What is Ankle Replacement Surgery?

What is Ankle Replacement Surgery?

An ankle replacement, also called ankle arthroplasty, surgically replaces a damaged ankle joint with a new, artificial joint. The ankle joint (tibiotalar joint) is what makes it possible for the shinbone (tibia) to lie on the top bone of the foot (talus). Ankle replacement surgeries are used to treat severe ankle arthritis and joint pain.

Arthritis is a common factor in the deterioration of bones in the feet. The cartilage that protects the bones, allowing them to move freely, may begin to wear away. Painful inflammation and swelling may develop in the joint. The osteoarthritis affecting this joint can eventually make the ankle pain unbearable and walking extremely difficult.

If the pain gets too severe for a person to carry on with their normal daily activities, ankle replacement surgery may be the best option to eliminate this pain.

How is an Ankle Replacement Surgery Performed?


Ankle replacement surgery is done while the patient is under anesthesia, usually a regional nerve block with sedation. The surgeon makes an incision in the ankle, allowing access to the damaged joint. The surgeon then removes and replaces unhealthy bones and cartilage with artificial (prosthetic) implants made of titanium, cobalt-chrome, and polyethylene (plastic). 

The surgery usually lasts about two hours. Ankle replacements can provide pain relief from ankle arthritis and reestablish smooth movement to the joint.

Some patients may not be good candidates for this kind of surgery. Other patients may do better with an alternative procedure. An orthopedic specialist can determine which surgery is best for their patient.

Risks to Consider


Recovery after ankle replacement is slow, but most patients are back to daily tasks within a few months. Complete healing can take longer. There is always an initial period of crutches, walkers, or even a knee scooter. Throughout the healing period, the surgeon will continue to view X-rays of the area to ensure the bones have not moved out of place and are healing together correctly. 

Some uncommon risks are:

  • Blood clots are a risk with any surgery; movement is the best way to prevent blood clots after surgery. Your orthopedic doctor might suggest lower leg exercises to increase blood circulation. Sometimes blood thinning medications are used, but not always.
  • Infection after ankle replacement surgery is a serious matter. Infections can develop weeks, months, or possibly years after any joint replacement surgery. To avoid infection, doctors recommend patients take antibiotics before any surgery.
  • Nerve damage caused by ankle replacement surgery is uncommon. Since the nerves and blood vessels leading to the foot connect via the ankle, the possibility of damage to these structures exists; however, this damage is usually not permanent.
  • Non-alignment of bones is a significant concern with artificial joint replacement. This refers to the possibility that the bones do not join properly or move or loosen over time. If the misalignment becomes too painful, the patient may need a revised ankle surgery or fusion.

Preparing for an Ankle Replacement Surgery


Preparations for ankle replacement surgery are designed with each patient’s specific needs in mind. Preparing for surgery might include the following:

  • Physical therapy - Your doctor might suggest exercises to strengthen the areas surrounding the ankle joint and to prepare you for the initial period of non-weight bearing
  • Stop smoking - Smoking prohibits healing and extends the healing time
  • Lose weight - Losing weight can help a patient during recovery—lessening the weight bearing on the new joint shortens the healing time     
  • Physical exam - Visit your doctor for a pre-surgical physical exam to ensure that you’re fit enough to undergo surgery
  • Lab tests - All necessary lab work should be done prior to surgery
  • Complete health & insurance forms - Prior to surgery patients must complete all the required paperwork
  • Stop medications - Your surgeon will advise which medications should be discontinued prior to surgery and which medications should be taken
  • Fast - Your surgeon will advise how many hours you should refrain from eating or drinking prior to the surgery
  • Care plan after surgery - Have a care plan for your arrival at home. Someone should stay with you for a while when you first get home to ensure your safety.

Ankle Replacement Surgery Recovery

After the Surgery

Recovery from ankle replacement surgery differs for each patient. Factors to consider include age, current physical health, how complicated the surgery was, and how well a patient adhered to their doctor’s follow-up orders. 

Here is a list of what you might expect during your recovery at home.

  • After surgery
    • Follow all written and verbal postoperative instructions
    • Rest and elevate your ankle for the first two weeks
    • Keep your bandage or cast dry—do not change it
    • Take all prescribed medications
    • Avoid smoking
    • Pain medication can cause constipation, so increase your fiber intake while on this type of medication     
    • Eat healthy to support your healing with the necessary nutrients
  • Recovery time depends on the complexity of the ankle surgery, a person’s age, their general health, and how quickly they heal. The swelling and tenderness associated with ankle replacement surgery can take three to four months to subside. The total recovery time for this type of surgery can take up to a year.
  • Follow-up visit. The doctor will remove the cast or bandage from your ankle. Some patients are taken aback at the sight of the surgery—but this area will heal within a few months. More future visits can be scheduled. 
  • Footwear. A patient may need to wear a walking boot for two to four weeks before trying regular shoes. Occasionally, the walking boot must be worn for up to four months before normal shoes can be worn.
  • Returning to work. Most people can expect to return to work around 12 weeks after the surgery. In rare instances, if a person’s job doesn’t require a lot of walking, they might return sooner.
  • Daily living. Following ankle replacement surgery, normal daily activities should resume gradually. It will take at least six months before full weight-bearing exercise may be allowed.
  • Physical therapy. Do not skip physical therapy. Most ankle replacement surgery will be followed by a physical therapy regimen. This therapy will include exercises to increase range of motion and strength. Your doctor will determine how much exercise is needed      and when it should begin. Some physical therapy can take place with a cast or boot, while other exercises must wait for the removal of these orthopedic devices. Patients may be required to wear a splint for a few weeks to strengthen the ankle. Most physical therapy continues for at least two months but can last up to 12 months after surgery.

Sometimes a revision of the original ankle replacement surgery is necessary. Over time, ankle replacement parts can shift or wear out, causing pain and swelling. If this occurs, it might be necessary to perform another ankle replacement surgery.

Keeping a healthy body weight and avoiding high-impact activities can improve the implant's life.

Get Care

Receive an Ankle Replacement Surgery at NewYork-Presbyterian

If you have osteoarthritis in your ankle and are often in pain, it may be time to visit your doctor to discuss your symptoms and the possibility of ankle replacement surgery or another alternative. 

NewYork-Presbyterian provides surgical and nonsurgical alternatives for orthopedic injuries and diseases affecting people of every age. Our expert surgeons, doctors, and healthcare professionals offer the highest quality care for replacement surgeries involving hips, knees, ankles, shoulders, elbows, hands, and spinal injuries.

Contact one of our orthopedic centers to determine if ankle replacement surgery is suitable for your specific condition or if another alternative will work for you.