Abstract Object To investigate the clinical effect of peroneal osteotomy and arthroscopic compress cannulated screws on ankle arthrodesis. Methods From January 2015 to December 2018 , 47 patients with severe ankle osteoarthritis treated by ankle arthrodesis in our department. Among them, 27 patients received peroneal osteotomy fusion and 20 patients received arthroscopic fusion. Results ①There were significant differences in operation time, postoperative drainage volume and average length of stay between the two groups (P<0.05). ②Before and 12 months after surgery, there was no statistically significant difference in AOFAS score and VAS score (P>0.05), but the scores 6 months after surgery were significantly better in the arthroscopy group than in the peroneal osteotomy group, with statistically significant difference (P<0.01).③the fusion rate of the two groups, the difference between the two groups was not statistically significant (P>0.05). ④the tibialtalus valgus angle was statistically significant (P<0.01). Conclusion Peroneal osteotomy and arthroscopic ankle arthrodesis could effectively correct malformation and improve ankle function in the treatment of ankle arthritis.During the operation, we should pay attention to restore the alignment of the ankle joint and the stability .