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Foot and ankle surgery · London

Total ankle replacement, by a BOFAS subspecialist.

A motion-preserving alternative to fusion for end-stage ankle arthritis, done by a foot and ankle consultant with a high case volume on modern cementless implants, in a CQC-registered London hospital with structured post-op physiotherapy.

A stethoscope on a clinical desk

Indicative pricing

What a private ankle replacement costs in London.

Indicative ranges across UK units.

In short

£22,000–£38,000, home in 2 to 3 nights.

Procedure Indicative range
Consultant clinic and full imaging work-up £450–£900
Total ankle replacement, unilateral, all-inclusive £22,000–£38,000
Revision arthrodesis after failed TAR £24,000–£42,000
Bilateral staged ankle replacement (per side) £22,000–£38,000
Post-op physiotherapy package (12 sessions) £720–£1,320
Second-opinion review of imaging and notes £250–£450

Prices vary by hospital, surgeon, implant system and whether a corrective osteotomy or ligament balancing is planned. Insurance usually funds TAR for end-stage arthritis with an approved diagnosis code; self-pay figures above are all-inclusive.

The problem

The right operation, the right surgeon, the right implant.

A stiff, painful ankle sent onto a general orthopaedic list is often steered to fusion by default. A high-volume subspecialist looks at whether replacement fits, and picks an implant to match your bone and alignment.

  • Is replacement even right for you?

    Age, demand level, alignment, bone stock and the state of your subtalar joint decide whether TAR or fusion wins. A subspecialist opinion beats a default.

  • Worried about complications?

    Wound-healing problems, subsidence and revision arthrodesis are the honest risks, quoted before you consent, with a named point of contact for concerns.

  • Want a modern implant, planned properly?

    PSI-planned Infinity, Cadence and Salto Talaris, INBONE II for bone loss, STAR for balanced ligaments, and revision systems if needed.

When it helps

When ankle replacement fits, and when fusion wins.

The most common indications, plus the red flags that point towards fusion, deformity correction or joint-preserving surgery.

  • End-stage post-traumatic ankle OA

    The commonest indication. Old pilon, malleolar or talar fractures leaving a painful, stiff tibiotalar joint.

  • Primary osteoarthritis of the ankle

    Less common than at the hip or knee, but responds well to replacement in older, lower-demand patients with good alignment.

  • Rheumatoid and inflammatory arthritis

    Selected patients on stable DMARDs where hindfoot motion needs to be preserved for adjacent-joint disease.

  • Selected AVN of the talus

    Limited talar avascular necrosis with an intact body can be replaced with careful implant selection and cement augmentation.

  • Failed ankle fusion causing adjacent OA

    Take-down of a painful fusion with hindfoot arthritis into a replacement, in specialist centres only.

  • Young high-demand manual worker

    Heavy labour, impact sport or a service career points towards fusion, which is more durable under load.

  • Coronal deformity over 20 degrees

    Large varus or valgus deformity, or a Charcot or neuropathic ankle, is a relative or absolute contraindication to replacement.

  • Active infection, poor skin, BMI over 40

    Active or recent deep infection, poor anterior skin envelope, uncontrolled diabetes or severe obesity are red flags to work through before booking.

Implant options

The modern implants in use, and when fusion still wins.

  • Infinity, Wright/Stryker

    A modern fixed-bearing cementless implant with the Prophecy patient-specific instrumentation (PSI) system planned from a pre-op CT.

  • Cadence, Integra

    Fixed-bearing cementless design with a broad talar footprint and instrumented flat-cut talar preparation.

  • INBONE II, Stryker

    Intramedullary-referenced stemmed tibial component for cases with proximal tibial bone loss or previous fracture malunion.

  • Salto Talaris, Integra

    Fixed-bearing anatomic implant with a long clinical record, often chosen for straightforward primary OA.

  • STAR, Stryker

    Mobile-bearing cementless implant, the original three-component design still used in selected patients with balanced ligaments.

  • Zimmer TM Total Ankle

    Trabecular metal design with a lateral transfibular approach for patients where an anterior approach is compromised.

  • Ankle arthrodesis (fusion)

    The alternative. More durable under heavy load, 95%+ ten-year survival, but no motion and higher long-term adjacent-joint OA.

  • Second-opinion review

    A specialist review of your imaging and notes. Sometimes the answer is a bracing programme or a joint-preserving osteotomy, not a replacement.

Safety and outcomes

Outcomes and risks, honestly.

Modern TAR gives 85 to 90 per cent patient satisfaction with major pain relief on the AOS score, 10 to 15 degrees of dorsiflexion and 25 to 35 degrees of plantarflexion, and 85 to 92 per cent implant survival at ten years.

  • General anaesthetic with popliteal block

    General anaesthetic with an ultrasound-guided popliteal sciatic block for the first 18 to 24 hours of pain relief. An anaesthetist reviews you the night before.

  • Wound-healing problems, 10 to 15 per cent

    The anterior ankle skin envelope is thin. Superficial wound issues in around one in eight cases; smoking, diabetes and steroids increase the risk.

  • Superficial infection 1 to 3 per cent

    Managed with oral antibiotics and dressings. Deep infection is uncommon at around 0.5 to 1 per cent but can require component removal.

  • Subsidence and aseptic loosening

    The talar component is more vulnerable than the tibial. Annual X-rays look for radiolucent lines, subsidence and peri-prosthetic cysts.

  • Cyst formation, actively monitored

    Small peri-prosthetic cysts are common; expanding cysts are grafted early to protect bone stock for any future revision.

  • Revision arthrodesis, 5 to 8 per cent at 10 years

    A minority of replacements need to be converted to a fusion at ten years. Modern implants are designed with revision bone stock in mind.

  • DVT prophylaxis for 6 weeks

    Chemical thromboprophylaxis for six weeks post-op, typically low molecular weight heparin then a direct oral anticoagulant, plus mechanical calf devices in hospital.

  • Driving at 8 to 12 weeks

    Driving is usually possible at 8 to 12 weeks for a right ankle, earlier for a left ankle in an automatic car. Insurers require you to be out of the boot.

  • Red flags after discharge

    Worsening rest pain, wound discharge, fever, sudden calf swelling or chest pain: call the ward or go to A&E the same day.

Reading your operation note

Your TAR note in four parts. Read the last one first.

Whichever implant is used, the note the surgeon sends you keeps to the same shape.

A London orthopaedic surgeon reviewing a total ankle replacement operation note

A quiet reminder

Orthopaedic notes are precise and can read coldly. A plain-English explanation can help.

If anything is unclear, ask your clinician to talk you through it at your next appointment.

  1. 01 Header

    Diagnosis, alignment and implant

    Which joint, the underlying diagnosis, the coronal and sagittal alignment, and the implant chosen with sizes and PSI plan reference.

  2. 02 Technique

    Approach, cuts and balancing

    Anterior tibialis-sparing approach, tibial and talar cuts, deltoid or lateral ligament balancing, any adjunctive calcaneal osteotomy or gastrocnemius release.

  3. 03 Findings

    Intra-op findings and complications

    Bone quality, cartilage state of the subtalar joint, any intra-op fracture, and the final range of motion on table.

  4. 04 Impression

    Rehab plan and review schedule

    Read this first: weight-bearing status, boot timeline, physiotherapy referral, DVT plan and review appointments at 2, 6, 12 weeks and 1 year.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Cover for total ankle replacement varies by insurer and by indication.

Frequently asked

Common questions about total ankle replacement.

Quick answers on replacement vs fusion, implant lifespan, recovery, contraindications and London centres.

  • Ankle replacement or ankle fusion, which is right for me?

    Replacement preserves 10 to 15 degrees of dorsiflexion and 25 to 35 degrees of plantarflexion, protects the subtalar and talonavicular joints from adjacent-joint OA, and gives 85 to 90 per cent satisfaction at ten years. Fusion is more durable under heavy load with over 95 per cent ten-year survival, but you lose ankle motion. Younger high-demand manual workers usually do better with a fusion; older, lower-demand patients with reasonable alignment usually do better with a replacement.

  • How long does a modern total ankle replacement last?

    Ten-year implant survival with current cementless designs such as the Infinity, Cadence and Salto Talaris is 85 to 92 per cent, and around 5 to 8 per cent of primaries need to be converted to a fusion by ten years. NICE IPG638 supports the use of TAR for end-stage arthritis in appropriately selected patients under specialist follow-up.

  • What does private ankle replacement cost in the UK?

    An all-inclusive unilateral total ankle replacement in London runs £22,000 to £38,000, covering the consultant, anaesthetist, implant, two to three nights in hospital and standard follow-up. A revision arthrodesis is £24,000 to £42,000. A second-opinion review of your imaging is £250 to £450.

  • How long is the recovery?

    You are non-weight-bearing on crutches for the first two weeks with the ankle in a back-slab, then protected weight-bearing in a walker boot at 4 to 6 weeks, then full weight-bearing in the boot by 6 to 8 weeks. Most patients are out of the boot at 10 to 12 weeks, driving at 8 to 12 weeks, and back to a desk job at 4 to 6 weeks. Full functional recovery takes 9 to 12 months.

  • Who should not have a total ankle replacement?

    Absolute contraindications include active deep infection, Charcot neuroarthropathy, severe peripheral neuropathy, and complete talar avascular necrosis. Relative contraindications include age under 50 in a heavy manual worker, coronal deformity greater than 20 degrees, poor tibial or talar bone stock, uncontrolled diabetes and a BMI over 40. For most of these an ankle fusion is the safer operation.

  • Which London centres offer ankle replacement?

    Ankle replacement is performed by BOFAS subspecialist consultants at a number of private and NHS centres in London. Check that your surgeon is a foot and ankle subspecialist who performs ankle replacement regularly.

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