Overview
Total ankle replacement resurfaces the worn ankle joint (the tibiotalar joint, where your tibia meets the ankle bone) with metal and plastic components, preserving motion. The alternative for end-stage ankle arthritis is ankle fusion (arthrodesis), which eliminates pain by locking the joint permanently. Replacement keeps the ankle moving, which protects the neighboring joints below it (the subtalar and talonavicular joints) from the extra wear those joints develop when the main ankle is fused. Modern implant designs and techniques have improved substantially over the past decade, making replacement a real option for the right patient.
How the Procedure Works
Your surgeon approaches the ankle from the front. The worn cartilage and a thin layer of bone are removed from the bottom of the tibia and the top of the ankle bone using precision cutting guides aligned to the mechanical axis of your leg. A metal component is fitted to the tibia and another to the ankle bone, either press-fit into place or cemented, depending on the implant system, with a plastic (polyethylene) spacer between them that acts as the new bearing surface. The ankle is then moved through its full range to confirm it tracks smoothly. Any tilt or tightness in alignment is corrected at the same time, because a balanced, straight ankle makes the implant last longer.
When to Consider Ankle Replacement
End-stage ankle arthritis
Bone-on-bone arthritis that is limiting your life, when you want to keep ankle motion rather than fuse the joint.
Low to moderate activity level
You walk for daily activity and recreation but are not running or jumping regularly.
Good bone quality and alignment
Adequate bone density to support the implants, and any malalignment that can be corrected.
Treats: Ankle Osteoarthritis
Physicians Who Perform Ankle Replacement
Risks & Why We Still Recommend It
Every operation carries risk. This procedure is offered because the condition, when left untreated, can cause end-stage ankle arthritis that is painful, stiffens the joint, and overloads the joints below it. The decision to proceed weighs the risks of surgery against the limitations the condition places on daily function. Surgery does not remove risk; it addresses a problem that is otherwise progressive. Whether it is appropriate is determined for each patient in consultation with the surgeon.
Risks include wound complications (the front of the ankle has thin skin and soft tissue, which makes healing more demanding), implant loosening, sinking of the implant into bone (subsidence), plastic wear over time, fracture of the ankle bones around the implant, infection, nerve injury, and the possibility of additional surgery, including conversion to fusion. We offer it because keeping the ankle moving improves how you walk and protects the joints below from overload.
Frequently Asked
questions we hear in clinicWhy choose replacement instead of fusing the ankle?
Ankle fusion eliminates pain by locking the joint permanently. Replacement keeps the ankle moving, which protects the neighboring joints below it from the extra wear those joints develop when the main ankle is fused.
Who is a good candidate?
Someone with bone-on-bone ankle arthritis that is limiting daily life, a low to moderate activity level (walking for daily activity and recreation rather than running or jumping regularly), good bone quality, and alignment that can be corrected.
What is the new ankle made of?
A metal component is fitted to the tibia and another to the ankle bone, with a plastic (polyethylene) spacer between them that acts as the new bearing surface.
Could I still end up needing a fusion later?
It is possible. The risks of ankle replacement include additional surgery, including conversion to fusion, along with wound complications, implant loosening, and plastic wear over time. The full list is in the Risks section above.
Is ankle replacement a proven option?
Modern implant designs and techniques have improved substantially over the past decade, making replacement a real option for the right patient.
Further Reading
External patient-education references and related OSI pages for additional background: