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Ankle replacement surgery
Surgery to replace the ankle bones and joints using prothesis. Ankle replacement surgery can be a highly effective personalised treatment option for patients with painful ankle joints caused by arthritis or injury.
What is ankle replacement surgery?
Ankle replacement surgery is a common treatment to relieve the pain caused by ankle arthritis. With use over time, the cartilage on the surface of the bones starts to wear away, often resulting in pain, inflammation, and reduced mobility.
If other treatments haven’t proved successful, your surgeon may suggest total ankle replacement surgery to reduce pain and help improve the ankle’s range of movement. This involves removing damaged bone and cartilage and replacing it with an artificial implant made of metal components with a durable plastic insert between them made from plastic and metal.
The ankle’s anatomy
To understand what happens during total ankle replacement surgery, it’s helpful to understand the structure of your ankle:
Bones
The ankle joint is made up of three bones:
- the tibia (known colloquially as the shinbone)
- the fibula (the smaller of your leg bones and the bump on the outside)
- the talus (one of the bones deep inside your ankle joint)
Ligaments
The ligaments in your ankle are soft-tissue structures, largely made up of collagen and elastic fibres, that connect your lower leg bones together. They help stabilise the ankle, preventing it from twisting or collapsing.
Your ankle has three main sets of ligaments. These are:
- Medial (or deltoid) ligaments. These ligaments join the end of the tibia (the bump on the inside of your ankle) to the talus, calcaneus and navicular bones.
- Lateral ligaments: These join the end of the fibula (the bump on the outside of the ankle), to the talus and calcaneus.
- Syndesmotic ligaments: These ligaments connect the tibia and fibula.
Cartilage
Ankle cartilage plays a crucial role in maintaining joint health and mobility. This smooth, flexible tissue covers the ends of bones in the ankle joint, allowing them to glide over each other while keeping friction to a minimum.
Healthy cartilage acts as a cushion, absorbing impact and preventing bones from grinding together, which helps avoid pain and inflammation. However, when the ankle cartilage becomes damaged, either from injury, inflammation, or general wear and tear, this protective layer can thin and wear away, leaving the bones to rub together and causing pain and stiffness (ankle osteoarthritis).
Ankle arthritis has been shown to affect your mobility and your quality of life as much as end stage heart failure. Early diagnosis and treatment are essential to manage cartilage damage effectively and prevent further complications. For those experiencing ankle pain or discomfort, consulting a specialist can help restore joint function and improve long-term outcomes.
How the ankle works
The ankle joint works a little like a hinge, allowing movement upwards and downwards. The difference is there’s also some sliding and rotation of the talus within the ankle joint, as well as additional movement in the nearby joints.
The subtalar joint, located below the ankle, is responsible for these side-to-side movements, which come into play when we walk on an uneven surface.
The talonavicular joint sits in front of the ankle joint and facilitates the twisting movements of the arch of your foot.
What is arthritis of the ankle?
Osteoarthritis of the ankle is when the cartilage that lines the surface of your bones becomes worn or damaged, either as a result of wear and tear or damage following injury or disease. The subsequent lack of any protective layer means bone starts to rub against bone. Typically, the main symptoms are pain and limited mobility.
In many cases, extra bits of bone tissue begin to form (known as bone spurs) and, together with scarring of the joint capsule, is responsible for increasing stiffness in the joint.
End-stage ankle osteoarthritis is where all non-surgical treatments have failed, and surgery may be considered.
Why do I need an ankle replacement?
Your specialist may suggest ankle fusion surgery if you have advanced osteoarthritis, rheumatoid arthritis or severe arthritis caused by an injury, and your symptoms haven't improved after other treatments. These symptoms can include severe pain, inflammation and stiffness from movement of the arthritic joint, and can result in difficulty walking.
While ankle arthritis is a common problem for many in middle age, it can also affect younger people. This procedure offers some of the best chances for recovery and being able to walk without pain and discomfort.
When should I see an ankle specialist?
If you're experiencing pain and stiffness in your ankle, then you could benefit from the opinion of a medical professional. You can browse the profiles of our expert orthopaedic surgeons and book an appointment with one of our specialist ankle consultants here.
If you have private medical insurance, you’ll need a GP referral letter and a reference from your private medical insurer to hand.
Your consultant will request any necessary imaging tests, which can sometimes be arranged for the same day as your consultation. All treatment routes will be discussed with you before total ankle replacement surgery is considered. You'll be given all the information you need to make an informed decision, so you’re completely comfortable with your proposed treatment plan.
Need to know
Total ankle replacement surgery, also known as ankle arthroplasty, is designed to relieve pain and restore mobility in patients with debilitating conditions such as severe osteoarthritis of the ankle.
The procedure involves replacing your worn-out ankle joint by resurfacing the ends of your tibia and talus with artificial components typically made of metal. These are fitted with a durable plastic insert between them to allow a gliding motion replicating the natural motion of the joint. Your surgeon will fix the metal components into your bones using pegs with a special coating, which encourages your bone to grow into them after the procedure has been carried out.
Your ankle replacement surgery will usually take two hours and is typically carried out under a general anaesthetic, but other anaesthetic techniques are also available. Many of our world-leading surgeons are pioneers of this surgery and use state-of-the-art equipment and the latest techniques to improve patient outcomes and get you back to your usual routine as soon as possible.
You’ll have a consultation, during which, your consultant will explain how ankle replacement surgery works. They’ll talk you through all your alternative options, as well as any risks and side effects, and let you know what to expect during your operation and the days that follow.
You'll also be able to ask any questions you have about the procedure, including how long you should avoid eating and drinking before your general anaesthetic.
As well as assessing your level of function and your general health, your consultant will let you know what to expect after surgery, how you can best manage your recovery, and explain any risk factors associated with the surgery.
It's useful to have plans in place for your return home after your operation. You’ll want to use this time to arrange for someone to pick you up from the hospital, as you won't be able to drive. It's worth seeing if someone can assist you with your day-to-day activities such as shopping while you recover.
As the surgical anaesthesia wears off following the operation, you will feel some discomfort. Our team will be on hand to prescribe and manage pain medication throughout the duration of your recovery.
One of the most-asked questions regarding recovery is, “How long after ankle replacement surgery can you walk?” Your consultant will discuss your personalised post-operative care plan with you but, typically, you would be back to walking normally in three to six weeks after surgery. If you have previously undertaken long walks, hiking, cycling and sports such as golf, tennis or skiing, you should be able to return to all these activities, although it can take up to 12 months before it’s comfortable to do so.
- Weight bearing and core exercises
Following your surgery, you may be advised to avoid bearing any weight on your ankle. This means not putting any weight on your foot at any time and this could be for up to six weeks although many patients are encouraged to start weight bearing much sooner. Your physiotherapist will give you advice on how to manage at home, and make sure you can move around safely.
During your recovery, you’ll be using either crutches, a walking frame, or a knee scooter. You’ll most likely find this tiring, and you’ll be walking much less than usual.
In order to make sure the rest of your body doesn’t become weak and deconditioned, it’s important to keep your core strength up by doing exercises (twice a day is good) to prevent this. You’ll be given these exercises by our expert team.
- Elevation
Immediately following the procedure, and for a few weeks after, you’ll have swelling around your foot and ankle largely due to gravity and the surgery. Swelling is a perfectly normal response to injury or surgery. It’s the start of the healing process and is nothing to worry about. Too much swelling, however, can impede healing, so keeping your leg elevated for most of the day is recommended to reduce this.
- Pain control
It’s perfectly normal to experience some pain after your surgery, but we’ll make sure you have adequate pain relief, so any discomfort is tolerable. We recommended that you stick to your pain medication routine as this will help you to move around, exercise and rest.
- Keeping your dressing dry
For the first few weeks after your surgery, you should keep your plaster or dressings completely dry. This will mean using a special waterproof cast protector when you have a shower.
You may feel some itchiness and discomfort. It’s important that you don’t poke objects inside your cast, as this can result in sores developing.
- Return to driving
“When can I start driving after ankle replacement surgery?” is, understandably, one of the most commonly asked questions we hear.
As a rough guide, patients with a right-sided ankle replacement can normally return to driving 2-3 months after having ankle replacement surgery. If you’ve had a left ankle replacement, you should be able to return to driving an automatic car sooner.
Before you return to driving, it is a legal requirement that you must be able to do an emergency stop safely, and you must inform your insurance company that you’ve had surgery and are planning to return to driving.
As with any type of surgery, there are risks to consider. The most common of these include:
- Numbness
- Pain
- Reoperation
- Scarring
- Stiffness
- Swelling
- Wound redness or inflammation
Less common risks include:
- Blood clots
- Delayed bone healing
- Nerve or tendon injury
- Revision surgery due to the joint loosening or failing
- Worsening of any medical conditions
There may be other risks that are dependent on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure.
When is ankle replacement surgery needed?
Your consultant may suggest ankle replacement surgery if you have advanced osteoarthritis, rheumatoid arthritis or severe arthritis caused by an injury, and other more conservative treatments, such as medication, physical therapy, or bracing no longer help.
At this point your symptoms, most commonly severe pain, inflammation and stiffness of movement, are likely to interfere with your ability to walk, stand, or carry out routine tasks. If this is the case, then total ankle replacement may be necessary to restore mobility, reduce pain, and improve your overall quality of life.
While ankle arthritis is a common problem for older people and those in middle age, it can, in some cases, affect the young. Ankle replacement surgery offers a good chance of recovery and being able to walk without pain and discomfort.
What are the alternative treatment options to ankle replacement surgery?
The good news is that the majority of ankle arthritis cases can be treated without surgery. Although a relatively straightforward procedure, ankle replacement surgery is a major operation, and is usually only recommended if other types of treatment haven’t worked or have stopped effectively alleviating your symptoms.
Initially, your consultant may suggest non-surgical treatments, including:
- Lifestyle changes: Cutting down on activities that cause pain, such as going upstairs, and contact sports. Changes in diet and weight loss can also help a lot.
- Painkillers: Your doctor may offer you paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs). If necessary, they might suggest stronger painkillers, such as codeine.
- Physiotherapy: General core stability exercise and strengthening exercises for the lower limbs can help reduce the discomfort of ankle arthritis and improve your walking gait.
- Steroid injections: If the treatments above prove unsuccessful, your consultant may then recommend steroid injections. These contain a synthetic version of the natural hormone cortisol, which can help reduce both inflammation and pain.
It may be that other treatments such as ankle fusion and PRP (platelet-rich plasma) injections could help. Your consultant will work closely with you to find the best option.
Should I have ankle replacement or ankle fusion?
The question of which procedure is better, total ankle replacement or ankle fusion surgery is one asked by every patient thinking about surgery for ankle arthritis. Both are excellent treatments that are there to improve function and quality of life, but there are some important differences to note.
Ankle fusion
Ankle fusion is a commonly used method for treating arthritis of the ankle. As the name suggests, involves fusing the bones in the ankle joint together using screws, plates, and bone grafts. The procedure does reduce the pain, but it also removes any motion you’ll have in your ankle following surgery.
It’s important to note that whilst there is no motion at the ankle joint, the foot has about 30 mobile joints, which still move and compensate so that if you have healthy adjacent joints, you should be able to walk relatively normally, and it may be very hard for someone to notice that you’ve had an ankle fusion.
However, this does mean that the other joints have to take on the extra load. This can, in turn, increase wear and tear, meaning some patients have a greater risk of developing arthritis in other parts of their ankle, foot or, in some cases, knee, hips, or lower back after surgery.
It also has a longer recovery time, with patients often spending up to 12 weeks in a plaster cast.
For some, ankle replacement surgery might not be a viable option – those with severe nerve damage, for example, or those who are significantly overweight, or with a history of diabetes. For these patients, ankle fusion might be recommended as a safer option and one they wish to discuss further with their consultant.
Ankle replacement
Theoretically, because the replacement joint mimics the natural movement of the ankle, it should result in less wear and tear of other parts of the patient’s ankle and adjacent joints.
Due to the fact that this is a relatively new procedure, there’s limited data to accurately predict the longevity of these replacement joints. We do know, however, that the parts that make up the new joint can wear out and become damaged by high-impact activity over time.
The TARVA clinical study
The Total Ankle Replacement Vs Arthrodesis (TARVA) study is a high-quality clinical study run by the NHS NIHR HTA programme designed to compare ankle replacement to ankle fusion. The study is a randomised controlled trial, involving 17 NHS centres and over 40 surgeons across the United Kingdom.
If you would like details on the findings of the TARVA study visit www.anklearthritis.co.uk. Your consultant will be able to share more information about the latest TARVA results with you.
Ultimately, there are many factors that will determine which of these procedures is better suited to your individual needs. Your age, general health, plus any associated medical problems, such as diabetes, neurological disease or additional arthritis in the hip or knee joints, are all contributing factors and will have an impact on any surgical outcome.
Your consultant will talk these through with you to make sure you have a treatment plan you feel completely comfortable with.
How do I book an ankle replacement appointment?
To discuss your ankle pain with an orthopaedic consultant who specialises in ankle treatments:
- Have your GP referral letter to hand as this can help speed up the booking process.
- We’ll confirm your appointment on the phone or, if you have any special requests, we'll get back to you via phone or email within 24 hours.
- Alternatively, you can book online by finding your chosen consultant in our finder
Specialists in ankle replacement surgery
We've established a reputation as leaders in ankle replacement surgery across our network of hospitals. We are also home to London Ankle & Arthritis Centre based at our St John’s Wood facility, The Wellington Hospital. The team carries out more than the number of ankle replacements compared to the UK national average, based on NJR (National Joint Registry) data.
Our consultants have access to innovative, cutting-edge equipment, and carry out the most intricate surgical procedures, every year. They are at the forefront of research into the outcomes and effectiveness of ankle replacement technology and have pioneered the introduction of the patient specific PROPHECY™ instrumentation technique, which allows us to create joint replacements that are perfectly tailored to each patient’s unique anatomy.
Why get a second opinion?
There are several reasons why you might consider a second opinion, including:
- You’re not confident that the correct diagnosis has been made
- You still have unanswered questions after speaking to your doctor, and you don't fully understand the information you've been given
- You're unsure and unhappy with the treatment recommended to you and have been told you can't have a different type of treatment
- You have received treatment elsewhere and it hasn’t gone to plan
- You've been told that there’s nothing more that more can be done.
Our specialist second opinion service is available to patients from all over the world, both face-to-face and remotely. It covers everything from complex circumstances to decisions about different treatment options.
Our ankle replacement locations
The Lister Hospital
Chelsea Bridge Road SW1W 8RH London
The Princess Grace Hospital
42-52 Nottingham Place W1U 5NY London
The Harborne Hospital
Mindelsohn Way B15 2FQ Birmingham
London Bridge Hospital
27 Tooley Street SE1 2PR London
The Wellington Hospital
Wellington Place St John's Wood NW8 9LE London
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This content is intended for general information only and does not replace the need for personal advice from a qualified health professional.