The main surgical treatments for end-stage ankle arthritis are ankle arthrodesis or total ankle replacement (TAR). Approximately 3,000 patients with ankle arthritis undergo ankle arthrodesis or TAR in the NHS each year. Both treatments are available on the NHS, and both have been reported to have good results. Some studies suggest that TAR restores a more natural walking pattern than ankle fusion but other studies have suggested that the need for further surgery is higher with TAR than with fusion. Information on all TARs implanted in the NHS has been captured on the National Joint Registry since 2010, but no similar national registry exists for ankle fusion. There has never been a published randomized trial directly comparing the two procedures.