Ankle Replacement Recovery: Timeline and How Long It Lasts

Ankle replacement surgery swaps the worn joint surfaces for a metal and plastic implant. If you are still comparing options, read ankle fusion vs. ankle replacement first. For the operation itself, see foot and ankle joint fusion and replacement.

What does ankle replacement surgery give you?

• Pain relief that lasts. In studies averaging about 10 years of follow-up, pain scores fell by about 4.5 points and foot and ankle scores rose by about 40 points.^[5]
• An ankle that still moves. Because the joint keeps moving, less stress passes to the joints nearby.^[1] Pooled studies comparing it with fusion found better ankle motion and better function scores after replacement.^[6]
• A better walk. A review of 17 studies found moderate evidence of better walking mechanics after replacement than before it.^[7]
• Satisfied patients. In Sweden’s national registry, 71% of 241 people were satisfied or very satisfied, and 12% were dissatisfied, up to two years after surgery.^[8] One center’s series of 118 replacements reported overall satisfaction of 89%.^[9]
• A more active life. A review with about 3.5 years of follow-up found that participation in sport and activity rose from 41% before ankle replacement to 59% after. Among people who had a replacement or an ankle fusion, the most common activities were swimming, hiking, cycling and skiing.^[10]

What does ankle replacement recovery look like?

There is no single standard plan. A review of 84 studies found no consensus on immobilization, weight-bearing or therapy.^[11] Implant makers’ own instructions differ too, so the ranges below are a guide, not your schedule.^[12] The later stages use figures for foot and ankle arthritis surgery in general, not ankle replacement alone.^[1] In pooled studies of 1,514 people, most of the improvement people noticed came within the first year.^[13]

When can I walk after ankle replacement?

Among makers’ protocols for seven implants, partial weight started at week 2, 3 or 7, and full weight at week 4 or week 6.^[12] Your surgeon may choose a different plan based on what else was done during your surgery.

Driving and work

If your right ankle was replaced, a study of 60 people found that 92% had a safe braking time at six weeks, and all who finished the study did by nine weeks.^[14] Check with your surgeon first.

In a study of 53 working people under 65, those with desk jobs returned at about 2.7 weeks on average, and those with physical jobs at about 13 weeks. Five retired or cut back their role.^[15] See recovery after foot and ankle surgery.

How long does an ankle replacement last?

“Survival” in these studies usually means the implant has not needed revision, which is surgery to exchange or remove parts of it. Here is what large data sets show at about 10 years.^{[4,16,3,17,18,19]}

The trend is encouraging. In Sweden, current designs did better than early ones, and in Australian data, surgery done since 2015 carried a lower risk of revision than earlier surgery. Better implants, tools, surgeon experience and patient selection may all play a part, and registries can’t separate them.^[18,16]

Longer-term numbers are lower. Registry survival at 15 years ranged from 56% to 78%, and a large literature review pooled it at 72%.^[3,19] In Sweden, about 58% of all implants, including older designs, had not been exchanged or removed at 20 years.^[18]

What affects how long it lasts?

• Age. In Australian data, people under 55 had about twice the revision risk of those 75 and older.^[16]
• Weight. A body mass index of 30 or more was linked to about 1.5 times the risk. The most common reason for revision is the implant coming loose from the bone without infection.^[16]
• Other problems in the foot. Arthritis or deformity that needed a fusion or bone cut at the same time was linked to early revision.^[17]
• Surgical volume. In France, centers doing 10 or fewer replacements a year had worse survival. It is a fair question to ask any surgeon about experience.^[17]

How do you prepare for ankle replacement surgery?

• Stop smoking. Smokers do worse after ankle replacement, with more infections and poorer function scores.^[20]
• Get your blood sugar under control. An A1c of 8% or higher, and nerve damage, are each linked to surgical site infection after foot and ankle surgery.^[21]
• Plan for help and time off. You won’t be walking normally for a while, so set up your home, arrange rides and tell your surgeon what your work involves.

Our checklist for foot and ankle surgery covers the rest.

What are the limits of ankle replacement?

Revision is not the only extra surgery people may need. In 262 ankles followed for at least 10 years, a review found revision of any kind in about 31%, unplanned further surgery in about 42% and infection in about 3%, although those ankles were treated years ago and newer implants may differ.^[22] In a randomized trial of 303 people, replacement and fusion both improved walking and standing scores at one year, without a clinically or statistically significant difference.^[23] Pooled studies found no difference from fusion in pain relief, walking analysis or satisfaction, with more complications and reoperations after replacement.^[6] In England, 10.2% of replacements had been revised at 10 years, against 2.5% of fusions, and the 25-year risk of fusing a nearby joint did not differ significantly.^[4] High-impact sports such as tennis, soccer and running were consistently limited after surgery.^[10] The review of 58 papers rated its own evidence as weak.^[2] Your surgeon can explain how these numbers apply to you.

Common questions

How long does an ankle replacement last?

Many last 10 years or more. National data show that about 66% to 90% have not been revised at 10 years, and 56% to 78% at 15 years.^[3,4]

Can I run after an ankle replacement?

Running and other high-impact sports were consistently limited after surgery in research. Ask your surgeon what is reasonable for your implant.^[10]

Will I need another surgery someday?

You may. Some people need revision or other further surgery, and the chance rises with time.^[22]

What does an ankle replacement do for pain and motion?

It offers relief from the pain of advanced arthritis with an ankle that still moves.^[1] In a review of 58 papers, foot and ankle scores rose from 40 to 80 out of 100, and ankle motion rose from 23 to 34 degrees.^[2]

The bottom line

Ankle replacement offers pain relief and an ankle that keeps moving, and most people in national data have not needed revision at 10 years. Recovery is measured in months, with protected weeks at the start and follow-up over the long term. Dr. Ozturk is a double board certified Foot and Ankle Surgeon and podiatrist who sees patients in Lyndhurst, Paramus and Millburn. Our parent practice explains arthritis care (external site), or you can request an appointment to talk through your ankle.