If you need ankle surgery, ankle replacement may offer a better range of motion and more natural movement than ankle fusion. Success and complication rates are similar.

Ankle joint replacement, or ankle arthroplasty, is a type of surgery to treat late-stage arthritis. The surgery involves removing damaged tissue in your ankle and replacing it with a prosthesis made from metal and plastic.

The gold standard surgery for ankle arthritis used to be ankle fusion. Fusion involves permanently connecting your foot to your lower leg, so it’s no longer moveable.

Nowadays, ankle joint replacement has surpassed fusion as the gold standard for people who are eligible. It offers benefits over fusion, such as:

  • improving ankle motion
  • improving walking gait
  • preserving the structure of your joint

The number of ankle joint replacements performed each year in the United States is increasing. From 2009 to 2019, the number of yearly procedures rose from 2,180 to 5,147.

Read on to learn about ankle joint replacement, including who makes a good candidate, what the procedure involves, and what to expect during recovery.

location of ankle joint replacement in the footShare on Pinterest
Illustration by Brittany England

Ankle joint replacement is used to treat ankle arthritis. Post-traumatic arthritis is the most common type of arthritis of the ankle. This form of arthritis develops quickly after a sudden ankle injury.

Doctors usually recommend ankle joint replacement only to people with advanced arthritis that hasn’t responded to more conservative treatment options such as:

The ideal candidate is usually somebody “middle-aged” or over, with regular alignment of the ankle and a relatively good range of motion.

Other factors that make you a good candidate include:

  • not having obesity
  • not having a physically demanding lifestyle
  • not having any nerve or blood vessel impairment in your leg
  • having good bone strength

Diabetes and ankle joint replacement

Having underlying health issues like diabetes can make you more prone to surgical complications and may affect your candidacy for ankle surgery.

However, in a 2022 review of studies, researchers found that people with diabetes didn’t seem to be at a higher risk of complications from ankle joint replacement but did seem to be at an increased risk from ankle fusion.

Ankle replacement is usually done under general anesthesia, meaning you’ll be asleep during the procedure. Surgical staff will also likely give you a nerve block, which blocks pain signals from your lower leg.

Your procedure will likely last about 60 to 90 minutes and look something like this:

  1. You’ll receive general anesthesia, usually through a tube inserted into one of your veins, often in the back of your hand. If administered a nerve block, you’ll receive it through a thin needle in your leg.
  2. The surgical team will connect you to machines that monitor your vital signs, such as your heart rate and blood pressure.
  3. Your surgeon will disinfect your skin and make incisions around your foot and ankle.
  4. Your surgeon will remove your damaged bone and tissue and replace it with an artificial replacement made up of two pieces of metal with plastic in between.
  5. They will close the wound with stitches.

You’ll likely wake up with your leg elevated and in a cast or splint.

What is the success rate for ankle replacement surgery?

In a 2019 review of studies, researchers found that about 1 in 8 people needed revision surgery or ankle fusion after 5 years and about 1 in 5 people after 10 years.

The review also found that certain groups were at a higher risk of needing revision surgery, including people with:

  • dementia
  • chronic pulmonary disease
  • diabetes
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You may need to stay at the hospital for a couple of days after your procedure. You may have pain when the nerve block wears off, but the medical team can give you pain relievers to help manage your discomfort.

You’ll have to use crutches for a couple of weeks after your procedure and try to stay off your feet as much as possible. After the first 2 weeks, you may be able to walk in a boot or special brace. Your team will remove the boot or brace about 6 weeks after your procedure.

Potential complications include:

  • infection
  • nerve damage
  • bleeding
  • blood clots
  • bone misalignment
  • new arthritis
  • need for revision surgery

In a 2023 review of studies, researchers found an average complication rate of 23.7% among 4,412 ankles.

Ankle fusion surgery (aka ankle arthrodesis) joins the bones in your ankle so you can no longer move them. Surgeons achieve this by implanting screws or plates to keep the joint in place so your body will form new bone between your foot and leg.

Ankle replacements may offer a better range of motion and more natural movement than ankle fusion.

A 2020 systematic review found no significant difference between ankle fusion and ankle replacement in terms of revision or complication rates. A 2019 study also found no significant difference in cost.

Here are some frequently asked questions people have about ankle replacements.

What are ankle joint replacements made out of?

Early ankle replacements developed in the 1970s required cement to attach them to your bones. Modern implants avoid the need for cement and are usually made up of two pieces of metal with plastic in between them.

How soon can I walk after ankle replacement surgery?

After your surgery, you’ll need to walk with crutches and keep weight off your foot for about 2 weeks. After this period, you’ll be able to walk with a special brace or boot until you can fully bear your weight, usually after about 6 weeks.

How soon can I drive after ankle replacement surgery?

Most people do not drive until they can fully bear weight, after about 6 weeks. You might be able to drive sooner if the surgery was not on the leg you use to drive.

How painful is ankle replacement?

You shouldn’t feel pain during surgery but may have significant pain afterward. Your doctor can give you pain medications to help you manage your discomfort.

How long do ankle replacements last?

In a 2020 study, researchers found that among 60 procedures, 97.3% and 84.3% of implants lasted 5 and 10 years, respectively.

Ankle joint replacement is a surgery used to treat severe arthritis that you can’t manage with more conservative treatment options. The procedure involves replacing the damaged part of your ankle with an artificial replacement.

Ankle joint replacements are becoming more common since they offer a better range of motion than ankle fusion. Your doctor can help you decide whether you may be a good candidate.