Abstract Objective: To investigate the effect of arthroscopic ankle fusion with headless compression screw on advanced traumatic ankle arthritis (TAA). Methods: The clinical data of 78 patients with advanced TAA in our hospital from January 2017 to May 2020 were selected and grouped according to the treatment plan, 39 cases in each group. The control group received open ankle fusion treatment, and the study group received arthroscopic headless Compression screw ankle fusion treatment. Compare the two groups of surgery-related indicators, bone fusion, pain degree (VAS score), ankle joint function (AOFAS score) and perioperative immuno-inflammatory indicators [tumor necrosis factor-α (TNF-α), interleukin ( IL)-1β, IL-6], oxidative stress indicators [superoxide dismutase (SOD), malondialdehyde (MDA)] levels. Results: The operation time of the study group was longer than that of the control group, and the amount of blood loss and postoperative hospital stay were less than that of the control group (P<0.05); the bone fusion rate (71.79%) of the study group was higher than that of the control group (48.72) at 3 months after operation. %) (P＜0.05); the serum levels of TNF-α, IL-1β, and IL-6 in the study group were lower than those in the control group (P＜0.05); the serum SOD and MDA levels in the study group 3 days after operation Lower than the control group (P＜0.05); The VAS scores of the study group were lower than those of the control group at 1 month, 2 months, and 3 months after surgery (P＜0.05); the study group AOFAS at 3 months and 12 months after surgery The scores were higher than those of the control group (P＜0.05). Conclusion: Arthroscopic headless compression screw ankle fusion is effective in treating patients with advanced TAA, which can further reduce surgical trauma, promote patient recovery, and improve patient prognosis.