoarthritis Scale score at one year and two years and shorter hospital stay in the arthroscopic arthrodesis group. Complications, surgical time, and radiographic alignment were similar between the two groups.


Open and arthroscopic ankle arthrodesis were associated with significant improvement in terms of pain and function as measured with the Ankle Osteoarthritis Scale score. Arthroscopic arthrodesis resulted in a shorter hospital stay and showed better outcomes at one and two years.

Level of Evidence: 

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

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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