I’m scheduled to have an ankle fusion next week. The surgeon I’m seeing didn’t answer all my questions today. He says “don’t overthink this.” But I would still like to know what kind of problems I could potentially run into after surgery. I did read the patient disclosure form with all the usual blood clots that can kill you kind of stuff. What about the actual ankle? Will it work? Will I be better?

When ankle pain from osteoarthritis is severe, function is low, and conservative care isn’t helping, surgeons turn to a fusion procedure known as an arthrodesis. There are two ways to do this surgery: open ankle and arthroscopic. As the names suggest, open ankle involves large incisions. Arthroscopy can be done with tiny incisions or just puncture holes where the scope is inserted into the joint.

Naturally, the question arises: which technique works better? Which one is preferred when measured by improvement in pain levels, function, and costs (hospital stay)? Perhaps you discussed some of these details with your surgeon. It is likely you will have another chance to ask a few more questions either during the pre-operative exam (unless this was it) or the day of the surgery.

Most of the time, patients do sail through this procedure. Whether performed arthroscopically or with an open incision, the rate of problems or complications is fairly equal between the two groups. According to a recent study from Canada comparing results of ankle arthrodesis when done arthroscopically versus open incision, 60 patients (30 in both groups) all improved significantly.

The arthroscopic group did show even greater improvement (statistically better) compared with the open incision group. And the arthroscopic group was in the hospital on average 1.2 fewer days.

There was no difference between the groups in terms of length of time (number of minutes) to do the surgery or quality of alignment of the bones (as viewed on X-ray). The number and type of complications (e.g., nonunion of the bone, delayed wound healing, painful hardware that had to be removed) were also the same between the two groups.

The authors concluded that surgical treatment for end-stage osteoarthritis of the ankle can be safely done arthroscopically. Compared with open incision procedures, arthroscopic arthrodesis provides better overall results faster and without an increase in postoperative problems or complications.

Previous studies reported difficulty correcting a particular ankle deformity (coronal plane deformity) using arthroscopic techniques. But these surgeons say it’s just a matter of repositioning the talus bone in the ankle to restore normal alignment and that can be done arthroscopically as well.