Ankle fusion and total ankle replacement are both highly effective for severe ankle arthritis. The choice depends on age, activity level, deformity, and the state of neighbouring joints. This guide covers both procedures.
ℹ️ This appointment usually takes place 2-4 weeks before surgery. Ankle replacement and fusion are major procedures, so the assessment is thorough.
You will meet the nursing and anaesthetic teams. A full medical review is carried out, including cardiac assessment if needed. Home preparation is essential because of the prolonged non-weight-bearing period.
Full pre-operative screen including blood count, kidney function, and clotting studies.
Blood thinners, anti-inflammatory drugs, and immunosuppressants may need to be adjusted. Diabetes control is reviewed if relevant.
Usually performed under general anaesthesia or spinal anaesthesia, with a popliteal nerve block for post-operative pain relief.
If you are having an ankle replacement, ensure any dental infections are treated beforehand. Bacteria from the mouth can seed a new joint.
You will be non-weight-bearing for 6 weeks. Set up a downstairs sleeping area if possible, and arrange for someone to help for at least the first 1-2 weeks.
ℹ️ You will be given a specific arrival time. Do not eat or drink (other than clear water up to 2 hours before) from midnight the night before. Bring your medication list and any documents sent by the hospital.
You will be admitted to the ward or day surgery unit, change into a gown, and be seen by the nursing, anaesthetic, and surgical teams before theatre.
Your surgeon will confirm the procedure, mark the operative side, and you will sign a consent form before going to theatre.
You will meet the anaesthetist in the anaesthetic room. Once anaesthesia is established, the procedure will begin.
After surgery you will wake in the recovery room where nurses monitor your vital signs until you are stable and comfortable.
Most foot and ankle surgery is performed as a day case, meaning you go home the same day. More complex procedures such as ankle replacement or flat foot reconstruction usually require 1-3 nights in hospital. Before discharge, the team will check your pain is controlled, give you wound care instructions, and confirm your follow-up appointment.
You will be given oral pain relief before discharge. Take it regularly for the first 48 hours rather than waiting until pain is severe.
A nurse will check the wound before you leave and explain how to keep it clean and dry.
You will be shown how to use crutches and given clear instructions about weight-bearing on your operated foot.
You will receive a letter for your GP and details of your next outpatient appointment, usually at 2 weeks for a wound check.
Arrange for a family member or friend to collect you. You must not drive after a general anaesthetic or sedation.
⚠️ Important: Wound problems are a recognised complication, particularly in patients with diabetes, vascular disease, or who smoke. Report any wound discharge, increasing redness, or fever urgently.
Keep the foot elevated above the level of your heart for as much of the day as possible during the first 2 weeks. This significantly reduces swelling and helps healing.
Avoid getting the wound wet until it is fully healed, usually 10-14 days. Use a waterproof cover when showering.
Do not wait until pain is severe before taking medication. Regular simple analgesia (paracetamol, ibuprofen if appropriate) is more effective than taking it only when needed.
This is usually 2 weeks after surgery. Sutures or clips will be removed if used.
Seek urgent advice if you develop increasing redness, warmth, swelling, discharge from the wound, calf pain or swelling (possible DVT), shortness of breath, or a temperature above 38°C.
Strict non-weight-bearing on crutches. Foot kept elevated to reduce swelling.
Plaster removed, wound checked, and replaced with a new cast or boot. Continued non-weight-bearing.
X-rays confirm healing. Gradual transition from partial to full weight-bearing in a walking boot.
Out of the boot and into supportive shoes. Walking comfortably for moderate distances.
Continuing improvement. Return to most desired activities. Long-term outcome assessed at 12 months.
Both are effective. Fusion is more durable and better suited to younger, active patients. Replacement preserves motion and gives a more natural gait, typically preferred in older, less active patients.
Yes, usually for the first 6 weeks. After that, you will use a walking boot.
For right-sided surgery, usually 10-12 weeks. For left-sided surgery in an automatic, around 4-6 weeks if comfortable.
Desk work: 4-8 weeks. Standing work: 3-6 months. Heavy manual work: often longer or may require redeployment.
Plain-English answers to the things people most often ask, grounded in published guidance. Tap a question to open it.
The UK TARVA trial found that ankle fusion and total ankle replacement both improved quality of life and were safe, with no clear overall winner. Fusion removes ankle movement but is very durable; replacement keeps some movement but may need revision over time.
The choice is individual, weighing your age, activity and the neighbouring joints.
A fusion joins the ankle bones with screws or plates so they heal into one. A replacement resurfaces the worn joint with metal and plastic implants.
Your surgeon will explain which suits your ankle.
Usually a general or spinal anaesthetic with a nerve block for pain relief.
Your anaesthetist will go through this with you.
Both involve months of recovery. A fusion needs the bone to unite before full weight-bearing, so there is usually a period of protected or limited loading.
Rehabilitation continues after the boot comes off.
Arrange home help, crutches or a frame, and time off. If you smoke, stopping improves bone healing, which matters most for a fusion.
Sorting the home set-up in advance makes the early weeks easier.
Wound discharge, spreading redness or a temperature can signal infection, and calf or chest symptoms can signal a clot.
Seek prompt help if these occur.