Ankle replacement
An operation to replace a worn, arthritic ankle joint with metal and plastic parts, aiming to relieve pain while keeping some ankle movement.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- Ankle replacement swaps a worn, arthritic ankle joint for metal and plastic parts to relieve pain while keeping some movement.
- The main alternative is ankle fusion, which removes pain well but stiffens the joint; the right choice depends on you, not just the X-ray.
- It is not permanent: the National Joint Registry reports roughly a 15% chance of needing revision surgery within 10 years.
- Choose a surgeon who does ankle replacements regularly, as results depend on careful patient selection and experience.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your surgeon will give you advice for your situation.
Can give good relief from arthritis pain
People with active or recent infection in or around the ankle.
Pain is controlled and the leg is kept elevated. You are shown how to move safely on crutches and given blood-clot prevention before going home.
A clear, staged weight-bearing and physiotherapy plan, with named contacts.
Pain is controlled and the leg is kept elevated. You are shown how to move safely on crutches and given blood-clot...
The ankle is protected in a cast or boot, often with limited or no weight through it at first. The wound is...
You are usually allowed to put more weight through the ankle and move out of the cast into a boot or supportive...
Walking distance and comfort improve. Swelling can persist for some months, and the ankle continues to settle.
What is an ankle replacement?
An ankle replacement is an operation for severe ankle arthritis, where the smooth cartilage in the joint has worn away and bone rubs on bone, causing pain and stiffness. The surgeon removes the damaged joint surfaces and replaces them with metal and plastic parts, much like a hip or knee replacement.
The main aim is to relieve pain while keeping some movement in the ankle. The other major operation for a worn ankle is ankle fusion, where the joint is permanently stiffened so the bones grow together. Fusion is very good at relieving pain but removes ankle movement; replacement keeps some movement but is a more complex implant that can wear out.
Ankle replacement is usually only considered after simpler treatments — painkillers, physiotherapy, supportive footwear or braces, and sometimes injections — have not controlled the pain. The choice between replacement and fusion depends on your age, activity, the state of nearby joints and what matters most to you, and should be made with a foot and ankle surgeon.
It is important to know that ankle replacements have not yet matched the very long-term results of hip and knee replacements, so durability and the chance of future surgery are important parts of the decision.
Types & techniques
There isn't one single operation. The right approach depends on you — which is something to discuss with your surgeon.
Ankle replacement versus ankle fusion
| Replacement | Fusion | |
|---|---|---|
| Ankle movement | Some kept | Lost |
| Pain relief | Usually good | Usually good |
| Strain on nearby joints | Lower | Higher over time |
| Future surgery | Implant can wear/loosen | Non-union or later fusion of other joints |
Neither operation makes the ankle normal. The best choice depends on your age, activity, weight, bone quality and nearby joints — discuss this carefully with your surgeon.
Preparing for your surgery
- See a foot and ankle surgeon, who will examine your ankle, review X-rays and sometimes a CT scan, and assess nearby joints.
- Discuss replacement versus fusion openly, as both are reasonable for severe ankle arthritis.
- Tell the team about diabetes, smoking, inflammatory arthritis or any condition affecting healing, as these affect suitability.
- Reach a healthy weight if possible, as high body weight can increase load on the implant.
- Stop smoking if you can, as it raises the risk of wound and bone-healing problems.
- Plan for a short hospital stay and a period in a cast or boot afterwards, with help at home and time off work.
- Discuss blood-clot prevention and how your usual medicines will be managed around surgery.
What happens
The operation is usually done under a general anaesthetic, often combined with a regional nerve block to help with pain afterwards; sometimes a spinal anaesthetic is used.
The surgeon makes a cut over the front of the ankle, removes the worn joint surfaces and accurately fits the metal components to the shin bone and the talus, with a plastic spacer between them to act as the new bearing surface. The position is checked carefully, often with X-rays during the operation. The wound is closed and the ankle is supported in a cast or boot.
The operation usually takes around one to two hours. Most people stay in hospital for a few days while pain is controlled and the leg is rested and elevated.
Is this operation right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- People with active or recent infection in or around the ankle.
- Those with poor skin or circulation over the front of the ankle, or uncontrolled diabetes, where wound healing is a serious concern.
- Very young, very active or significantly overweight people, in whom an implant may wear out quickly and fusion may be advised instead.
- People with poor bone quality or severe deformity that the implant cannot reliably support.
Delay surgery if…
- There is active infection anywhere that could seed the new joint.
- A suspected or confirmed blood clot in the leg needs treating first.
- Diabetes, smoking or other health issues need optimising to reduce wound and healing risks.
- A clear decision between replacement and fusion has not yet been reached.
Alternatives to discuss
- Painkillers, activity modification and weight management.
- Physiotherapy, supportive footwear, insoles or an ankle brace.
- Steroid or other injections into the joint for temporary relief.
- Ankle fusion, the main surgical alternative, which is very durable but removes movement.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Anaesthetic choices
The safest option depends on the operation, your health, the facility and your surgeon/anaesthetist. Ask what is planned and why.
Benefits
- Can give good relief from arthritis pain
- Keeps some ankle movement, which fusion does not
- May feel more natural to walk on than a fused ankle for some people
- Puts less long-term strain on nearby foot joints than fusion
Risks & complications
- Pain, swelling and bruising that settle over weeks to months
- A scar over the front of the ankle
- A period in a cast or boot with reduced mobility and being unable to drive
- Wound-healing problems, which are not unusual after ankle surgery
- A break in the bone around the implant during or after surgery
- Nerve damage causing numbness, altered feeling or, less often, weakness
- A blood clot in the leg (deep vein thrombosis), which can travel to the lungs
- The implant loosening or the plastic wearing over time, which may need revision
- Deep infection of the joint replacement, which can need major further surgery
- Persistent pain despite a well-positioned implant
- Failure of the replacement needing conversion to a fusion
- Problems related to the anaesthetic
Two issues deserve particular attention. First, wound healing over the front of the ankle can be slow because the skin is thin, and this is worse in smokers and people with diabetes. Second, an ankle replacement is not permanent: the National Joint Registry reports about a 15% chance of needing revision surgery within 10 years, and replacements have not yet matched the long-term durability of hip and knee replacements. Ask your surgeon about their own results and how many ankle replacements they do each year.
Published figures to discuss
Reported survival and complication rates vary widely with the implant design, the surgeon's experience and patient factors such as weight, activity, bone quality and diabetes. National Joint Registry data give the most relevant UK figure for the chance of revision. The figures below are cautious and should be read as general guidance, not a personal prediction.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Revision surgery within 10 years | About 15% (National Joint Registry) | Registry-based figure; varies by implant and patient. Replacements are less durable than hip or knee replacements. | Survival of primary ankle replacements: data from global joint registries (PMC)ncbi.nlm.nih.govPublished figure |
| Deep infection of the joint replacement | Less than 1% (NJR patient information) | Uncommon but serious, potentially needing major further surgery. | Survival of primary ankle replacements: data from global joint registries (PMC)ncbi.nlm.nih.govPublished figure |
| Wound-healing problems | Around 1 in 8 (NJR patient information) | The thin skin over the front of the ankle heals slowly; smoking and diabetes increase this risk. | Survival of primary ankle replacements: data from global joint registries (PMC)ncbi.nlm.nih.govPublished figure |
| Nerve damage | About 1 in 23 (NJR patient information) | Usually numbness or altered feeling; less often weakness. | Survival of primary ankle replacements: data from global joint registries (PMC)ncbi.nlm.nih.govPublished figure |
| Fracture around the implant | About 1 in 25 (NJR patient information) | Can occur during or after surgery and may need additional fixation. | Survival of primary ankle replacements: data from global joint registries (PMC)ncbi.nlm.nih.govPublished figure |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
Recovery — what to expect, and when
Recovery is gradual and measured in months. Expect a short hospital stay, several weeks in a cast or boot with limited weight-bearing, then a physiotherapy programme as pain settles and movement returns.
- Swelling around the ankle and foot that can last several months
- Stiffness that gradually eases with physiotherapy
- Tiredness and slow build-up of walking distance
- A scar over the front of the ankle that fades over months
Aftercare
- Keep the leg elevated in the early weeks to control swelling.
- Keep the cast or boot dry and wear it exactly as instructed.
- Take blood-clot prevention as advised and watch for calf pain, swelling or breathlessness.
- Only put weight through the ankle as your surgeon allows, using crutches or a frame.
- Attend physiotherapy and do your exercises to rebuild movement and strength.
- Do not drive until you can safely control a vehicle and your team confirms it is allowed.
- Keep follow-up appointments, including X-rays, so the implant is monitored over time.
- Crutches or a walking frame ready at home
- A plan for getting home and managing without driving
- Time off work arranged (longer for jobs on your feet)
- Help at home for the first weeks
- A waterproof cover for showering with the boot or cast
- The clinic's contact number saved for wound or clot concerns
Scars and how they heal
The operation usually leaves a scar over the front of the ankle. Because the skin here is thin, wound healing can be slow and the scar occasionally thickened or sensitive. Protecting the wound and not smoking help healing. Report any redness, gaping, discharge or the wound failing to close.
⚠ Get urgent help if…
- Calf pain, swelling, warmth or redness, or sudden breathlessness or chest pain — possible blood clot, seek urgent help
- Spreading redness, heat, increasing pain or discharge from the wound — possible infection
- The wound opening up or failing to heal
- A high temperature or feeling generally unwell
- Sudden severe pain or inability to bear weight, which may suggest a fracture or implant problem
- New numbness, severe burning pain or weakness in the foot
Who to contact: your surgeon or clinic first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your surgeon gives you.
Results & realistic expectations
A good result means much less arthritis pain, with some preserved ankle movement and improved walking. Most people are pleased with pain relief, although the ankle does not become normal and some swelling or stiffness can remain.
Because the implant can wear or loosen over time, the result is not necessarily permanent. The National Joint Registry reports around a 15% chance of needing revision surgery within 10 years, and outcomes vary with implant type, surgeon experience and patient factors. A careful discussion of replacement versus fusion is essential to a good decision.
Ankle replacements are durable for many people but do not yet last as reliably as hip or knee replacements. Implants can wear, loosen or fail over the years, and the National Joint Registry reports roughly a 15% chance of revision within 10 years. Younger, heavier and more active people tend to put more demand on the implant. Long-term monitoring, including X-rays, helps pick up problems early; if a replacement fails, options include revision surgery or conversion to a fusion.
Combining with other procedures
Ankle replacement is sometimes combined with procedures to correct alignment or to treat arthritis in nearby joints, which can lengthen the operation and recovery. Your surgeon will explain if any additional procedure is planned.
Follow-up & long-term care
You will be reviewed to check the wound and progress, and then at intervals with X-rays to monitor the implant over the long term. Report wound problems, calf pain, new pain or any change in how the ankle feels promptly.
- Attend long-term follow-up appointments and X-rays to monitor the implant.
- Keep to a healthy weight to reduce load on the replacement.
- Choose lower-impact activities and avoid high-impact sport, as advised, to protect the implant.
- Report new pain, swelling or change in function early, as it may signal a problem.
Revision and secondary surgery reality
- Around 15% of ankle replacements need revision within 10 years, according to the National Joint Registry.
- Revision can involve exchanging worn parts, or converting the replacement to a fusion if the implant cannot be salvaged.
- Younger, heavier and more active people tend to place more demand on the implant.
- Long-term X-ray monitoring helps detect loosening or wear before it causes major problems.
Ask your surgeon for their own revision rate, what counts as a revision, and what is included in the written aftercare policy.
What good aftercare looks like
- A clear, staged weight-bearing and physiotherapy plan, with named contacts.
- Active blood-clot prevention and clear advice on clot warning signs.
- Prompt review of any wound concern, given the thin skin over the ankle.
- Planned long-term follow-up with X-rays to monitor the implant.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- The surgeon's fee and the complexity of your ankle
- Anaesthetic fee and type, including any nerve block
- Theatre and facility fees
- The implant itself and any imaging such as CT before surgery
- Length of hospital stay
- Physiotherapy and follow-up appointments, including long-term X-rays
- Any further treatment if a complication or revision is needed
- The operating surgeon's fee
- Anaesthetist's fee and the type of anaesthetic
- Theatre, facility and hospital-stay fees
- The cost of the implant
- Physiotherapy sessions included and the cost of further ones
- Long-term follow-up and X-ray monitoring
- What happens, and who pays, if a complication or revision occurs
On the NHS? Ankle replacement is available on the NHS for severe ankle arthritis when other treatments have failed; private care is sometimes chosen for speed or choice of surgeon.
You're entitled to your total cost in writing — including aftercare and any revision — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Not being offered a genuine discussion of fusion as an alternative.
- Underplaying that the implant is not permanent and may need revision.
- No discussion of wound-healing risk, especially in smokers and people with diabetes.
- No long-term follow-up and X-ray monitoring plan.
Marketing red flags
- Promising a 'normal' or 'permanent' ankle.
- Comparing ankle replacement to hip or knee replacement without noting it is less durable.
- Encouraging high-impact sport after a replacement.
- No mention of revision rates, wound problems or the fusion alternative.
Choosing a surgeon safely
- Check your surgeon is on the GMC Specialist Register for this area.
- Make sure they practise at a CQC-registered location, and look for membership of bodies like BAAPS or BAPRAS.
- You're entitled to a two-stage consent process with time to reflect (a cooling-off period). The surgeon who will operate must consent you — not a salesperson.
- Be wary of pressure: time-limited offers, discounts or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including aftercare and any revision — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good surgeon will welcome every one of these.
- For me, would a replacement or a fusion give the better long-term result?
- How many ankle replacements do you do each year, and what are your results?
- Which implant do you use and why, and what is its track record?
- What is my personal risk of wound-healing problems and revision?
- How will my weight or activity affect how long the implant lasts?
- What does my recovery and weight-bearing timeline look like?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the surgeon who carries out my operation, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this operation not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Should I have a replacement or a fusion?
Is ankle replacement available on the NHS?
How long will the new ankle last?
How long is the recovery?
Will I be able to walk normally and do sport?
What happens if the replacement wears out?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: National Joint Registry — Ankle replacement (patient information) BOFAS — Patient guide to ankle arthritis Survival of primary ankle replacements: data from global joint registries (PMC) Ten-year revision rates of contemporary total ankle arthroplasties — meta-analysis (PubMed) 10-year survival of total ankle arthroplasties — Swedish Ankle Register (PMC) NICE NG226 — Osteoarthritis in over 16s: diagnosis and management (2022)
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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