Key takeaways:
- In a survey of US centers, the average bundled quote for an ankle replacement was higher than for a fusion, but the difference was not statistically significant, and quotes for both varied enormously.
- Since 2024, Medicare has covered total ankle replacement in surgery centers, where it pays less than in a hospital.
- A fusion is usually cheaper up front. The long-term picture depends on which large study you read, and they disagree on which needs more repeat surgery.
- If you run a foot and ankle practice, I also cover what these numbers mean for the patients trying to get a price out of you.
When I reviewed the pages that rank for this comparison, most covered only one of the two operations, and none put US prices, Medicare rates and revision data for both on the same page. This one does.
Ankle replacement vs fusion cost at a glance
A 2019 study had researchers call 50 US centers asking for a bundled price, as a patient would. Only 21 of them, 42%, could give one. Among those that did, the mean quote was $50,332 for an ankle replacement and $41,756 for a fusion, a difference that was not statistically significant. Private centers quoted less than academic ones for both: $37,937 against $56,529 for replacement, and $29,037 against $48,116 for fusion. (JAAOS Global Research and Reviews, 2019)
| Total ankle replacement | Ankle fusion | |
|---|---|---|
| Procedure code | CPT 27702 | CPT 27870 (open fusion) |
| Mean bundled quote, 2019 survey | $50,332 | $41,756 |
| Private centers | $37,937 | $29,037 |
| Academic centers | $56,529 | $48,116 |
| Medicare average cost, 2005 to 2014 | $12,559 | $6,963 |
The Medicare figures come from a national analysis of more than 28,000 Medicare patients treated between 2005 and 2014. (Foot & Ankle Specialist, 2020)
The single biggest lesson in that survey is not the average. It is that more than half of centers could not tell a patient what the surgery would cost.
What insurers and Medicare pay
For 2024, Medicare’s rate for total ankle replacement was $17,775 in a hospital outpatient department and $14,467 in an ambulatory surgery center, the first year the procedure was allowed in surgery centers, according to Zimmer Biomet’s summary of the 2024 final rules. (Zimmer Biomet 2024 OPPS reimbursement update)
For you as a patient, that matters in two ways. A surgery center is usually cheaper than a hospital, and your share of the bill depends on your deductible and coinsurance more than on which of the two operations you have.
Long-term cost: revisions and repeat surgery
Up front, fusion is generally the cheaper operation. Over decades, the question is which one sends you back to the operating room.
Two large datasets point in different directions:
- England, 25 years, 41,039 patients. Fusion had a much lower revision rate than replacement: 2% against 6.1% at five years, 2.5% against 10.2% at ten years and 3.1% against 13.55% at twenty years. The risk of later needing a neighbouring joint fused was not significantly different. (Foot & Ankle International, 2025)
- US Medicare, 2005 to 2014. In this population, replacement showed lower revision and complication rates than fusion, while costing more. (Foot & Ankle Specialist, 2020)
The two studies cover different countries, years, patients and implants. The honest answer is that the long-term cost depends heavily on the patient and the surgeon, so ask your surgeon for their own numbers.
What the studies say about value
A US cost-effectiveness model for a 60-year-old patient found ankle replacement cost $20,200 more than fusion but delivered 1.7 more quality-adjusted life years, about $11,800 per year of good-quality life gained, which is well within what health systems usually treat as good value. (Clinical Orthopaedics and Related Research, 2011)
The UK’s TARVA trial randomized 303 patients aged 50 to 85. At one year, walking and standing scores were not significantly different between the two groups. Wound healing problems were more common after replacement (13.4% against 5.7%). The researchers estimated a 69% likelihood that replacement is cost-effective over a patient’s lifetime. (Health Technology Assessment, 2023)
Recovery and what patients value
Fusion locks the ankle joint, so the ankle no longer bends. Replacement keeps motion. In a survey of 1,410 people choosing between the two, 72% preferred replacement, ankle range of motion mattered most to them, and the chance of more surgery mattered least. There was no difference in what they were willing to pay. (Journal of the American Academy of Orthopaedic Surgeons, 2025)
Questions to ask before you choose
- Am I a candidate for both? Bone quality, deformity, weight and activity level all matter.
- Can you give me a bundled price? If the answer is no, ask what each part will cost.
- Can this be done at a surgery center?
- How many of each operation do you do, and what are your revision rates?
- What does recovery look like for me, in weeks and in work days lost?
Foot problems rarely come alone. My pages on bunion surgery cost and plantar fasciitis treatment cost cover two of the most common, and knee replacement cost covers the joint patients most often compare against.
What this means if you run a foot and ankle practice
A few facts, side by side.
Medicare use of total ankle replacement grew 502% between 2007 and 2022, while the inflation-adjusted surgeon fee for it fell 37% between 2007 and 2025. (Journal of Foot and Ankle Surgery, 2025)
When researchers phoned 50 US centers as patients, only 42% could give a bundled price for the two operations.
When 1,410 consumers were asked, 72% preferred replacement, and they were willing to pay the same for either.
Since 2024, the case can be done in a surgery center.
What those mean together for your practice is for you to work out. The patients choosing an ankle surgeon are reading before they call, and few practices are answering the price question they are asking.
If you want to see how your foot and ankle pages answer that question today, book a 20-minute call. I will look at your site and your market before we talk. You can also read what a page like this is worth to an orthopedic practice.
Frequently asked questions
Is ankle replacement more expensive than ankle fusion? Usually somewhat, but not always significantly. In a survey of US centers, the mean bundled quote was $50,332 for replacement and $41,756 for fusion, with a difference that was not statistically significant.
Does Medicare cover ankle replacement at a surgery center? Yes. Medicare added total ankle replacement to the surgery center list for 2024, when it paid $14,467 in a surgery center against $17,775 in a hospital outpatient department.
Which needs more repeat surgery, replacement or fusion? Studies disagree. A 25-year English registry found more revisions after replacement, while a US Medicare analysis found fewer.
Is ankle replacement worth the higher upfront cost? A US model found it cost-effective at about $11,800 per quality-adjusted life year, and a UK trial estimated a 69% chance it is cost-effective over a lifetime.
Why do cash quotes vary so much? Academic centers quoted much higher than private ones in one survey, and fewer than half of centers could quote a bundled price at all.
