Foot and ankle
Total ankle replacement
Replaces damaged joint surfaces and may preserve ankle movement in carefully selected patients.
General guidance
When it may be considered
- symptomatic ankle osteoarthritis
- suitable anatomy and alignment
- a functional goal that justifies preserving joint movement
Individual decision
How suitability is determined
Biological age, alignment, ligaments, bone quality, neighbouring joints and activity level all influence the choice between ankle replacement and fusion.
An abnormal scan alone is not an indication for surgery. The symptoms, clinical examination, progression and the patient's goals must be considered together.
Surgical plan
Decisions that tailor the procedure
- alignment, ligament stability and bone quality
- skin condition, blood supply, neuropathy and the risk of infection
- osteoarthritis in adjacent joints and overall range of motion
- activity level and the possibility of later revision surgery
Alternatives
What is discussed before surgery
Bracing, appropriate footwear, exercise and pain relief are initial options. In advanced osteoarthritis, ankle replacement is compared with fusion; according to the 2026 AAOS guideline, PRP and hyaluronic acid alone have not shown a consistent benefit.
Before the procedure
Preparation and safety
- treat any skin lesions and optimise circulation and metabolic control;
- plan for wound protection and graded weight-bearing;
- bring all investigation results, previous operative records and a complete list of medication;
- tell the medical team about diabetes, anticoagulant treatment, allergies, smoking and any active infection;
After the procedure
Rehabilitation
Rehabilitation includes wound protection, progressive mobilisation, radiographic follow-up and activity modification.
The exact protocol, permitted weight-bearing and follow-up schedule depend on the procedure performed and individual progress.
Informed consent
Risks and limitations
Possible complications include infection, instability, implant subsidence, wear, fracture, persistent pain and the need for revision surgery.
No procedure can guarantee complete pain relief or a return to a particular level of activity.
After surgery
Signs that require prompt medical assessment
- fever, discharge, spreading redness or worsening pain at the wound;
- sudden swelling of the calf, chest pain or difficulty breathing;
- uncontrolled pain, new numbness, or a change in the colour or temperature of the limb.
For severe symptoms or an emergency, call 112. The instructions given to you at discharge take priority over the general information on this page.
Editorial responsibility
Medically reviewed content
Dr. Răzvan Anițaș
Consultant orthopaedic and trauma surgeon; PhD in medical sciences
Last editorial update: 22 August 2026
Medical sources used for patient information
First step
Consultation, diagnosis and an individual treatment recommendation
This information does not replace a consultation. Surgery is recommended only after the individual benefits, alternatives and risks have been assessed.