Aim: A medium term review of total ankle replacements with a view to reviewing follow up protocols, reassessing the usefulness of the SF12 Health Survey questionnaire, and to determine factors that may indicate early failure.

Method: Sixty-five ankle replacements in 58 patients with an average age at operation of 65 (44–80) (32 males: 23 females, 3 died) were reviewed after a mean of 41 months (8–97 months). They were assessed via postal questionnaire and a research clinic with regard to their pain, difficulty and SF 12 scores, their outcome perception and range of movement. Additionally, we looked retrospectively at their notes and latest X-rays.

Results: Indications for operation were OA (79.5%), RA (18.2%) and psoriatic arthropathy (2.3%). Patients’ perceptions of their outcomes were 41(78.8%) good, 5(9.6%) moderate and 6(11.5%) poor. The average “mean pain score” was 3.6 and average “mean difficulty score “ was 4.0. There was no significant change between the pre and post-operative mean SF 12 scores. Save for 2 anomalies, poor outcomes and SF12 scores were only seen in post-traumatic OA(100%) and RA patients. Prostheses used were Beuchel-Pappas, OSG and DePuy Mobility. There are no revisions to date. The average range of movement was 26°. X-rays generally showed good prosthesis alignment, minimal insert wear, occasional non-enlarging, small (1–2mm) cysts around the tibial component.

Conclusions: The SF 12 scores seem to be unresponsive. The pain and difficulty scores more reflect the patients’ perception of outcome. With the low incidence of revision, risk factors for early failure are difficult to establish but patients with radiological cysts, talar collapse or more severe deformities of the foot/ankle might be the ones who need regular review.