Open versus arthroscopic fusion of the subtalar joint: a randomized controlled trial

Abstract

Background and purpose: Our primary aim was to compare the early complication rate (< 6 weeks postoperatively) after open or arthroscopic fusion of the subtalar joint. Secondary outcomes included late complications (> 6 weeks postoperatively), function, pain, and patient satisfaction.

Methods: In this prospective randomized controlled trial, patients listed for subtalar joint fusion were included and randomized for open or arthroscopic fusion. Complications were assessed at scheduled visits at 2 and 6 weeks, 3, 6, and 12 months postoperatively. Functional scores, pain scores, and patient satisfaction were assessed at 3, 6, and 12 months postoperatively, and PROMS at baseline (preoperatively), 3, 6, and 12 months postoperatively. The scores were compared over time between the groups using Fisher's exact test and linear mixed models.

Results: 51 patients were included between 2013 and 2020, of whom 25 were allocated to open and 26 to arthroscopic fusion. 3 early complications (2 sural nerve lesions, 1 infection) occurred in the open fusion group (12%; 95% confidence interval [CI] 3-32) and 3 (2 wound healing problems, 1 screw exchange) in the arthroscopic group (12%; CI 3-31). Late complications included screw removal (n = 5) in the open fusion group versus screw removal (n = 5), non-union (n = 2), bony prominence/calcification removal (n = 1), sural nerve lesion (n = 1), lesion of the calcaneal branch of the tibial nerve (n = 1), complex regional pain syndrome type II (n = 1), and secondary plantar fasciitis (n = 1) in the arthroscopic fusion group. No superiority of arthroscopic over open fusion was found regarding early (P = 1.0) and late complications (P = 0.2), function and pain scores, and patient satisfaction over 12 months Conclusion: Arthroscopic fusion did not result in fewer early complications compared with open fusion. Secondary outcomes did not differ significantly between the approaches.

Figure 1

Flowchart of patient inclusion.

Figure 2

Scatterplot showing the operation time per included patient. Trend lines showing the operation time over the years for the open (blue line) and arthroscopic (green line) group.