Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

End-stage ankle arthritis — characterized by complete loss of joint cartilage, severe pain with all weight-bearing, and significant loss of motion — has two primary surgical solutions: total ankle replacement (arthroplasty) and ankle arthrodesis (fusion). Both procedures are effective for relieving pain and restoring function, but they differ in their effects on motion, activity tolerance, adjacent joint health, and long-term durability. At Balance Foot & Ankle in Southeast Michigan, Dr. Tom Biernacki helps patients with severe ankle arthritis understand which procedure best fits their age, activity level, deformity, and bone quality.

Ankle Fusion (Arthrodesis)

Ankle fusion eliminates the arthritic joint by permanently joining the tibia and talus together with screws, plates, or intramedullary nails. The fused ankle cannot move up or down (no dorsiflexion or plantarflexion), but the pain from the arthritic joint is eliminated. Fusion has a long track record — it has been the standard surgical treatment for ankle arthritis for decades — with high rates of pain relief (85–90% of patients satisfied). The major drawback is that the lost ankle motion is partially transferred to the subtalar and midfoot joints, which experience increased stress and can develop symptomatic arthritis over time (“adjacent joint arthritis”). This risk increases over years and decades, which is why fusion may be preferred in older, less active patients where the 20-year consequences are less relevant. Fusion is also preferred when bone quality is poor, when significant deformity exists that cannot be corrected with a prosthesis, or when infection risk is elevated.

Total Ankle Replacement (Arthroplasty)

Total ankle replacement resurfaces the arthritic joint with metal and polyethylene components, preserving ankle motion. Modern third-generation prostheses (INBONE, STAR, Infinity, Vantage, Cadence) have significantly improved long-term results compared to early implant designs. The key advantage of ankle replacement is preservation of ankle motion — patients typically regain 60–70% of normal ankle range of motion — which feels more natural during gait and reduces stress transfer to adjacent joints. Ten-year implant survival is approximately 80–90% with modern implants in appropriately selected patients. Revision surgery (converting a failed replacement to fusion or replacing the prosthesis) is technically demanding but feasible. Ankle replacement is generally preferred for active patients between ages 55–70 with good bone quality, minimal deformity, and adequate body weight. Obesity, significant coronal deformity, osteonecrosis of the talus, and prior deep infection are relative contraindications.

How to Choose

The decision between ankle fusion and replacement depends on multiple factors evaluated together. Younger patients (<55) typically benefit from fusion because the long-term durability of current implants through a 30–40 year lifespan is uncertain, and the consequences of revision at 70 are better than revision at 50. Patients 55–70 with good bone quality and moderate activity levels are good candidates for replacement. Patients over 70 with lower activity demands often do equally well with either procedure. Pre-existing subtalar arthritis may influence the decision — if the subtalar joint is also arthritic, fusion of both simultaneously may be more appropriate than replacement. Dr. Biernacki conducts a comprehensive evaluation including weight-bearing CT, vascular assessment, and activity discussion to provide individualized recommendations.

Frequently Asked Questions

If ankle arthritis is limiting your life, there are effective surgical solutions. Contact Balance Foot & Ankle to schedule a consultation with Dr. Biernacki and discuss which approach is right for you.

Considering Ankle Replacement or Fusion?

Our fellowship-trained surgeons specialize in both total ankle replacement and ankle fusion procedures. Get a personalized recommendation based on your condition.

Explore Our Ankle Surgery Options | Book Your Appointment | Call (810) 206-1402

Clinical References

1. Haddad SL, et al. Intermediate and long-term outcomes of total ankle arthroplasty and ankle arthrodesis. J Bone Joint Surg Am. 2007;89(9):1899-1905.
2. Daniels TR, et al. Total ankle replacement versus ankle arthrodesis: a comparison of outcomes. J Bone Joint Surg Am. 2014;96(19):e161.
3. Lawton CD, et al. Total ankle arthroplasty versus ankle arthrodesis — a comparison of outcomes. Foot Ankle Int. 2017;38(10):1069-1075.

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Dr. Tom Biernacki, DPM

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Dr. Tom Biernacki, DPM

Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.