What is Total Ankle Replacement?

Total Ankle Replacement, also called ankle arthroplasty, is a surgical procedure that replaces a damaged ankle joint with an artificial implant. The goal is to relieve pain, restore mobility, and preserve motion in patients with severe ankle arthritis. Unlike ankle fusion, which eliminates joint movement, ankle replacement allows the ankle to bend and flex more naturally, helping patients walk with a more normal gait.

Causes

Total Ankle Replacement is most often recommended for patients with advanced ankle arthritis caused by:

  • Osteoarthritis – gradual wear and tear of the joint cartilage over time

  • Post‑traumatic arthritis – arthritis that develops after a fracture, severe sprain, or repeated ankle injuries

  • Rheumatoid arthritis – an autoimmune disease that damages joint lining and cartilage

  • Severe fractures – injuries that significantly damage the ankle joint surface and lead to long‑term pain and stiffness

Symptoms

Patients considered for ankle replacement typically experience:

  • Chronic ankle pain that does not improve with nonsurgical treatments

  • Stiffness and loss of ankle motion

  • Swelling and tenderness around the joint

  • Difficulty walking, climbing stairs, or standing for long periods

  • Instability or a feeling that the ankle “gives way”

  • Reduced quality of life due to pain and limited mobility

Diagnosis

A thorough evaluation is needed before recommending ankle replacement. This may include:

  • Medical history and physical exam – assessing pain, mobility, and ankle alignment

  • Imaging studies – X‑rays, CT scans, or MRI to evaluate the extent of arthritis and bone quality

  • Gait analysis – observing how the ankle functions during walking

  • Review of nonsurgical treatments – ensuring conservative care has been attempted without success

Nonsurgical Treatment

Before surgery, most patients try conservative treatments such as:

  • Medications – anti‑inflammatory drugs or pain relievers

  • Bracing or orthotics – to support the ankle and reduce stress on the joint

  • Physical therapy – to strengthen surrounding muscles and improve flexibility

  • Corticosteroid injections – for temporary pain relief

  • Lifestyle modifications – weight management and activity adjustments to reduce joint strain

If these measures fail to control symptoms, surgery may be considered.

When is Surgery Needed?

Total Ankle Replacement is typically recommended when:

  • Severe arthritis causes persistent pain and disability

  • Nonsurgical treatments no longer provide relief

  • The ankle joint is significantly damaged but surrounding bones and ligaments are healthy enough to support an implant

  • Patients wish to preserve ankle motion rather than undergo ankle fusion

Surgical procedure:

  • Damaged bone and cartilage are removed from the ankle joint

  • Metal and plastic components are implanted to recreate the joint surfaces

  • The artificial joint allows smoother movement and reduces pain

Benefits:

  • Pain relief

  • Improved mobility and function

  • Preservation of ankle motion compared to fusion

Risks:

As with any surgery, risks include infection, blood clots, implant loosening, nerve injury, or the need for revision surgery in the future. Modern implants typically last 10–15 years or longer in many patients.