Ankle Replacement or Fusion: Which Is Best for Me?
Ankle arthritis · Decision guide
Fusion or replacement?
Which way do the factors point?
When ankle arthritis no longer settles with non-operative treatment, the two main operations are ankle fusion (arthrodesis) and total ankle replacement. These six factors help guide which option is likely to suit you best.
Age & activity level
Favours fusionYounger, with very high physical demands
Favours replacementOlder, with moderate physical demands
Arthritis in neighbouring joints
Favours fusionAnkle only; neighbouring joints healthy*
Favours replacementSubtalar or midfoot joints already worn
Body weight (BMI)
Favours fusionHigher BMI, with heavy loading through the ankle
Favours replacementLower BMI
Deformity
Favours fusionLarge or rigid deformity
Favours replacementMild and correctable
Skin & soft tissue
Favours fusionPoor soft-tissue cover or circulation
Favours replacementHealthy skin with a good blood supply
Occupation
Favours fusionManual or labouring work, high impact
Favours replacementSedentary to moderately active work
Why healthy neighbours favour fusion
Arthritis that later develops in the joints next to a fused ankle can usually be managed, whereas a failed ankle replacement can be more difficult to put right.
No single factor decides
Most people have factors pointing both ways. The right choice is reached together through shared decision making, informed by your examination, Weight-Bearing CT imaging and your own goals.
Considering surgery for ankle arthritis?
Arrange a consultation to discuss whether fusion or replacement is right for you.
This guide is general information to help you prepare for a discussion with your surgeon. It is not a substitute for an individual consultation.
Written by: Matthew Welck | Consultant Orthopaedic Foot & Ankle Surgeon London — last updated 5 October 2026