Modern implants, careful patient selection, and surgical expertise are expanding options for patients with complex ankle arthritis

Total ankle replacement is performed far less frequently than hip or knee arthroplasty, in part due to the ankle joint’s complex anatomy and the technical demands of the procedure. Successful outcomes often depend on surgeon experience and careful patient selection. For patients with end-stage ankle arthritis, untreated or inadequately managed disease can lead to chronic pain, decreased mobility, and significant functional limitation.

Barnes-Jewish Hospital and WashU Medicine in St. Louis, Missouri, perform the most total ankle replacements in the region, and have extensive experience treating a wide range of ankle pathology and complexity. WashU Medicine orthopedic surgeon Kelly Hynes, MD, together with her colleagues, are advancing total ankle replacement surgery with leading-edge techniques and modern tools.

New implant technology, surgical planning, and patient selection are transforming the role of total ankle replacement (TAR) in the treatment of ankle arthritis, particularly in patients with post-traumatic arthritis. These technologies make surgery more precise and personalized, helping patients achieve a naturally functioning ankle and return to active lives with durable, tailored treatment options.

“Total ankle replacement implants have improved dramatically over time,” says Dr. Hynes. “Patients today benefit from well-established, high-performing implants, with continued advancements expected to further improve longevity and function.”

Precision planning and implant innovation

Modern TAR relies on precise preoperative planning. Innovations include patient-specific instruments and cutting guides developed using CT images, customized implant sizing and alignment optimization, and software-based surgical simulations for correcting deformities. These tools allow surgeons to correct alignment, optimize positioning, and potentially reduce the risk of early failure or revision surgery.

Modern TAR implants are constructed from highly durable alloys and medical-grade polyethylene. These materials reduce wear and extend the lifespan of implants compared with earlier designs.

”Modern implants last longer and are more forgiving for patients who are slightly more active,” Dr. Hynes says. “We are constantly evaluating new designs to further reduce revision rates.”

Patient selection and indications

Patients referred for evaluation for TAR most commonly present with persistent pain and functional limitation from advanced ankle arthritis, often related to prior trauma.

Unlike hip or knee osteoarthritis, ankle arthritis is often secondary to trauma, developing years after injuries such as ankle fractures from skiing or snowboarding accidents, old soccer or basketball injuries with ligament damage, or repeated severe ankle sprains that lead to chronic instability.

Factors such as malalignment, ligamentous instability, or prior fractures can accelerate degeneration, sometimes within a year, while in some cases the degenerative process may evolve more gradually over several years.

Total ankle replacement is recommended for patients over 50, given the risks of multiple revisions in younger, more active patients.

“For those under 50, ankle fusion remains the preferred option, providing long-lasting pain relief even if range of motion is sacrificed,” Dr. Hynes says. “Early replacement increases the likelihood of revision later in life, when insufficient bone may limit reconstructive options.”

Other indications for TAR may include rheumatoid arthritis, hemophilia, or rare congenital deformities. Osteoarthritis without a triggering condition is uncommon in the ankle.

TAR is also technically demanding. Many patients present with post-traumatic arthritis, deformity, or alignment issues that must be corrected at the time of surgery. As a result, surgeons often perform additional procedures alongside the ankle replacement to restore proper alignment and joint function.

“Total ankle replacement is a complex, highly specialized procedure that requires precise planning and execution,” Dr. Hynes says. “When performed by surgeons with advanced training and experience in this area, it can restore mobility and improve quality of life.”

Many patients also present with complex anatomy or deformities resulting from previous injury. In these cases, the surgical plan is tailored to each patient’s anatomy and pathology, reflecting the level of complexity this team routinely manages.

Outcomes and future directions

Advances in implant technology, surgical planning, and instrumentation have improved outcomes for patients undergoing total ankle replacement. Many patients experience meaningful pain relief and improved range of motion, allowing them to return to comfortable daily activities, though high-impact activity remains limited.

As implant technology continues to evolve, surgeons anticipate improvements in implant longevity, fewer revision procedures, and expanded treatment options for patients with complex ankle arthritis.

“Total ankle replacement has emerged as a strong treatment option for patients with post-traumatic arthritis and deformity, thanks to innovations in implant design and surgical planning,” Dr. Hynes says. “With continued innovation in implant design, careful patient selection, and better surgical techniques, we expect outcomes and durability to keep improving.”

Expert care for complex ankle conditions

WashU Medicine and Barnes-Jewish Hospital are national leaders in caring for patients with orthopedic conditions. WashU Medicine physicians are also committed to education and research, leading innovative clinical trials and training the next generation of orthopedic surgeons.

The team combines advanced surgical techniques with individualized  treatment planning and strong communication with referring physicians to ensure patients receive timely evaluation and expert care.

To learn more, visit us online or call 314-514-3500.

To refer a new patient:

• Call: 314-514-3500
• Fax: 314-878-7678