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prospective comparison of open and arthroscopic ankle arthrodesis using validated outcome

Disclosures. Research SupportIntegra foundationWyethBiomimeticInstitutional supportIntegra foundationLinvatecSynthesWright MedicalConsultancyZimmerLinvatecWright MedicalIntegra. Background. Ankle Arthrodesis remains the gold standard treatment for isolated ankle arthritisDespite improved techniques a 10% nonunion rate, 9% re-operation rate, 5% below knee amputation rate post ankle arthrodesis persists8The high nonunion rate and number of complications has provided the impetus f1144

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prospective comparison of open and arthroscopic ankle arthrodesis using validated outcome

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    1. Prospective Comparison of Open and Arthroscopic Ankle Arthrodesis using Validated Outcome M Di Silvestro, MSc, MD FRCSC, P Copperthorne MD, F Krause MD, M Glazbrook MD PhD FRCSC, M Penner MD FRCSC, A Younger MD FRCSC, K Wing MD FRCSC University of British Columbia Vancouver, CANADA

    2. Disclosures Research Support Integra foundation Wyeth Biomimetic Institutional support Integra foundation Linvatec Synthes Wright Medical Consultancy Zimmer Linvatec Wright Medical Integra

    3. Background Ankle Arthrodesis remains the gold standard treatment for isolated ankle arthritis Despite improved techniques a 10% nonunion rate, 9% re-operation rate, 5% below knee amputation rate post ankle arthrodesis persists8 The high nonunion rate and number of complications has provided the impetus for the development of a technique that respects the soft tissue envelope while achieving the accepted principles of rigid fixation of the ankle joint in a plantigrade position with compression across two well opposed boney surfaces after the meticulous removal of articular cartilage Arthroscopic Ankle Arthrodesis has been recommended by some as a solution to the relatively high rate of complications associated with the open technique However there is little evidence to support the arthroscopic technique

    4. Purpose The purpose of this study was to prospectively compare an open and arthroscopic technique of ankle arthrodesis using validated outcome measures

    5. Methods Subjects: Inclusion: >18yo, isolated symptomatic ankle arthritis Exclusion: patients undergoing additional procedures, previous ankle or hindfoot fusions , ongoing infections Design: Prospective: patient data was gathered at 0 months, 6 months and 1 year (only patients with baseline data were included) Outcome Measures: Ankle Osteoarthritis Score (AOS), Tourniquet Time, Length of Stay in Hospital (LOSH), Union Rate, Complication Rate, Coronal and Sagittal Radiographic Alignment Power: AOS (1° outcome measure) change from baseline to 1 year, SD 14 based on the initial 14 patients, >9 pt AOS change as significant Type I Error: 5%, Type II Error: 15% 30 patients required in each group

    6. Techniques Open: transfibular + anteromedial approaches Fibula used as a physiologic plate Arthroscopic: anterolateral, anteromedial +/- posteromedial portals Both Techniques used meticulous preparation of the joint surfaces while maintaining the boney contours + rigid internal fixation with 2-3 screws (6.5, 7.0 or 7.3)

    7. Demographics *There were no significant differences found between the groups

    8. Results *Significant Difference

    9. Results: AOS

    10. AOS Baseline – 12mon Change *p = .017

    11. Discussion This was a prospective validated comparison of two very similar groups using an arthroscopic and open technique of ankle fusion There was no difference in the rate of union or malunion The study was not powered for this comparison The arthroscopic group stayed significantly fewer days (1.5d) in hospital The 2.3d was longer than seen by Ogilvie et al (1d) This was likely because of the large geographic catchment area There was no significant difference in tourniquet times The absolute time difference was only 7 min AOS scores were far superior at 12months in the arthroscopic group The Open group’s AOS score improved 19 points versus 34.5 points in the Arthroscopic Group This approached significance with a p = 0.017 We hypothesize that there may be more partial unions at 12 months in the open group despite radiographic appearance of union At 18-24 months the AOS numbers may very well equalize with complete union in the open group

    12. Conclusion The current study to our knowledge is the first to prospectively compare open and arthroscopic ankle arthrodesis using a validated outcome measure (AOS). The results of this study suggest that arthroscopic ankle fusions can be expected to deliver shorter hospital stays with similar surgical times, nonunion and complications rates in addition to improved patient outcomes at one year. Based on these findings we view arthroscopic ankle arthrodesis as a second gold standard in the treatment of endstage isolated ankle arthritis.

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