Ankle Joint Replacement

What is an Ankle Joint Replacement?

Ankle joint replacement, also known as Total Ankle Arthroplasty, is a surgical procedure performed to relieve pain and immobility due to ankle arthritis.


Ankle joint replacement ensures the minimal destruction of the bones and preservation of the other joints of the foot from arthritis.


It also facilitates improved joint motion. However, wear-and-tear of the prosthesis is a major concern with joint replacement, especially in younger patients.

Treatment for Ankle Joint Arthritis

Arthritis is a chronic disease that leads to severe pain, swelling and disability. 


Conservative treatment of ankle arthritis involves oral medications, bracing, physical therapy, modification of activity and joint injections. Ankle arthritis can also be treated by:

  • Arthrodesis - fusing the tibia (shinbone) and talus (foot bone). Although the operation provides pain relief, it eliminates the movement of the ankle.
  • Ankle Joint Replacement - as below


Why Consider an Ankle Joint Replacement?

Ankle arthritis can be treated with ankle joint replacement surgery, where the diseased joint ends are replaced with metal and plastic prostheses. The causes of ankle arthritis can include: 

  • Osteoarthritis
  • Inflammatory Arthritis such as Rheumatoid Arthritis
  • Infection 
  • Arthritis after fracture



Indications for Ankle Joint Replacement?

Ankle joint replacement is indicated with the following:

  • When conservative treatments fail to reduce the pain and joint function
  • Recommended for elderly patients with a low functional demand
  • Rheumatoid arthritis


However, the procedure is contraindicated in patients with

  • Dead bone in the talus (ankle bone) and significant deformity
  • Infections of the ankle (previous or current)
  • Significant lower extremity neuropathy
  • Inadequate function or loss of leg muscle function
  • Poor blood supply to the leg
  • Inadequate presence of soft tissues


Ankle Joint Replacement Procedure Steps

The procedure is performed after appropriate diagnostic assessments, pre surgery checks and preparations are complete in a hospital and normally takes about two and a half hours.


The procedure is performed under a general anaesthetic and applies advanced technologies. The procedures includes the following steps:

  • An incision over the front of the ankle. 
  • Muscles are retracted, and tendons and ligaments are moved away to expose the ankle joint. 
  • Damaged parts of the tibia, fibula and talus bone are removed using special instruments,
  • Remaining bone parts are reshaped to fit the new artificial joint or prosthesis. 
  • Screws may be used to support the artificial ankle.
  • Tendons and other structures are placed back in position covering the new joint
  • At the end of the surgery the wound is sutured closed and covered with a sterile dressing and the patient is sent to the recovery ward for observation

Advancement in improved techniques and better implant designs are enhancing the outcomes allowing increased activity after surgery. 


You will be advised to avoid high-impact activities that can damage the new ankle, such as contact sports and running. The prosthesis lasts for 10 or more years.


This depends on the extent of damage before surgery, your overall health and level of activity.

Ankle Joint Replacement Surgery Preparation

Once you and your surgeon have decided that surgery is required, preparation is necessary to achieve the best results and a quick and problem free recovery. 


  • Infections - Treat any tooth, gum, bladder or bowel problems before surgery to reduce the risk of infection
  • Smoking - Stop or cut down smoking to reduce your surgery risks and improve your recovery
  • Weight - Consider losing weight (if overweight) before surgery
  • Medications - refer Medication Information below
  • Fast beforehand - Depending on the type of anaesthesia you'll be receiving, your doctor may advise you to refrain from eating and drinking six to twelve hours before the procedure.
  • Arrange for a ride - You will not be allowed to drive yourself home after the procedure, so make arrangements for someone to pick you up. If you live alone, arrange for someone to check on you that evening or, ideally, to stay with you for the rest of the day.

  • Things to Avoid

    • Stop or cut down on smoking to reduce your surgery risks and improve your recovery
    • Avoid injury (cuts/scratches) to the foot and leg

  • Pre Surgery Tests

    • May be required depending on your other health problems (such as diabetes or heart disease) 
    • Other specialists may need to be consulted to ensure your health during and after surgery is looked after. 

  • Medication Information

    • Blood thinning medications such as Aspirin and Warfarin may need to be ceased up to 7 days prior to surgery. 
    • Other medications can usually be continued but will need to be discussed with your surgeon

  • Physical & Mental Prep

    Surgery has a significant impact on both your mental and physical health. You can ensure the best result by:


    • Eating a well-balanced diet.
    • Exercising within the limits of your pain 
    • Considering losing weight (if overweight) before surgery 
    • Treating any tooth, gum, bladder or bowel problems before surgery to reduce the risk of infection
    • Being prepared to have time off work, hobbies, and your regular daily activities
    • Having support from friends or family

Returning Home After Surgery

When you go home you need to take special precautions around the house to make sure it is safe. Your post operative plans should include:

  • Mobility or Stability - You may have to accommodate crutches, wheelchair or knee scooter and may need ramps for stairs
  • Sleeping - modify your sleeping arrangements (especially if you are sleeping upstairs) for easy access
  • Access - ensure you have easy access to food, water, medications and any other essentials
  • Showering - You may require rails in your bathroom or a shower chair, and will and a specialised shower bag to keep your foot dry


Assess your home situation to ensure you have adequate home support in the first few weeks following surgery. If you live alone it may be necessary to arrange a package of community care to help during the first few weeks at home.


Ankle Joint Replacement Surgery Process

  • Day of Surgery

    • You will arrive fast at the hospital at a predetermined time.
    • Please bring all your scans (x-ray, CT, MRI) with you.
    • Please bring all your medications with you.

  • Surgery Recovery

    • You are kept in the recovery room for observation and their vitals are monitored. 
    • You will stay in hospital for 1-2 nights, depending on your pain or in case of complications. 
    • Once your pain is under control and you can mobilise (you may require crutches), you will discharge.
    • Physiotherapy is available to help you mobilise

  • During Surgery

    • The procedure includes the administration of general and/or local anaesthesia, followed by a surgical incision at the front of your ankle. 
    • Cartilage from your shin bone (tibia) and ankle bone (talus) is cut and removed.
    • Your new custom metal ankle replacement is inserted. 
    • The wound is stitched up and a dressing is applied.
    • A plaster cast is applied to your ankle 

  • Discharge Medications

    • Pain: You will be provided with a script for pain medications
    • Blood Thinners: You may also require a script for a blood thinner (to help reduce the risk of blood clots).
    • Regular Medications: You will be instructed as to whether to recommence your normal medications

Ankle Joint Replacement Rehabilitation Program

  • 1-2 Weeks- Post Op Rehab

    • Elevation is absolutely critical to reducing pain and ensuring the success of your surgery. Keep your foot, ankle, and knee above the level of your heart as much as possible for the first few weeks to reduce swelling. This is most critical in the first few days. Ice may not as helpful because you have thick bandages/dressings.
    • Cast/Dressings: Please don’t remove or alter your cast. Removing your cast/dressings also removes the sterility around the surgical site, and can lead to early wound infection. Some bleeding is normal, but if your bandages become soaked, please let us know, and we can change them for you. 
    • Pain: Continue to use paracetamol, ibuprofen or other pain medications as needed. 
    • Walking/cast: Please remain in the cast at all times, and limit the amount of walking you do – this will reduce the risk of any wound healing problems. 

  • Week 6-12- Post Op Rehab

    • Wound: Your wound should be completely healed. 
    • Pain: Pain levels will continue to improve, and hopefully you will be using very minimal amounts of pain relief. 
    • Walking / shoewear: You will be transitioned to your regular shoewear which should be comfortable and supportive. You may gradually return to your normal level of activity. 
    • Driving can also be resumed if you were driving a manual car or your right foot was the one operated on. 

  • Week 2-6 - Post Op Rehab

    • Wound: Your stitches should have been removed and the wound almost healed. Your surgeon will inform you about whether you may shower/wet the wound. 
    • Pain: Your use of pain medication should continue to reduce
    • Walking/shoewear:  You will be placed in a moon boot and you may commence weight-bearing. You may remove the boot whilst in bed, but it must be on whenever you walk or weight bear. You may begin to do more walking, but still, be aware that this may lead to swelling and pain. 
    • Work: Returning to full time or different duties at work will depend on your occupation. Patients can return to work as early as three weeks if they have a desk job and can take up to three months for recovery if their job requires heavy labour. 
    • Driving can also be resumed within 2-3 weeks after surgery (depending on foot-operated and if manual/automatic car) 

  • Weeks 12 and onward Post-Op Rehab

    • You will continue to see improvements in pain, function and swelling over the course of the next 6 months and be getting back to your normal level of function.

Ankle Joint Replacement Risks & Complications Associated

  • General Risks with Surgery

    • Anaesthetics - Allergic reactions to medications, nausea and vomiting. Your anaesthetist will be able to discuss with you further
    • Blood Loss -Blood loss is typically minimal during surgery and the risk of requiring a transfusion is very low 
    • Surgical Injury - When having surgery there is the risk that nearby structures (e.g. nerves, arteries) can be damaged in the process. 
    • Blood Clotting - Blood clots can form in the leg’s calf muscles causing Deep Venous Thrombosis (DVT) and can travel to the lung (Pulmonary Embolism). These can occasionally be serious and even life-threatening. If you get calf pain or shortness of breath at any stage, you should notify your surgeon. The risk of clots is reduced by blood-thinning medications and other means.  
    • Infection – The risk of infection is around 1%. This can range from superficial wound infection to deep infection, Treatment can also range from a course of oral antibiotics or require hospital admission with multiple surgeries and removal of hardware. Very rarely infection can lead to systemic illness, loss of limb or loss of life. 
    • Death Due to Surgery - Serious medical problems can lead to ongoing health concerns (heart problems, kidney failure, pneumonia, bladder infections), causing prolonged hospitalization and in rare cases death.
    • Delayed Healing - Some patients take longer to heal than others, particularly people with diabetes or heart disease 
    • CRPS (Complex regional pain syndrome) – A condition where you may experience numbness, burning, pain, sensitivity, altered sweating, temperature intolerance. It is caused by altered nerve response and can range from mild to severe and require a pain specialist consultation.  
  • Created by potrace 1.16, written by Peter Selinger 2001-2019

    Specific Surgery Risk

    As with any surgery, ankle replacement surgery involves certain risks and complications. 

    They include:


    • Infection
    • Nerve damage 
    • Unresolved pain and swelling 
    • Joint stiffness or restricted movement

    In rare cases, a second surgery may be necessary to correct the problems.

Surgical Follow Ups

  • 2-3 Weeks After Surgery

    • Check-Up with Surgeon
    • Wound review 
    • Suture removal
    • Redressing of wound
    • Commence weight bearing in moonboot
    • Commencement of physiotherapy 

  • 12 Weeks After Surgery

    • Check Up with Surgeon
    • Wound review 
    • Xray to assess the healing
    • Ongoing physiotherapy

  • 6 Weeks After Surgery

    • Check-Up with Surgeon
    • Wound review 
    • Xray to assess the healing
    • Transition to regular shoe
    • Ongoing physiotherapy

  • 6-12 Months After Surgery

    • Check-Up with Surgeon
    • Xray to assess healing
    • Ongoing physiotherapy

How Can I Minimise Post Operative Complications?


  • Elevation - Keeping your foot/ankle elevated above your heart when sitting and sleeping will help with pain, swelling and help wound healing
  • Blood clots (DVT or PE) - Through early mobilisation, stockings, and medications
  • Pain - Keep on top of pain with regular use of pain medications as directed by your surgeon
  • Dressings - Keep dressings dry and intact
  • Shoewear - Keep your prescribed shoe (heel wedge, moonboot) on as instructed
  • Let us know early if you have any questions or worries


What Are the Consequences of Surgery? 

Sometimes the potential risks and consequences of your surgical procedure need to be weighed against the benefits of a successful surgical outcome.


These benefits can include:

  • Freedom from pain
  • Increased movement
  • Greater flexibility
  • Maintained independence
  • Improved outlook
  • Longer more enjoyable life
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