Total Ankle Replacement Surgery

UPMC is an established leader in foot and ankle care and surgery, offering comprehensive services for a full spectrum of conditions, including total ankle replacement.

What Is Total Ankle Replacement?

Total ankle replacement is a surgical procedure to replace the entire damaged ankle joint with an artificial joint. It is performed to treat end-stage ankle arthritis, which can be caused by previous injury, instability, or wear-and-tear over time.

What are the benefits of total ankle replacement?

When compared to ankle fusion procedures to eliminate movement and reduce pain, total ankle replacement:

• Offers similar pain control.
• Enhances joint function and mobility.
• Preserves range of motion.
• Provides increased protection for surrounding joints.

What are the benefits of total ankle replacement technology?

In the Pittsburgh area, foot and ankle surgeons use the Stryker Prophecy® system presurgical planning technology. This system helps us develop a personalized approach that optimizes joint component sizing and alignment, improves surgical efficiency, and enhances patient outcomes. It allows surgeons to upload presurgical CT images and plan your entire surgical procedure — including surgical cuts, joint component placement, and alignment — based on your unique anatomy. 

Benefits of the technology for total ankle replacement include:

• A personalized, reproducible approach that follows surgical best practices.
• Enhanced outcomes due to optimal surgical cuts, joint placement, and alignment.
• Faster recovery with less pain.
• Increased precision, which improves the range of motion and natural feel of the replacement joint.
• Reduced operative time, which is associated with a lower risk of infection.

Is ankle replacement a major surgery?

Total ankle replacement is considered to be major surgery.

Conditions we treat with total ankle replacement

Total ankle replacement is performed to treat end-stage ankle arthritis. Between 80% and 90% of end-stage ankle arthritis cases are caused by previous ankle injuries, such as fractures or sprains, that lead to instability.

End-stage ankle arthritis may also be caused by:

• Infection.
• Osteoarthritis due to wear and tear on the joint.
• Osteonecrosis (bone tissue death).
• Rheumatoid arthritis, an autoimmune condition that causes joint damage.
• Tumors.

Why Would I Need Total Ankle Replacement?

You may need total ankle replacement if you have end-stage ankle arthritis and are looking for a surgical treatment option that preserves ankle mobility.

Who’s a candidate for total ankle replacement?

You may be a candidate for total ankle replacement if you need surgical treatment for end-stage arthritis and want to preserve your natural range of ankle motion.

Alternatives to total ankle replacement

An alternative to total ankle replacement is arthrodesis (ankle fusion), which fuses the ankle bones to eliminate movement and reduce pain.

What Are the Risks and Complications of Total Ankle Replacement?

Like any surgical procedure, total ankle replacement comes with some risks, including: 

• Allergic reactions to medication or anesthesia.
• Bleeding or blood clots.
• Difficulty healing after surgery.
• Dislocation or loosening of the artificial joint.
• Infection.
• Nerve or blood vessel damage.
• Joint pain, weakness, stiffness, or instability that doesn’t improve after surgery.

What Should I Expect From Total Ankle Replacement?

Before: How to prepare for total ankle replacement

Before your procedure, you will meet with your care team and have a physical exam. Your care team will talk with you about how to prepare for your procedure, including what you might need to help you recover safely at home. 

Your care team may order tests, such as:

• Blood or urine tests — Your doctor may order blood work and urine studies to make sure you are healthy enough for the procedure and check for signs of illness or infection.
• CT scan — A computed tomography (CT) scan that creates images of the bones and structures in your ankle.
• Electrocardiogram (ECG or EKG)— This test records the electrical activity of your heart, shows abnormal rhythms (arrhythmias or dysrhythmias), and can sometimes detect heart muscle damage. EKGs are often performed before a procedure to ensure your heart is healthy and to identify potential problems.
• MRI — MRI is a diagnostic procedure that combines large magnets, radio frequencies, and a computer to produce detailed images of organs and structures within your body.
• X-ray — Your doctor may order an x-ray to learn more about the condition of the bones and tissues in your ankle.

Your doctor will explain the procedure to you and answer your questions.

To prepare for the procedure, you should:

• Fast for a certain period of time prior to the procedure. Your doctor will tell you if you need to fast or how long to fast (usually overnight).
• Have any tests that your doctor recommends. For example, your doctor may request a blood test before the procedure to determine how long it takes your blood to clot.
• Tell your doctor if you are sensitive or allergic to any medications, iodine, latex, tape, or anesthetic agents (local and general).
• Tell your doctor about all medications (prescription and over-the-counter) and herbal or other supplements you are taking.
• Tell your doctor if you have any other health conditions. Your care team may need to take certain precautions during your procedure for your safety.
• Tell your doctor if you have a history of bleeding disorders or if you are taking any blood-thinning medications, aspirin, or other medications that affect blood clotting. You may need to stop some of your medications before the procedure.

On the day of your procedure, be sure to bring your photo ID and health insurance card(s). Leave valuables such as cash and jewelry at home.

You may need to stay overnight in the hospital after your total ankle replacement surgery. However, in some cases, ankle replacement surgery can be performed as an outpatient procedure, so you can go home the same day.

Your doctor will let you know if you will need to stay overnight in the hospital or if you will be discharged the same day. If you stay overnight, you should bring toiletries, a robe, slippers, a cell phone and charger, medications, and a change of clothes.

Whether you stay overnight or are discharged the same day, you will need to arrange for someone to drive you home after you are discharged.

During your total ankle replacement

When you arrive at the hospital, you will meet with your care team for final preparations.

You will receive an IV in your hand or arm. You will have either general anesthesia to put you to sleep or an epidural to prevent you from feeling pain below your waist.

After you are positioned on a procedure table, your doctor will:

• Load your images and surgical plan into a computer so they can see them during the procedure.
• Use cutting guides to make a precise incision (cut) in the front of your ankle to access your ankle joint.
• Move your tendons, nerves, and blood vessels out of the way.
• Remove your damaged ankle joint, including the lower end of your shin bone (tibia) and the upper part of your foot bone (talus).
• Place metal caps on the ends of the tibia and talus.
• Place a plastic insert between the ends of your tibia and talus that allows your ankle to move naturally.
• Move and bend your ankle to make sure your new ankle joint functions properly.
• Close your incision with stitches or glue.

After your procedure, your surgeon will place a bandage over your incision and make sure your condition is stable.

How long does total ankle replacement take?

Total ankle replacement takes one to two hours. More than half of those getting a total ankle replacement can go home the same day, while others require a one-night hospital stay.

How painful is total ankle replacement?

You will have general or local anesthesia during your total ankle replacement, so you should not feel any pain during surgery. Your doctor may give you a nerve block that helps to control pain for up to 24 hours after surgery. You will receive medication to manage post-surgical pain.

Most patients notice a significant decrease in arthritis pain within several weeks of their total ankle replacement surgery.

Recovery after total ankle replacement

After your procedure is complete, you will be monitored in the recovery area. If you are staying overnight in the hospital, you will be transferred to your hospital room.

If you are having outpatient ankle replacement surgery, your doctor will let you know when it is safe for you to go home. You will need someone to drive you home from the hospital after you are discharged.

Before you go home, your doctor will tell you:

• How to care for your wound and watch for signs of infection or complications.
• What medications you need to take.
• When you should begin physical therapy.
• When to call your doctor or 911 if you have certain symptoms.
• When you should schedule your follow-up appointments, if one has not been scheduled already.
• When you can return to your normal activities, such as driving and bathing.

How long are you in the hospital after a total ankle replacement?

Most people who require an inpatient hospital stay are discharged after one night.

How long does it take to recover from a total ankle replacement?

You will need to wear a splint for the first three weeks after surgery. During this time, you will not be able to place any weight on your ankle.

After the first three weeks, you will need to wear a walking boot and can place some weight on your ankle. After six weeks, you can begin physical therapy and may be able to gradually resume normal activities and wear your usual footwear.

What activities should I avoid after ankle replacement?

You will not be able to put any weight on your ankle for about three weeks after surgery. After that, you will need to avoid driving and strenuous activity for several more weeks. Even after you are completely healed, your doctor may advise you to avoid high-impact activities, such as jumping or contact sports.

Can you walk normally after ankle replacement?

Most patients regain a normal range of motion and mobility after total ankle replacement and can walk normally. Compared with ankle fusion, total ankle replacement promotes a more natural gait by allowing the foot to move up and down.

When to call your doctor about complications

You should let your surgeon know if you have:

• A fever of more than 100.0°F.
• Difficulty breathing.
• Difficulty with walking or keeping your balance.
• New or increasing shortness of breath.
• Numbness, tingling, pain, swelling, or weakness in your leg.
• Pain, redness, bleeding, drainage, or increased swelling at your treatment site.
• Severe pain that does not respond to medication.

If symptoms are severe — or if you experience chest pain or shortness of breath — you should call 911 or visit the nearest emergency department.

What’s the prognosis of total ankle replacement?

In most cases, total ankle replacement decreases joint pain and preserves range of motion in your ankle.

What is the life expectancy of an ankle replacement?

Most total ankle replacements last for at least 10 years, depending on your age, activity level, and other factors.

What’s the success rate of total ankle replacement?

Most patients report improved quality of life and reduced pain after total ankle replacement. Compared to ankle fusion procedures, total ankle replacement offers enhanced mobility and reduces stress on nearby joints.

Center of Ankle Excellence in Southwest Pa.

UPMC experts are pioneers in total ankle replacement procedures. As a high-volume total ankle replacement center with outstanding outcomes and a commitment to ongoing research and education, UPMC in Southwest Pa. has been recognized as one of only 14 Stryker Centers of Excellence in the U.S. — and the only such center in Pennsylvania.

Why Choose UPMC for Total Ankle Replacement?

When you choose UPMC for total ankle replacement, you will receive:

• Access to world-class orthopaedic expertise — Our world-renowned experts treat the full spectrum of ankle disorders using the latest best practices and techniques.
• Nationally recognized care — UPMC in Southwest Pa. is one of only 14 centers in the U.S. to earn the Stryker Center of Excellence distinction and is recognized as a national leader in total ankle replacement volumes, outcomes, research, and education.
• Personalized surgical treatment — Our presurgical planning technology enables our surgeons to customize your care to your unique anatomy, leading to improved recovery, range of motion, and quality of life after surgery.

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By UPMC Editorial Staff. Last reviewed on 2026-05-26.