Ankle replacement surgery at Bournemouth Hospital

What is ankle replacement surgery?

Ankle replacement surgery, also known as ankle arthroplasty or total ankle replacement, is a procedure that replaces the worn or damaged surfaces of the ankle joint with artificial components, similar to hip or knee replacement.

It is most commonly performed to treat ankle arthritis when pain, stiffness and swelling no longer respond to non-surgical treatments and there are reasons not to perform the more common procedure of ankle joint fusion (arthrodesis). Currently, in the UK, approximately 30% of definitive ankle arthritis operations are replacements, with most of the remainder being ankle fusions.

What are the benefits of ankle replacement surgery?

Ankle replacement aims to:

• Reduce pain caused by arthritis
• Preserve or improve ankle flexibility
• Improve walking comfort and ability
• Reduce stiffness and swelling
• Improve long-term mobility and quality of life.

What is ankle arthritis?

Ankle arthritis occurs when the cartilage that cushions the joint's bone surfaces wears away, causing the bones to rub together. This leads to pain, swelling, stiffness and reduced mobility.

What causes ankle arthritis?

Common causes include:

• Most commonly, previous ankle fractures or injuries, including repeated sprains
• Long-term wear and tear
• Rheumatoid arthritis and similar conditions causing inflammation of the lining (synovium) of the ankle joint
• Long-term ankle joint or leg deformity.

What happens if ankle arthritis is left untreated?

Symptoms tend to persist and may worsen over time, leading to:

• Increasing pain
• Increasing ankle joint deformity with sideways angulation of the heel
• Reduced mobility, including difficulty walking with consequent loss of independence in daily activities.

Total Ankle Replacement (TAR) vs Ankle fusion (Ankle Arthrodesis; AA) – what’s the difference?

Both procedures can successfully treat severe ankle arthritis, but they work differently:

• Ankle fusion removes the damaged joint surfaces and fuses the bones together, relieving pain by eliminating movement at that joint. Since so much of the flexibility in the foot during walking actually occurs in the joints adjacent to the ankle, walking pattern and function can still be normal as long as those other joints, and the knee joint above, are still healthy and pain-free. Those other joints work a little harder to compensate for the fused ankle.
• Ankle replacement preserves flexibility by replacing the ankle joint surfaces. This relieves pain arising from the arthritic ankle joint whilst demanding no extra movement from the other foot joints or the knee joint above, as is the case if the ankle is fused. In scientific studies, TAR results in more natural gait mechanics compared to AA.

If you have reached the stage where your ankle arthritis is affecting your quality of life badly enough to justify definitive surgery, despite having tried appropriate non-surgical measures, the next decision is whether TAR or AA is the more appropriate for you. This is an individual decision to be talked through with your specialist.

What conditions can ankle replacement surgery treat?

Ankle replacement is most commonly used to treat:

• Osteoarthritis (wear and tear arthritis)
• Rheumatoid arthritis
• Post-traumatic arthritis (after injury or fracture)
• Severe ankle stiffness or deformity caused by arthritis.

How do I know if I need ankle replacement surgery?

You may be recommended surgery if:

• Pain affects your daily life
• Your ankle is stiff or swollen most days
• Walking or standing is difficult
• Traditional treatments no longer help
• X-ray images show severe arthritis.

Who is suitable for ankle replacement surgery?

You may be suitable if you:

• Have severe ankle arthritis
• Want to preserve ankle movement
• Are in good general health
• Have reasonable bone quality
• Have a stable ankle alignment.

Who is not suitable for ankle replacement surgery?

Ankle replacement surgery may not be recommended if you:

• Have severe deformity
• Have poor bone quality
• Have uncontrolled diabetes
• Smoke heavily
• Have active infection
• Are very physically active (high-impact sports).

Can I have ankle replacement surgery if I am overweight?

It may be possible to have ankle replacement surgery if you are overweight, but a higher body weight can increase the risk of complications and implant wear. Your surgeon will assess your individual situation.

What are the alternatives to ankle replacement surgery?

Alternatives include:

• Physiotherapy
• Orthotics or ankle braces
• Anti-inflammatory medication
• Steroid injections
• Adjustment to certain activities
• Ankle fusion surgery (if ankle replacement is not suitable).

What are the different types of ankle replacement surgery?

Ankle replacement implants are designed to mimic the smooth, gliding movement of a healthy ankle joint. Each implant is made up of two metal components that attach to the bones of the ankle, with a plastic spacer that sits between them. This spacer is made from a durable medical-grade plastic (polyethene) and acts like the joint’s natural cartilage – allowing the metal surfaces to glide smoothly without friction. It also absorbs shock when you walk, helping the ankle move more comfortably.

There are two main types of ankle replacement implants:

Fixed bearing implants
In a fixed bearing implant, the plastic spacer is securely attached to one of the metal components. Because it doesn’t move independently, this design often offers greater stability and is often recommended for patients with lower activity levels or reduced ankle alignment. It provides reliable support and reduces the risk of the spacer shifting out of place.

Mobile bearing implants
In a mobile bearing implant, the plastic spacer can move slightly between the metal components, allowing a more natural rolling motion through the ankle. This design can offer greater flexibility and smoother movement, particularly for patients with good bone quality and stable ankle alignment. It may also reduce wear on the implant over time.

Your surgeon will recommend the most suitable option based on your ankle anatomy, activity level, bone quality and the underlying cause of your arthritis. Both designs aim to reduce pain and restore movement. The choice simply depends on what will give you the safest and most durable result.

How should I prepare for ankle replacement surgery?

Your surgeon may advise you to:

• Stop smoking
• Review medications
• Maintain a healthy weight
• Arrange help at home
• Prepare for a period of non-weight-bearing
• Attend your pre-operative assessment.

What happens at my ankle replacement pre-operative assessment?

This appointment includes:

• A medical history review
• Blood tests or scans
• Anaesthetic assessment
• Mobility and home support planning
• Instructions for preparing for surgery.

What happens on the day of my ankle replacement surgery?

You’ll meet your surgical and anaesthetic team, and your ankle will be marked for accuracy. Most procedures are performed under general anaesthetic, sometimes with added local anaesthetic for pain relief.

What happens during ankle replacement surgery?

Ankle replacement usually takes 1–2 hours. Your surgeon will remove the damaged joint surfaces and replace them with metal and plastic components designed to mimic natural movement. These components often have a special coating that encourages bone to grow onto them, helping the implant bond securely. Once the artificial component is in place, the wound is closed with stitches or staples, and a cast or dressing is applied.

Ankle arthroscopy (keyhole surgery)

Some ankle problems can be treated with ankle arthroscopy, a minimally invasive procedure. Your surgeon will make small incisions, insert a tiny camera and use fine instruments to remove loose cartilage, bone spurs or inflamed tissue. This may be an option if your arthritis is mild or if you have a specific injury inside the joint.

How long does it take to recover from ankle replacement surgery?

After surgery, you’ll wake in the recovery room where your wound, blood pressure and pulse will be monitored. Your ankle may be in a cast, and you may have a small drain to remove excess fluid. A drip will keep you hydrated and provide pain relief.

Hospital stay
Most patients stay 2–3 nights. Your leg (and ankle) will be elevated, and physiotherapists will help you begin moving safely using crutches or a walker. You will not be able to bear weight on your foot for several weeks.

Going home
You will need someone to drive you home and support you during the first few days. Your stitches or staples are usually removed after 10–14 days, and your cast may be replaced with a lighter one.

Weight bearing
You will remain non-weight-bearing initially. Partial weight bearing may begin around 6 weeks, depending on X-ray results. Full weight bearing is usually allowed once the implant has settled and healing is confirmed.

Returning to activities

• Walking: With aids immediately after surgery and without aids after several weeks
• Driving: Usually after 8–12 weeks
• Work: Desk work after 4–6 weeks; manual work may take longer
• Exercise: Low-impact exercise after 12 weeks. High-impact sports are not recommended.

Most patients make a good recovery, but full healing can take several months. Your healthcare team and consultant will be at hand to support you at every step of your recovery journey.

What are the risks and complications of ankle replacement surgery?

All surgery carries risks. These may include:

• Pain
• Bleeding
• Infection
• Swelling
• Blood clots or DVT (deep vein thrombosis)
• Nerve injury
• Stiffness
• Loosening or wear of the implant.

What are the signs of ankle replacement failure?

Signs may include:

• Increasing pain
• Swelling
• Instability
• Reduced movement
• Difficulty walking.

If this happens, revision surgery may be needed.

What is the ankle replacement surgery success rate?

Ankle replacement has a high success rate, with many implants lasting 10–15 years or more, depending on activity levels and overall health.

How much does ankle replacement surgery cost at Nuffield Health?

For pricing information, please contact your local hospital. The hospital or your healthcare team will give you a fixed all-inclusive price for the treatment following your initial consultation.