Objective To compare the clinical effects of ankle arthrodesis using revers PHILOS plate fixation versus PHILOS plate plus cannulated screws fixation with transfibular approach. Methods A retrospective study was conducted on 60 patients who underwent ankle arthrodesis with transfibular approach for end-stage arthritis in our department from January 2014 to May 2019. All cases were classified into stage-3 arothritis aceording to Morrey-Wiedeman classification.30 patients who underwent ankle arthrodesis using PHILOS plate fixation were termed as Group A, while the remaining 30 patients who underwent ankle arthrodesis using PHILOS plate plus cannulated screws fixation were named as Group B.The time of operation, the amount of bleeding, the time of loading, the time of complete osseous fusion, The AOFAS scores and VAS scores were recorded before operation and at the last follow-up. Results The operation time and bleeding volume of group B were greater than that of group A, but the difference was not statistically significant (P > 0.05).The average follow-up duration was 19.53±5.22 months in group A and 21.00±5.63 months in group B. The weight-bearing time of group B （6.32±0.48 weeks）was earlier than that of group A（7.10±0.85 weeks）,showing significant difference(P < 0.05). Both groups achieved complete osseous fusion, but group B(11.16±1.50 weeks) took less time than group A（11.97±2.61 weeks）,showing significant difference(P < 0.05). At the last follow-up, the AOFAS scores were significantly higher than those before operation,VAS scores were significantly reduced compared with those before operation (P < 0.05), but there was no statistical significance between the two groups (P > 0.05). Conclusion Two groups had achieved satisfactory results.Accord with the principle of ankle arthrodesis, ankle arthrodesis with PHILOS plate plus cannulated screws was more reliable for the treatment of end-stage ankle arthritis. the fusion time was shorter, and patients could recover earlier.