When ankle arthritis makes every step painful and limits the activities you love, total ankle replacement can be a life-changing solution. At MUSC Health, our orthopaedic foot and ankle surgeons specialize in ankle arthroplasty — replacing damaged joint surfaces with precision-engineered implants to relieve pain and restore motion.
As an academic medical center, MUSC Health coordinates orthopaedic surgeons, physiatrists, physical therapists, and advanced practice providers in a single care model designed around your recovery. Our surgeons participate in research to continuously improve implant design and outcomes for patients with ankle arthritis. Whether your arthritis followed a fracture, a severe sprain, or an inflammatory condition like rheumatoid arthritis, we will help you understand all your options.
Understanding Ankle Arthritis
Ankle arthritis develops when the cartilage cushioning the ankle joint wears away, causing the bones to rub together painfully. Unlike hip or knee arthritis, ankle arthritis most often results from a prior injury — including fractures, severe sprains, or ligament tears. It can also develop from inflammatory conditions such as rheumatoid arthritis or psoriatic arthritis.
Conservative treatments — anti-inflammatory medications, physical therapy, bracing, and corticosteroid injections — can manage symptoms for years. When non-surgical care is no longer effective, total ankle replacement may be the right next step.
Causes of Ankle Arthritis
Post-traumatic arthritis (most common) — following a fracture, severe sprain, or ligament injury
Osteoarthritis (wear-and-tear)
Rheumatoid or psoriatic arthritis
Osteonecrosis (loss of blood supply to the ankle joint)
Symptoms of Ankle Arthritis
Persistent pain in the ankle, especially with walking or standing
Swelling around the ankle joint
Morning stiffness that improves with movement
Reduced range of motion
Grinding or catching sensation
Difficulty with stairs, inclines, or uneven ground
Total Ankle Replacement vs. Ankle Fusion: Understanding Your Options
In a total ankle replacement, the damaged joint surfaces of the tibia and talus are removed and replaced with metal components, with a smooth polyethylene spacer between them. This restores the joint's natural mechanics, allows continued ankle motion, and enables most patients to return to an active lifestyle.
Surgery is performed under regional anesthesia and takes approximately two hours. Most patients go home the same day. A small incision at the front of the ankle provides access to the joint.
TAR is typically the preferred approach for patients who want to preserve flexibility and maintain an active lifestyle after surgery.
Ankle fusion permanently joins the ankle bones together using screws, plates, or bone grafts — eliminating joint motion but reliably relieving pain. Recovery typically requires eight to twelve weeks in a cast, making it a longer rehabilitation than TAR.
Fusion may be more appropriate for younger patients (for whom a replacement may not last a lifetime), patients with significant bone loss, those with nerve damage or reduced foot sensation, or patients whose anatomy is not well-suited to an implant.
Our orthopaedic team helps each patient weigh the benefits and trade-offs of both approaches based on age, anatomy, activity goals, and overall health.
What to Expect After a Total Ankle Replacement
Review imaging, discuss anesthesia, pre-op PT may be recommended to strengthen surrounding muscles.
TAR is performed as an outpatient procedure. Most patients go home the same day once safely recovered from anesthesia and able to use crutches.
Ankle protected in splint or cast. Leg must stay elevated. No weight bearing. A support person at home is strongly recommended during this phase.
At the two-week follow-up, the splint is removed. Transition to a protective walking boot. Begin gradual weight bearing with support.
Transition out of the boot. Formal PT begins — focused on restoring range of motion, strength, and balance.
Most patients are approximately 90% recovered at six months. Return to higher-impact activity varies by individual.
Our goal is to provide comprehensive foot and ankle care that restores movement, relieves pain, and allows you to get back to the life you love-one step at a time. ”
Frequently Asked Questions About Total Ankle Replacement
Total ankle replacement (TAR), also called ankle arthroplasty, replaces the damaged surfaces of the ankle joint with artificial implants. The ends of the tibia and talus are replaced with metal components, with a smooth polyethylene spacer between them. TAR relieves pain from ankle arthritis while preserving the ankle's natural range of motion. It is most often recommended for patients with severe ankle arthritis who want to remain physically active.
Good candidates have severe ankle arthritis not responsive to conservative treatment, adequate bone density for implant support, and a desire to preserve ankle motion for an active lifestyle. Patients with significant bone loss, nerve damage, or certain anatomical factors may be better suited for ankle fusion. Our orthopaedic team evaluates each patient individually using imaging and clinical assessment.
Total ankle replacement preserves motion by replacing the joint with implants. Ankle fusion permanently joins the ankle bones, eliminating motion but reliably relieving pain. Fusion may change foot mechanics over time and adds stress to adjacent joints. TAR is generally preferred for active patients; fusion may suit younger patients or those with specific anatomical factors.
Total ankle replacement takes approximately two hours. It is performed under regional anesthesia as an outpatient procedure — most patients go home the same day.
Recovery follows a phased progression: non-weight-bearing for the first two weeks, walking boot through week six, physical therapy beginning around week six. Most patients are approximately 90% recovered at six months.
Ankle replacement has a success rate of approximately 85 to 90 percent at ten years and around 75 percent at fifteen years. Outcomes depend on patient age, activity level, body weight, bone quality, and the underlying cause of arthritis.
Modern implant materials — including designs that allow bone to grow into the components — are extending implant longevity. Depending on age at surgery, revision may eventually be needed. Your surgeon will discuss expected implant lifespan and revision options during your consultation.
Total ankle replacement is generally covered by most major insurance plans when medically necessary. Verify coverage details, including deductibles and out-of-pocket costs, with your insurance provider before scheduling surgery.
Call 843-876-0111, schedule online through MyChart at mychart.muschealth.com, or ask your primary care provider for a referral to our orthopaedic foot and ankle team.
