Clinical Outcomes and Safety Profile of Open and Arthroscopic Subtalar Joint Arthrodesis: A Systematic Review.

Abstract

Open and arthroscopic subtalar arthrodesis are safe and effective surgeries for patients with notable arthritis; however, not an established superiority among them has been found. This systematic review aims to present all of the available literature on studies directly comparing both surgeries. Two independent authors completed a systematic literature search using the following databases: PubMed, Embase, and the Cochrane library. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis protocol and the Cochrane Handbook guidelines were followed. In addition, the MINORS score was used to evaluate the quality and bias of the nonrandomized controlled trials. Our search criteria included only studies that included both open and arthroscopic subtalar arthrodesis. A total of four studies including 125 open and 130 arthroscopic surgeries met the inclusion criteria for the current systematic review. The mean age and body mass index of patients in the open and arthroscopic groups were 50.0 ± 2.3 and 47.9 ± 1.4 years and 29.0 ± 3.7 and 29.5 ± 2.6 kg/m2, respectively. Patients in the open cohort and arthroscopic cohort were followed for a mean of 16.9 ± 6.5 and 15.8 ± 4.7 months, respectively. Union rate was 95.4% ± 4.6% vs. 93.6 ± 4.0%, and the time to fusion was 14 ± 1.6 vs. 10.5 ± 1.6 weeks. The overall complication rate among patients who underwent open arthrodesis was 44.0%, whereas the complication rate was 39% among patients who underwent arthroscopic arthrodesis. Patients stayed in the hospital for 2.2 ± 0.9 days following an open procedure versus 1.1 ± 0.5 days following minimally invasive procedures. The current systematic review found a high rate of union among both group of patients. Although trends suggested higher union rates and fewer complications in the arthroscopic cohort, no notable differences were found. Although limited, we hope that this systematic review may help to guide evidence-based decisions when planning the surgical management of patients with severe subtalar arthritis.