Ankle replacement or ankle fusion: Which surgery is best for ankle arthritis?

Ankle replacement or ankle fusion: Which surgery is best for ankle arthritis?

July 26, 2019

Ankle arthritis affects approximately 1% of the population.  In over 80% of cases the arthritis is caused by previous trauma such as an ankle fracture or recurrent ankle sprains.  This type of arthritis is termed ‘post traumatic’ arthritis.  Other types of arthritis include primary osteoarthritis (wear and tear) or inflammatory arthritis such as Rheumatoid arthritis.

Ankle arthritis can be challenging to treat as it often affects younger patients who are very active and still working.  In comparison, knee and hip arthritis often affects the older population.  If non-operative measures such as an ankle brace fail to improve the pain, surgery may be indicated.  For patients younger than 55 years of age, the gold standard treatment is an ankle fusion.  This operation can be done open or with keyhole surgery and involves fusing the talus to the tibia so that the ankle joint is stiff and no longer painful.  Post operatively, patients are immobilised in a cast for 6 weeks and then allowed to weight bear in a boot for a further 6 weeks.  90% of patients have good long-term outcomes following this surgery.

For older patients, there is also the option of a total ankle replacement, which is gaining popularity.  Although this operation has been available for many years, there have been recent advances in design, allowing the newer implants to be inserted with very accurate alignment1.  An example of a patient recently treated with a total ankle replacement is shown below.

The evidence so far suggests that an ankle replacement can perform as well as an ankle fusion and has the added benefit of allowing early weight bearing from 2 weeks, rather than immobilisation in a cast for 6 weeks. Currently a large study is being conducted, called the TARVA trial (Total Ankle Replacement versus arthrodesis)2, which aims to compare the two operations.

Recent national guidelines (Get It Right First Time – GIRFT3) suggest that less common operations such as ankle replacements should be done as a two-surgeon operation.  Therefore, Mr Elliot and Mr Marsland, both Consultant Orthopaedic Surgeons, have teamed up and now routinely perform total ankle replacements together at the Candover Clinic, offering an excellent service for patients.  At the same time as surgery, they also routinely perform a nerve block which involves a small injection behind the knee, so that post-operative pain is minimised. After surgery, patients are typically placed into a cast for two weeks, to allow the wound to heal, and can expect to spend one to two nights in hospital.  At two weeks, patients are reviewed in clinic and can then safely weight bear as tolerated in a boot and start physiotherapy to work on range of motion and strengthening.

If you would like to know more about how best to treat your ankle pain, please contact Candover Clinic on 01256 315010 to arrange an appointment with Mr Robin Elliot or Mr Daniel Marsland.

  1. King A, Bali N, Kassam AA, Hughes A, Talbot N, Sharpe I. Early outcomes and radiographic alignment of the Infinity total ankle replacement with a minimum of two-year follow-up data. Foot Ankle Surg. 2018 Nov 22. pii: S1268-7731(18)30082-1. doi: 10.1016/j.fas.2018.11.007. [Epub ahead of print]
  2. TARVA trial. Information available at
  3. Information available at

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