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

Clinical Snapshot

Key Findings

• P Value: Not reported for between-group comparisons

• Effect Size: No formal effect size (odds ratio, risk difference, or standardised mean difference) calculated or reported for any outcome

• Primary Outcome: Union rate: 95.4% ± 4.6% (open) versus 93.6% ± 4.0% (arthroscopic); no statistically significant difference reported

• Nnt Or Sensitivity: NNT cannot be calculated from available data. Descriptive findings: time to fusion 14 ± 1.6 weeks (open) vs 10.5 ± 1.6 weeks (arthroscopic); complication rate 44.0% (open) vs 39.0% (arthroscopic); hospital length of stay 2.2 ± 0.9 days (open) vs 1.1 ± 0.5 days (arthroscopic) — none with inferential statistics

• Confidence Interval: Not reported for any outcome

Clinical Application

Both techniques are established in Australian orthopaedic practice. Arthroscopic subtalar arthrodesis requires advanced arthroscopic skill and appropriate instrumentation, limiting availability to high-volume foot and ankle centres. Open arthrodesis remains more widely accessible. The shorter hospital stay associated with arthroscopic approach (~1.1 vs 2.2 days) has resource and cost implications relevant to Australian public hospital settings. Subtalar arthrodesis (both open and arthroscopic) is performed in Australian tertiary orthopaedic and foot-and-ankle specialist centres. There is no specific PBS item number distinction between approaches; both are captured under relevant MBS item numbers for arthrodesis procedures. The TGA has approved relevant fixation hardware (cannulated screws, staples) used in both techniques. RACGP and AOFAS-aligned Australian guidelines do not currently specify superiority of one approach. The trend toward shorter hospitalisation with arthroscopic technique aligns with Australian healthcare system priorities around day-surgery and enhanced recovery pathways, but this review does not provide sufficient evidence to mandate a change in referral or surgical planning practice. Surgeons should continue to individualise approach selection based on deformity complexity, surgeon expertise, and patient factors. Adult patients (mean age ~49 years, BMI ~29 kg/m²) with significant subtalar joint arthritis refractory to conservative management, being considered for surgical arthrodesis. Generalisability to elderly patients, those with post-traumatic deformity, inflammatory arthropathy, or significant comorbidities is uncertain.

Abstract

BACKGROUND: 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. METHODS: 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. RESULTS: 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/m 2 , 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. CONCLUSION: 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.

References

1. 1.Encinas, R., Kiriluk, S. H., Reed, L., Jackson, J. B., Shaath, M. K., & Gonzalez, T. (2026). Clinical outcomes and safety profile of open and arthroscopic subtalar joint arthrodesis: A systematic review. The Journal of the American Academy of Orthopaedic Surgeons. https://doi.org/10.1136/BMJ.D5928