A comparison of adjacent joint arthrodesis rate in arthroscopic and open technique of ankle arthrodesis: A database analysis.

Transcription

1 A comparison of adjacent joint arthrodesis rate in arthroscopic and open technique of ankle arthrodesis: A database analysis. Khushdeep Vig, Ethan J. Fraser, Payal Desai, Christopher D. Murawski, Ian Savage-Elliott, John G. Kennedy Foot and Ankle Department, Hospital for Special Surgery New York, NY

2 Disclosure The authors have no financial conflicts to disclose

3 Introduction Arthrodesis is the gold standard for end stage ankle arthrosis not responsive to therapy 9, and is often preferred to arthroplasty in more active populations. 1-3,10 Most of the recent case series comparing arthroscopic and open ankle arthrodesis show that the arthroscopic technique results in the following in compared to open technique 4-6. shorter hospital stays less blood loss less morbidity reduced time to union

4 Introduction Complication of ankle arthrodesis: adjacent joint arthritis. Open ankle arthrodesis is associated with substantial arthritic change and deficits in functional outcome in the ipsilateral foot 7-8. Retrospective studies show this sequale of adjacent joint arthrosis is associated with both techniques 11. The purpose of the current study was to evaluate and compare trends in ankle arthrodesis procedures (arthroscopic and open), as well as to analyze the rate of patients undergoing subsequent adjacent joint arthrodesis procedures in the United States (U.S.).

5 Methods A PearlDiver Patient Record Database analysis ( ) PearlDiver is Health Insurance Portability and Accountability Act compliant national database compiled from a collection of the Medicare MEDPAR dataset and the United Healthcare Orthopedic Dataset (UHC) Patient type underwent ankle arthrodesis (arthroscopic or open), subsequent midfoot or hindfoot procedures (e.g. midtarsal fusion, pantalar fusion, subtalar fusion) Search performed by searching Current Procedural Codes (CPT).

6 Results The yearly incidence of open ankle arthrodesis significantly increased by 27.1% when comparing 2007 to 2010 (P <.05) and was most commonly performed in 2010 with 0.44 cases per 10,000 people (Figure 2) Incidence of Arthroscopic and Open Arthrodesis by Year Incidence Open Arthroscopic Year

7 Results 5.1 % (431/8474) received subsequent arthrodesis (mid-foot, hind-foot) index ankle fusion (open or arthroscopic). 93% (401/431) index procedure open arthrodesis 7.0% (30/431) index procedure arthroscopic arthrodesis (p=<0.001) 3.5% (297/8474) received subsequent subtalar arthrodesis 95% (282/297) index procedure open arthrodesis 5.0% (15/297) ) index procedure arthroscopic arthrodesis (p=<0.001)

8 Results Percentage of Subsequent Adjacent Joint Arthrodesis of the Subtalar Joint and Midfoot/Hindfoot after Index Arthroscopic or Open Arthrodesis 100% 5.00% 7.00% 90% 80% 70% 60% Percentage 50% 40% 95.00% 93.00% Arthroscopic Open 30% 20% 10% 0% Subtalar Arthrodesis Midfoot/Hindfoot Fusion Subsequent Adjacent Joint Procedure

9 Results Index arthroscopic arthrodesis were less likely to have a subsequent mid-foot and or hind-foot arthrodesis compared to index open ankle arthrodesis OR=0.46; 95%CI: ; P<0.0001). Index arthroscopic arthrodesis were less likely to go on to have a subtalar arthrodesis than index open ankle arthrodesis (OR: 0.33; 95%CI: ; P<.0001).

10 Discussion 5.1% of arthrodesis patients underwent a subsequent fusion of the mid-foot and/or hindfoot within a 7 year period. The arthroscopic technique was associated with a lower rate and lower odds ratio of adjacent joint arthrodesis, specifically of the subtalar joint Previous studies have suggested that the relationship between adjacent joint deterioration and ankle joint fusion is inevitable 12 or may not be a causative one 11.

11 Discussion Adjacent joint damage due to: Increased motion in adjacent joints Abnormal chronic loading of other joints 8 Biological advantages of arthroscopic procedure: minimum degree of soft-tissue envelope disruption reduce the degree of permanent functional impairment of the joints and soft tissues adjacent to the arthrodesis site. rapid activation of the bone-healing cascade leading earlier functional improvement 6.

12 Conclusion While open ankle arthrodesis is more commonly performed than arthroscopic arthrodesis, it is associated with a higher rate of subsequent adjacent joint arthrodesis. The factors that may potentiate these subsequent procedures should be further investigated.

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