Complication rates in open versus arthroscopic ankle arthrodesis in patients with avascular necrosis of the talus

BACKGROUND: Treatment strategies for talar avascular necrosis range from nonsurgical management to surgical interventions, including joint-sparing and joint-sacrificing procedures. However, no consensus exists on the optimal treatment approach, particularly in cases requiring ankle arthrodesis. PURPOSE: This study evaluated whether open ankle arthrodesis and arthroscopic ankle arthrodesis differ in complication rates when used for the treatment of talar avascular necrosis. STUDY DESIGN: Patient outcomes following ankle arthrodesis procedures were analyzed retrospectively using a national healthcare database containing diagnosis and procedure codes. METHODS: Utilizing data from the TriNetX database, we identified patients with talar avascular necrosis who underwent open or arthroscopic ankle arthrodesis between January 29, 2004, and January 29, 2024. Propensity score matching controlled for age, sex, long-term steroid use, and comorbidities. Primary outcomes included one-year rates of nonunion and hardware removal. Risk differences were calculated, and significance was assessed with Z-tests. RESULTS: No significant differences in orthopaedic complications between the open-ankle and arthroscopic cohorts, including rates of nonunion (30.6% vs. 31.1%, p = 0.936) and hardware removal (19.0% vs. 12.1%, p = 0.147) were found. CONCLUSION: This study found no significant differences in complication rates between open and arthroscopic ankle arthrodesis for talar avascular necrosis, including nonunion and hardware removal. These findings suggest that both open and arthroscopic approaches offer comparable complication profiles.