Total ankle replacement (ankle arthroplasty) is an operation to replace the damaged surfaces of the ankle joint with metal and plastic components. It aims to relieve pain while preserving ankle movement, unlike ankle fusion.
An incision is made over the front of the ankle. The damaged surfaces of the tibia and talus are carefully removed and replaced with metal components separated by a plastic bearing. The foot is positioned in a boot or cast. The operation takes approximately one and a half to two hours.
Ankle replacement is considered for severe ankle arthritis causing significant pain and stiffness when non-operative treatments have failed. It is an alternative to ankle fusion, with the advantage of preserving movement.
Pain medication, ankle bracing, activity modification, and injections. Ankle fusion (arthrodesis) is the main surgical alternative and remains the gold standard for younger, heavier, or very active patients.
Thorough pre-assessment. CT scan is usually required for planning. Smoking cessation is strongly advised. Plan for limited mobility for several weeks.
Good pain relief with preservation of ankle movement. Most patients can walk comfortably and perform daily activities. Modern ankle replacements have improving long-term survival, though they do not match the track record of hip or knee replacements.
Expected for several months.
Some improvement in movement but rarely a fully 'normal' range.
The anterior ankle skin is thin and vulnerable.
Fracture of the tibia or talus during surgery.
Loosening or subsidence of components. May require revision or conversion to fusion.
Deep infection may require implant removal.
Numbness on the top of the foot from stretching of the superficial peroneal nerve.
Not all patients achieve complete pain relief.
General or spinal anaesthesia with a nerve block for pain relief.
A cast or boot is worn for four to six weeks, initially with restricted weight-bearing. Physiotherapy begins after cast removal. Walking comfortably is usually achieved by three months. Full recovery takes six to twelve months.
Regular follow-up with X-rays at two weeks, six weeks, three months, and annually long-term.
Both are effective. Replacement preserves movement; fusion is more durable but eliminates ankle motion. Your surgeon will recommend the best option based on your individual circumstances.
Current evidence suggests 10–15 year survival rates of 80–90% for modern designs, with improving outcomes.