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Total Ankle Replacement

Total ankle replacement swaps out the damaged ankle joint for a metal and plastic implant while keeping ankle motion intact. It's an alternative to fusion for end-stage ankle arthritis. Third-generation implants have made a real difference in outcomes and durability, and the procedure has grown to over 15,000 cases annually in the US.

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Total Ankle Replacement surgery - orthopaedic procedure overview and what to expect

Who Needs Total Ankle Replacement?

Good candidates have end-stage ankle arthritis — osteoarthritis, post-traumatic, or rheumatoid — with significant pain and limited function that hasn't responded to conservative care. Moderate activity level, decent bone quality, and no major deformity make for the best outcomes.

What to Expect

1
Weight-bearing X-rays and CT scan for surgical planning
2
Surgery takes 1.5-2.5 hours under spinal or general anesthesia
3
The damaged ankle joint surfaces are removed and replaced with metal components and a plastic insert
4
Hospital stay of 1-2 days
5
Non-weight-bearing cast for 2-3 weeks, then a walking boot
6
Physical therapy begins at 6-8 weeks

Recovery Timeline

Weeks 1-3

Non-weight-bearing in a splint or cast. Keep leg elevated to control swelling.

Weeks 3-6

Transition to a walking boot. Protected weight bearing begins.

Months 2-3

Physical therapy to restore range of motion and strength. Regular shoes by month three for most patients.

Months 3-6

Progressive return to activity. Most daily activities restored. Continued strength training.

Months 6-12

Maximum recovery. Return to low-impact activities: walking, cycling, swimming, golf.

Risks & Complications

  • Implant loosening or failure
  • Wound healing problems (ankle skin is thin)
  • Infection (1-2%)
  • Nerve injury around the ankle
  • Need for revision or conversion to ankle fusion
  • Subsidence (implant sinking into bone)

Frequently Asked Questions

Is ankle replacement better than ankle fusion?

Replacement preserves motion, which takes stress off adjacent joints and lets you walk more naturally. Fusion is very durable and has decades of data behind it, but eliminates all ankle movement. The right call depends on your activity level, bone quality, deformity, and what your surgeon recommends.

How long does a total ankle replacement last?

Third-generation implants show 80-90% survival at 10 years in well-selected patients. Younger, heavier, and more active patients tend to need revisions sooner. Implant design has improved considerably in the last decade.

Can I walk normally after ankle replacement?

Most patients are walking with near-normal gait by 3-6 months. Unlike fusion, the implant allows natural push-off motion. Patient satisfaction with walking is generally high.

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Estimated Cost

$30,000 - $60,000 (before insurance). Covered by Medicare and most private plans when medically necessary.

Full cost breakdown

This information is for educational purposes only. Costs are estimates and vary by location, surgeon, and insurance. Always consult a qualified healthcare provider.