Ask a doctor what you should do about a hip or knee that’s been ground down by arthritis, and he’s likely to suggest joint replacement surgery. But when the joint in question is an ankle, the answers aren’t as clear-cut.

The longtime gold-standard surgery for treating bone-on-bone ankle pain has been ankle fusion, or arthrodesis.

But within the last decade, medical device companies have introduced a new generation of artificial ankles that are designed to better mimic the natural movements of this complex joint, making replacement an increasingly popular choice.

Industry estimates predict some 4,400 people in the U.S. will have ankle replacement surgery this year.

In March 2010, in fact, the American College of Foot and Ankle Surgeons gave these newer devices a vote of confidence, saying the safety profile of ankle replacements has become comparable to that of ankle fusion.

But early studies suggest that ankle replacements may wear out relatively quickly, leading to more complicated and perhaps riskier second surgeries within just a few years.

How do you know which option is best? Here’s how two patients weighed the pros and cons.

The Fusion Fix

Daniel Ward’s troubles began when he shattered his left ankle during a high-school football game. The injury never healed properly, and some four decades later, Daniel, a 52-year-old electrician in Alvarado, Texas, says the pain was so bad that he had to take frequent rest breaks just to cross the parking lot at the General Motors plant where he works.

Daniel is considering total ankle replacement, but because he is still relatively young he was wary of getting a replacement joint that would wear out quickly, leading to the need for more surgery.

Because Daniel is a bit bow-legged, his doctor, James Brodsky, MD, an orthopaedic surgeon in Dallas, advised against ankle replacement.

In fusions, surgeons use pins, screws, plates and bone grafts to permanently joint the tibia, or shinbone, to the talus bone in the ankle. The procedure eliminates pain by stopping bone-on-bone grinding at the expense of some mobility. But it doesn’t cause the Frankenstein lurch that some people fear.

“People can have fantastical functional results from fusions,” Dr. Brodsky says. “While it sounds terrible, it just stiffens the one bad joint – which is probably very stiff already – while leaving the surrounding joints flexible. The majority of people with fusions do not limp.”

Other activities are limited. Daniel says going up and down stairs, for example, requires him to step sideways.

The major advantage of an ankle fusion is that it should last a lifetime. But fusions also change the mechanics of the foot, increasing the likelihood that arthritis will strike some of the 30-plus adjacent joints.

For now, Daniel says his only regret is that he didn’t have surgery sooner: “It is not worth suffering and putting it off,” he says. Find a good doctor, get it done and get on with your life.”