© Ali Abbasian
Website Designed ByTotal ankle replacement relieves the pain of severe ankle arthritis while keeping movement in the joint. I am a consultant foot and ankle surgeon in London, and ankle replacement is a major part of my practice, both at Guy’s and St Thomas’ and privately at HCA hospitals. This page explains who it suits, what the operation involves, what recovery looks like and what the risks are.
On this page
In an ankle replacement, the worn surfaces of the ankle joint are removed and replaced with metal components, with a plastic bearing between them. The aim is to relieve pain and keep the ankle moving, so you can walk more comfortably and more naturally.
I use the Infinity ankle replacement with Prophecy planning. Before surgery, a CT scan of your ankle is used to plan the size and position of the implant and to make guides specific to your anatomy. You can watch an animation of the operation here.
Ankle replacement is usually considered for severe ankle arthritis that is causing significant pain and limiting your life, when simpler treatments such as painkillers, braces, insoles or injections have stopped helping.
It works best in people with good bone quality and circulation. It is not usually suitable if you have an active infection, poor blood supply to the leg, or nerve damage in the foot from diabetes. The risk of the implant failing is higher in people who are younger (particularly under 65), have diabetes, are significantly overweight, smoke or drink heavily, have lung disease or have a severe deformity. None of these automatically rules out a replacement, but we will weigh them up together.
The main alternative is an ankle fusion, which joins the bones of the ankle together. Both operations relieve pain well, and overall function is similar. A replacement keeps more movement in the ankle, while a fusion is less likely to need further operations. A large UK trial (TARVA) found similar improvements with both at one year. I explain the choice in more detail in ankle replacement versus fusion.
Many people with ankle arthritis also have problems elsewhere in the foot or ankle that need correcting at the same operation, so the new joint is balanced and lasts as long as possible. These are usually identified and discussed before surgery, but occasionally the need only becomes clear during the operation. Examples include:
The operation is done under general anaesthetic and takes around 90 minutes, or longer if additional procedures are needed. You will also have a nerve block, which numbs the ankle so you should wake up comfortable. Most people stay in hospital for one or two nights.
You will wake up in a below-knee half plaster with your leg raised. You will not be able to put weight on the leg for two weeks, so you will need crutches, a knee scooter or another walking aid. A physiotherapist will see you before you go home to choose the best one for you.
Keep your leg raised as much as possible to control swelling and pain, and use ice when you can. The nerve block usually wears off after about 24 hours. You will have strong painkillers to take regularly. The first two to three days are usually the most painful, and things improve quickly after that.
I will see you at two weeks to remove the plaster and check the wound. The stitches dissolve, so they don’t need removing. You will then go into a walking boot and, if all is well, start putting weight on the leg.
You can walk with full weight in the boot. You can take the boot off at rest, and to shower or bathe once the wound has healed. Swelling is common, especially after standing, so keep resting with your foot up and using ice.
You will start gentle exercises to move the ankle up and down, and I will refer you to a physiotherapist. At six weeks I will see you with an X-ray, and if everything is satisfactory you can stop using the boot and go back to your own shoes.
The aim now is to walk as normally as possible, heel to toe, and build up gradually. Increase your walking by around 10 to 20% a week, starting at around 1,000 steps a day and working up to 5,000. You may need a stick at first. Physiotherapy is in full swing, and exercises in a pool can help.
You should be walking around 5,000 steps a day comfortably and can start increasing this. You can try uneven ground and low-impact exercise such as cycling, a cross trainer or swimming. Towards the end of this period, some people return to golf or social tennis. Swelling after activity is still common but gradually settles. I will see you at six months for a check and X-ray.
I see patients with an X-ray every year. Sometimes cysts form in the bone around the implant without causing any pain, and occasionally they need treating to stop the implant loosening. Regular checks mean these can be picked up early.
You cannot drive in a plaster or boot on your right leg. Most people return to driving once they are out of the boot and can do an emergency stop safely. If the surgery is on your left ankle and you drive an automatic, you may be able to drive sooner. Check with your insurer first.
Return to work depends on your job. Desk-based work is often possible from around six weeks, or earlier if you can work from home with your foot raised. Physical jobs take longer, and we will plan this together.
Walking, cycling, swimming and golf are all fine once you have recovered. Many people manage a brisk hike or a social game of tennis. High-impact sports such as running and jumping are not recommended, as they increase wear on the implant.
On average, function scores roughly double after surgery, from about 40 to 80 out of 100. In one 10-year study, more than 4 in 10 people said they forget they have an artificial ankle.
About 8 to 9 in 10 ankle replacements are still working 10 years after surgery. Roughly 1 in 100 fail each year, most often because a component loosens from the bone. Ankle replacements do not yet last as long as hip and knee replacements.
If a replacement fails, it can usually be revised to a new implant, or converted to a fusion. Where there is significant bone loss, a larger implant, a bone graft or a custom-made implant may be needed. Read about my research on treating failed ankle replacements with custom 3D-printed implants.
Most complications are minor and do not affect the final result. These risks should be read alongside the general risks of foot and ankle surgery.
More common, usually minor:
Less common, more serious:
About 1 in 6 to 1 in 4 people have another procedure on the ankle in the long term. Most are smaller operations that keep the implant in place, such as removing bone spurs or treating problems elsewhere in the foot. A full revision of the implant is more likely after a replacement than after a fusion.
Ankle replacement is a specialised operation, and results are better in hospitals that do more of them. Hospitals doing 10 or fewer a year have higher failure rates. You can check how many ankle replacements any surgeon has performed on the National Joint Registry. My NJR profile shows 23 primary ankle replacements from 1 April 2025 to 31 March 2026, nearly three times the national average of 8.
The figures on this page are ranges from published studies and joint registries, not guarantees. Most of the evidence comes from observational studies, and results vary between patients, implants and surgeons. I will talk through your own risks at your consultation. For quick answers to common questions, including cost and insurance, see my ankle replacement FAQs.
If ankle arthritis is limiting your life, I can assess whether an ankle replacement, a fusion or a non-surgical treatment is right for you. Request an appointment or message us on WhatsApp.