Ask the Expert: Ankle Replacements

In this week’s installment of Ask the Expert, Dr. Jonathan Deland, Co-Chief of the Foot and Ankle Service at HSS, answers questions on what you need to know about ankle replacements.

Q1. Who should have an ankle replacement?

One should consider having an ankle replacement when there is severe arthritis of the ankle, with the pain from the ankle resulting in a limited ability to walk. Patients should have no infection, skin in good condition, and be approximately 55 years of age or older unless there are special circumstances.

Q2. When is the right time to have an ankle replacement?

The right time to have an ankle replacement is when the ankle is becoming painful enough that walking a few city blocks is difficult. In other words, aside from scheduling, this is a pain and function-related decision. The more pain and limitation you have, the easier the decision is to have an ankle replacement. Patients with mild pain and good function should wait as it’ll make the decision easier. Patients with very limited function and real pain should strongly consider the procedure.

Q3. What type of ankle replacement?

At this time, there is no consensus as to what is the best design for an ankle replacement. For example, the ankle replacements presently on the market vary much more in design than the design of hip or knee replacements. Just take a look at a few examples of the common ankle replacement. Although this is not an exclusive list, these are the Salto Talaris, the Infinity and INBONE replacements, the Zimmer Trabecular Metal ankle replacement and the STAR. I am a part of a team who developed the Zimmer ankle replacement. However, I have used the different types of ankle replacements. Also, at HSS, we are studying the different types of replacements and continue to use different types depending upon the situation. There is no one type best for all ankles. The success of ankle replacements is a relatively new development with not nearly the number of years for designs to converge as has happened to a large extent with hip and knee replacements. Further study on how patients are doing with the different designs over the long-term needs to be done.

Q4. What are the long-term and short-term problems for ankle replacements?

As with other joint replacements, the long-term problems to ask about are the loosening of the implant, subsidence, or sinking in, of the implant into the bone and development of cysts or loss of bone around the implant. Short-term problems include bony impingement in the areas of the ankle not replaced by the replacement (medial and later gutters) and normal risks of surgery such as infection, wound problems, numbness or nerve pain. Incidences of these are small.

Q5. Are there any further developments in ankle replacements?

There are different designs that will be coming out on the market. Important goals when discussing future ankle replacements are to take less bone, the longevity of the replacement (minimizing loosening and subsidence) as well as allowing good motion of the ankle.

Dr. Jonathan Deland, Foot & Ankle Surgeon, is the Co-Chief of the Foot and Ankle Service at Hospital for Special Surgery. He is a recipient of an NIH Grant on Posterior Tibial Tendon Insufficiency, which he initiated the creation. Dr. Deland also has a special expertise in foot and ankle sport injuries, acute and chronic Achilles ruptures/tears, and is the co-developer of the Zimmer Total Ankle Replacement.

The information provided in this blog by HSS and our affiliated physicians is for general informational and educational purposes, and should not be considered medical advice for any individual problem you may have. This information is not a substitute for the professional judgment of a qualified health care provider who is familiar with the unique facts about your condition and medical history. You should always consult your health care provider prior to starting any new treatment, or terminating or changing any ongoing treatment. Every post on this blog is the opinion of the author and may not reflect the official position of HSS. Please contact us if we can be helpful in answering any questions or to arrange for a visit or consult.


  1. Dr. Deland,
    I’m a 41 year old male. I had an accident and damage to my right ankle six years ago that resulted with a fused talus. I really didn’t receive the relief that I had expected with the fusion. Since then I now have two locations that are rubbing bone on bone. One is the Subtalar bone rubbing in the calcaneus joint area when I walk. The other area is the lower Fibia area rubbing bone on bone. I’ve been taking nerve block shots for the last 18 -24 months. Those are becoming less effective. I’ve had two Surgeons suggest fusing both of these locations together to eliminate the bone on bone rubbing and pain. I’m just frustrated at the thought of more fusions in my ankle. I know I’m not quite old enough to be considered for a TAR, but I at least wanted to possible make a trip to HSS and you review my case to give me the best options. I’m an active guy with three boys ages 10, 12, & 14. I would love the option to have a TAR, but I want to make sure I’m making the best choice possible for myself an my family.
    Thank you,

    1. Hi James- If you’re considering seeing Dr. Deland for an appointment, please contact our Physician Referral Service at 877-606-1555 for further assistance.

  2. Hi , my age is 45, and I have sever degeneration of subtalar joint, and some degeneration of the ankle joint at the same side.
    Any sulution other than fixing the joint
    I really got desperate finding a solution.
    Please advise..

  3. Hi Dr. Deland,
    Years ago you fused my subtalar joint and I have done very well with that surgery. I saw you about a year and a half ago because the joint in the bit toe has deteriorated. At that point you told me that it was close to bone on bone. You mentioned new experimental injections that you were doing in Europe which would simulate the cushion that is supposed to be there. Have you made any progress? I am very interested since it is very painful.
    Thank you,
    Jeanne Steele

    1. Hi Jeanne, thank you for reaching out. Dr. Jonathan Deland, orthopedic surgeon, says: “The treatment is not injections, but rather resurfacing of that joint. We have made progress with a successful trial in Europe. The treatment will be coming to the United States, but no time soon (roughly 2-3 years). In the meantime for patients who wish, I have been operating on them in Europe. For example, Laura Brutman:

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