Total Ankle Replacement

Name: Total Ankle Replacement (TAR) Surgery in London — Expert Patient Guide
Creator: Mr Matthew Welck
Keywords: total ankle replacement, ankle replacement London, ankle replacement North London, ankle replacement Hertfordshire, best ankle surgeon London, top foot and ankle surgeon, ankle arthritis surgery, sports injuries foot ankle, TAR surgery, foot surgeon London, ankle surgeon North London

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Expert Patient Guide · Foot & Ankle Surgeon · London & North London

Total Ankle Replacement (TAR) Surgery in London

A patient information guide by Mr Matthew Welck — Consultant Orthopaedic Foot & Ankle Surgeon, RNOH Stanmore & North London

At a Glance: Total Ankle Replacement

Procedure	Total ankle replacement (TAR) — replacement of the arthritic ankle joint surfaces with a metal and polyethylene implant that preserves movement.
Indication	End-stage ankle arthritis where non-operative measures no longer control pain or restore function.
Most Common Cause	Post-traumatic arthritis following ankle fracture or ligament injury; primary osteoarthritis; inflammatory arthritis (rheumatoid, psoriatic).
Hospital Stay	1–2 nights.
Recovery	Non-weight-bearing 0–2 weeks; gradual weight-bearing in cast 2–6 weeks; aircast boot 6–12 weeks; normal shoes from approximately 3 months.
Outcomes	85–95% good-to-excellent results in appropriately selected patients; implant survivorship 10–15+ years with modern implants.
Surgeon	Mr Matthew Welck — Consultant Foot & Ankle Surgeon, RNOH Stanmore & UCL. Private clinics in London, North London and Hertfordshire.

Mr Matthew Welck is a Consultant Orthopaedic Foot and Ankle Surgeon at the Royal National Orthopaedic Hospital (RNOH) Stanmore and Honorary Associate Clinical Professor at University College London (UCL). His NHS and private practice covers North London, Central London, Hertfordshire and the wider Greater London area, with national and international referrals for complex cases. With more than 50 peer-reviewed publications, he specialises in total ankle replacement, end-stage ankle arthritis, complex hindfoot deformity, and sports-related foot and ankle injuries. This patient information guide explains what total ankle replacement (TAR) involves, what recovery looks like, and the risks to consider.

Why Have Total Ankle Replacement Surgery?

Total ankle replacement is one of the most effective surgical treatments for end-stage ankle arthritis. It is considered when non-operative measures — activity modification, anti-inflammatory medication, bracing, physiotherapy and steroid or biologic injections — no longer control pain or restore meaningful function.

The key benefits of total ankle replacement include:

Significant and lasting pain relief
Preservation of ankle movement (in contrast to ankle fusion, which permanently stiffens the joint)
A more natural walking pattern (gait), which reduces limping
Reduced stress on neighbouring joints in the hindfoot and midfoot, lowering the risk of secondary arthritis
Improved ability to manage stairs, slopes and uneven ground
Return to low-impact recreational and sporting activities, including walking, hiking, cycling, swimming, golf and skiing
Improved overall quality of life, independence and mobility

Modern third- and fourth-generation implants have transformed outcomes. For appropriately selected patients, a well-performed total ankle replacement now offers durable function with implant survivorship comparable to other major joint replacements at 10–15 years.

Why it matters: Ankle fusion permanently stiffens the joint and increases load on neighbouring joints, accelerating wear. Total ankle replacement preserves movement and protects the rest of the foot — making it the preferred option for active patients with good bone stock and a well-aligned ankle.

Preparing for Surgery

Thorough preparation makes recovery smoother and reduces the risk of complications. Before admission you will:

Attend a pre-operative assessment to confirm fitness for anaesthesia and surgery
Be advised to stop smoking — smoking significantly increases the risk of wound complications and implant failure
Review your medications, as some (including blood thinners and certain rheumatology drugs) may need to be paused
Optimise weight, blood pressure and diabetic control where relevant

Practical preparation at home is equally important. Recommended equipment to consider purchasing before the surgery includes:

A foam leg-elevation cushion — keeping the foot above the level of the heart for the first two weeks dramatically reduces swelling and aids wound healing
A waterproof cast or dressing protector (for example, the LimbO waterproof protector) — this allows you to shower safely while in plaster, after the first 2 weeks
Crutches or a walking frame (provided by the hospital)
Loose-fitting trousers and a comfortable shoe for the unoperated foot
A clear, uncluttered walking route between your bed and the bathroom, with trip hazards removed
A friend or family member able to support you for the first 1–2 weeks

For more detailed pre-operative advice, please see our patient leaflets: Preparing for Foot Surgery (PDF) and Recommended Products Guide (PDF).

What Does the Surgery Involve?

Total ankle replacement is usually performed under a general anaesthetic, with a local nerve block, to eliminate pain straight after surgery. A tourniquet is normally applied to the thigh to reduce bleeding during the operation.

In simple terms, the surgeon:

Makes an incision at the front of the ankle
Carefully moves the tendons, nerves and blood vessels to the side to protect them
Removes the worn, arthritic surfaces from the lower end of the shin bone (tibia) and the top of the talus bone
Prepares the bone using purpose-designed instruments. Mr Welck uses patient-specific 3D-printed cutting guides based on a pre-operative CT scan
Implants a metal cap on the tibia and a metal cap on the talus
Inserts a smooth polyethylene (medical-grade plastic) spacer between the two metal components, which acts as the new cartilage and allows the ankle to bend smoothly

Additional small procedures — such as lengthening a tight Achilles tendon, correcting deformity, or fusing a worn neighbouring joint — may be performed at the same time to ensure the foot is balanced and the implant is loaded evenly. Total surgical time is typically 90–120 minutes.

Patient-specific 3D planning: Mr Welck uses pre-operative CT scanning and 3D-printed cutting guides tailored to each patient’s anatomy, improving the accuracy of implant positioning and reducing the risk of malalignment.

How Long Will You Be in Hospital?

Most patients stay in hospital for 1–2 nights. You will be ready to be discharged home once you:

Have your pain well-controlled with oral medication
Can transfer safely in and out of bed
Can mobilise a short distance non-weight-bearing on crutches
Have been reviewed and cleared by the physiotherapy team
Are medically stable from a general health perspective

You will go home in a below-knee plaster backslab, with a prescription for blood-thinning injections (anticoagulation) to reduce the risk of deep vein thrombosis (DVT).

What Does Recovery Look Like?

Recovery follows a structured rehabilitation protocol specific to total ankle replacement, consistent with the post-operative pathways used at RNOH Stanmore and within Mr Welck’s private practice.

Early Phase (0–6 weeks)

Strict elevation of the leg for the first 2 weeks
Non-weight-bearing in a backslab
Daily blood-thinning injections (anticoagulation) for 6 weeks
2-week clinic review: wound check, removal of sutures, and change into a full plaster cast — patients can then begin gentle weight-bearing in the cast with crutches
6-week clinic review: plaster removed, X-rays taken, transitioned into a removable aircast walker boot, and referral to physiotherapy

Mid-term Phase (6 weeks – 6 months)

Gradual weaning out of the boot into supportive footwear, typically by 10–12 weeks
Physiotherapy focuses on range of movement, calf strengthening, balance and gait re-education
Most patients return to driving once out of the boot and able to perform an emergency stop safely
Return to desk-based work is typical between 6–12 weeks; manual or standing roles usually require longer

Long-term Phase (6 months and beyond)

26-week clinic review with continued functional progress
1-year clinic review, followed by lifelong annual follow-up alternating between telephone and face-to-face clinics, with periodic X-rays to monitor the implant
Most patients reach their final functional outcome between 12 and 18 months after surgery

What Are the Risks?

Total ankle replacement is a highly successful operation, but as with any surgery there are risks. Procedure-specific risks include:

Infection — superficial wound infection is uncommon; deep peri-prosthetic infection is rare but serious and can require further surgery.
Wound healing problems — the skin at the front of the ankle is thin; smoking, diabetes and steroid use significantly increase risk.
Nerve injury — particularly to small superficial sensory nerves, sometimes leaving a patch of numbness or tingling on the top of the foot.
Implant loosening — the metal or plastic components may loosen over time and may require revision surgery.
Polyethylene wear — the plastic insert can wear and occasionally needs to be exchanged.
Peri-prosthetic fracture — of either the tibia or the talus, either during or after surgery.
Stiffness — some loss of movement compared with a normal ankle is expected after any joint replacement.
Ongoing pain — particularly if neighbouring joints (subtalar, midfoot) are also arthritic.
Need for revision surgery — modern implants typically last 10–15+ years; a small proportion of patients require revision or conversion to ankle fusion.

General risks of any foot and ankle surgery — including bleeding, blood clots (DVT/PE), complex regional pain syndrome, scar sensitivity and anaesthetic risks — are explained in more detail in our patient leaflets: Hindfoot Surgery Risks (PDF).

Why Choose Mr Welck?

Mr Matthew Welck is a Consultant Orthopaedic Foot and Ankle Surgeon at the Royal National Orthopaedic Hospital (RNOH) Stanmore and Honorary Associate Clinical Professor at University College London (UCL). He undertook double fellowship training, including time at the Foot and Ankle Institute in Baltimore, USA, and has published more than 50 peer-reviewed papers in foot and ankle surgery.

Patients consulting Mr Welck for total ankle replacement benefit from:

Sub-specialist experience in total ankle replacement, including primary and revision cases
Patient-specific 3D-printed cutting guides for optimal implant positioning
Comprehensive pre-operative assessment including weight-bearing CT where indicated
A close-knit multidisciplinary team of physiotherapists, specialist podiatrists and pain physicians
Convenient private clinic locations across Central London (The Wellington Hospital, The Princess Grace Hospital), North London (Highgate Hospital) and Hertfordshire (Spire Bushey Hospital), alongside his NHS practice at RNOH Stanmore
National and international tertiary referral acceptance for complex ankle reconstruction and revision cases

Mr Welck is a founding member of the Stanmore Foot & Ankle Specialists and a recipient of the European Foot & Ankle Society Best Scientific Paper Prize. His secondary referral practice covers total ankle replacement, ankle arthritis, sports injuries, hindfoot reconstruction and complex deformity correction, with patients referred from across North London, Central London, Hertfordshire and the wider UK.

Frequently Asked Questions

How long until I can walk normally?

Most patients walk comfortably in normal shoes around 3 months after total ankle replacement, with continued improvement in strength, balance and confidence up to 12–18 months.

When can I drive?

Most patients can drive 8–10 weeks after total ankle replacement surgery, once out of the aircast boot and able to perform an emergency stop safely. You must inform your motor insurer.

Can I return to sport after total ankle replacement?

Yes — most patients return to low-impact sport after total ankle replacement. Activities such as walking, hiking, cycling, swimming, golf, doubles tennis and skiing are actively encouraged. High-impact activities such as running, racquet singles and contact sports are generally discouraged to maximise implant longevity. As a foot and ankle surgeon with a specialist interest in sports injuries, Mr Welck will discuss realistic activity goals with you before surgery.

Will the implant set off airport security?

It may. You will be given a card confirming you have a metal joint implant, which you can show to airport staff.

How long does an ankle replacement last?

Modern total ankle replacement implants typically last 10–15 years or more, depending on activity level, body weight, bone quality and surgical technique.

Will I need any more surgery?

A small proportion of patients require further surgery — most commonly for adjacent-joint arthritis, polyethylene exchange, or revision to a new implant or ankle fusion.

Why choose Mr Matthew Welck as your foot and ankle surgeon in London?

Mr Welck is a Consultant Orthopaedic Foot and Ankle Surgeon at the RNOH Stanmore — the UK’s largest specialist orthopaedic hospital — and Honorary Associate Clinical Professor at UCL. His secondary referral practice covers total ankle replacement, ankle arthritis, sports injuries, hindfoot reconstruction and complex deformity correction, with patients referred from across North London, Central London, Hertfordshire and the wider UK. He has published more than 50 peer-reviewed papers on foot and ankle surgery and works as part of the Stanmore Foot & Ankle Specialists group.

Book a Consultation

If you are looking for an expert foot and ankle surgeon in London or North London for total ankle replacement, end-stage ankle arthritis or complex hindfoot reconstruction, Mr Welck offers comprehensive assessment with same-visit imaging where required.

To arrange a consultation with Mr Matthew Welck:

Telephone: 07547 395 270
Online booking: matthewwelck.com/appointments
NHS referrals: through your GP to Mr Welck at RNOH Stanmore

This information is provided for general patient education and does not replace individual medical advice. Please discuss your specific case with Mr Welck or another qualified Consultant Foot & Ankle Surgeon.

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