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.
Why patients choose us
- 01
A BOFAS foot and ankle subspecialist
Not a general orthopaedic list. A named consultant with a high total ankle arthroplasty case volume and a track record on modern implants.
- 02
The right operation for your ankle
Replacement is not always the answer. For high-demand workers, big deformity or poor bone stock we recommend fusion, before you commit.
- 03
Independent, and free
We are paid by no hospital, so the recommendation is impartial and costs you nothing.
Indicative pricing
What a private ankle replacement costs in London.
Indicative ranges across our partner units. Send the imaging and we quote firm figures across two or three options.
In short
A unilateral total ankle replacement in our London network: £22,000–£38,000, home in 2 to 3 nights.
| Procedure | Indicative range | Typical duration | Turnaround |
|---|---|---|---|
| Consultant clinic and full imaging work-up | £450–£900 | 45–60 min | Same visit |
| Total ankle replacement, unilateral, all-inclusive | £22,000–£38,000 | 90–150 min | 2–3 nights |
| Revision arthrodesis after failed TAR | £24,000–£42,000 | 150–210 min | 3–5 nights |
| Bilateral staged ankle replacement (per side) | £22,000–£38,000 | 90–150 min | 2–3 nights |
| Post-op physiotherapy package (12 sessions) | £720–£1,320 | 45 min each | Weekly |
| Second-opinion review of imaging and notes | £250–£450 | 30 min | 48 hours |
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.
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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.
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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.
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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.
The journey
From referral to rehab - what happens, in order.
One team from first message to the one-year review, including the boot timeline and physiotherapy programme.
Phase 1 · Before your operation
Concierge, off-stage for you
Phase 2 · On the day
Two to three nights in hospital
Phase 3 · After
Rehab and annual review
- 01
Before
You send us the imaging and story
A short, confidential form. Weight-bearing X-rays if you have them, any CT or MRI, and how the ankle limits your day.
- 02
Before
We come back with a recommendation
Within one working day: whether total ankle replacement fits, or whether ankle fusion is the safer call. Indicative price. An honest read either way.
- 03
Before
Consultant clinic and work-up
Weight-bearing AP and lateral X-rays, Saltzman hindfoot view, CT for bone stock, MRI for subtalar and talonavicular joints, DEXA if needed.
- 04
On the day
Admission and anaesthetic
Arrival, consent and a chat with the surgeon and anaesthetist. General anaesthetic with a popliteal block for post-op pain control.
- 05
On the day
The replacement itself
90 to 150 minutes. Anterior tibialis-sparing approach, cementless hydroxyapatite-coated tibial and talar components, polyethylene bearing, deformity correction if needed.
- 06
On the day
Two to three nights in hospital
Elevation, ice, a below-knee back-slab. Physiotherapy visit, chemical thromboprophylaxis, and a discharge plan with crutches and a walker boot.
- 07
After
Rehab and review
Non-weight-bearing for 2 weeks, protected weight-bearing in a boot at 4 to 6 weeks, full weight-bearing in the boot by 6 to 8 weeks. Review at 2, 6, 12 weeks and 1 year.
Typical end-to-end: 4–8 weeks to surgery. Boot: 10–12 weeks. Full recovery: 9–12 months.
When it helps
When ankle replacement fits, and when fusion wins.
The indications we see most, plus the red flags where we steer you towards fusion, deformity correction or joint-preserving surgery.
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End-stage post-traumatic ankle OA
The commonest indication. Old pilon, malleolar or talar fractures leaving a painful, stiff tibiotalar joint.
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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.
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Rheumatoid and inflammatory arthritis
Selected patients on stable DMARDs where hindfoot motion needs to be preserved for adjacent-joint disease.
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Selected AVN of the talus
Limited talar avascular necrosis with an intact body can be replaced with careful implant selection and cement augmentation.
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Failed ankle fusion causing adjacent OA
Take-down of a painful fusion with hindfoot arthritis into a replacement, in specialist centres only.
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Young high-demand manual worker
Heavy labour, impact sport or a service career pushes us towards fusion, which is more durable under load.
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Coronal deformity over 20 degrees
Large varus or valgus deformity, or a Charcot or neuropathic ankle, is a relative or absolute contraindication to replacement.
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Active infection, poor skin, BMI over 40
Active or recent deep infection, poor anterior skin envelope, uncontrolled diabetes or severe obesity are red flags we work through before booking.
Implant options
The modern implants we use, and when fusion still wins.
Fixed-bearing and mobile-bearing designs, PSI-planned from a pre-op CT where available, matched to your bone stock, alignment and demand level.
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Infinity, Wright/Stryker
A modern fixed-bearing cementless implant with the Prophecy patient-specific instrumentation (PSI) system planned from a pre-op CT.
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Cadence, Integra
Fixed-bearing cementless design with a broad talar footprint and instrumented flat-cut talar preparation.
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INBONE II, Stryker
Intramedullary-referenced stemmed tibial component for cases with proximal tibial bone loss or previous fracture malunion.
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Salto Talaris, Integra
Fixed-bearing anatomic implant with a long clinical record, often chosen for straightforward primary OA.
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STAR, Stryker
Mobile-bearing cementless implant, the original three-component design still used in selected patients with balanced ligaments.
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Zimmer TM Total Ankle
Trabecular metal design with a lateral transfibular approach for patients where an anterior approach is compromised.
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Ankle arthrodesis (fusion)
The alternative. More durable under heavy load, 95%+ ten-year survival, but no motion and higher long-term adjacent-joint OA.
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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.
Our vetted London network
A small panel of BOFAS subspecialists, we picked them.
Consultants working through Fortius Foot & Ankle, the London Foot & Ankle Centre, HCA Wellington, Cromwell BUPA and RNOH Private at Stanmore. Introductions are made privately, once we understand your case.
Selection criteria
How we choose every surgeon in our network.
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BOFAS foot and ankle subspecialists with high TAR case volumes
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CQC-registered private hospitals with orthopaedic critical care backup
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Access to modern PSI-planned implants and revision systems
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Named foot and ankle physiotherapists for structured post-op rehab
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.
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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.
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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.
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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.
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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.
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Cyst formation, actively monitored
Small peri-prosthetic cysts are common; expanding cysts are grafted early to protect bone stock for any future revision.
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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.
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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.
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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.
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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 quiet reminder
Orthopaedic notes are precise and can read coldly. We translate them for you.
If you would like us to talk you through the note before your review, just ask.
- 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.
- 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.
- 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.
- 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
Cover for total ankle replacement varies by insurer and by indication. We confirm cover in writing before booking.
Frequently asked
Everything we get asked about total ankle replacement.
Quick answers on replacement vs fusion, implant lifespan, recovery, contraindications and London centres.
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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.
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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.
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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. We confirm a firm figure within one working day.
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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.
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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.
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Which London centres do you work with for ankle replacement?
We partner with BOFAS subspecialist consultants working through the Fortius Foot & Ankle service, the London Foot & Ankle Centre, HCA at the Wellington and Princess Grace, the Cromwell (BUPA), and the private wing of the Royal National Orthopaedic Hospital at Stanmore. We match your case, imaging and insurer to the surgeon whose implant choice and location suit you best.
Ready to talk it through?
Send us your imaging. We come back within one working day, with a subspecialist match and a firm quote.
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