In case of increasing pain and failure of conservative treatment, surgery might be the only option to get rid of the pain. Once there is progressive degeneration of the joint an arthroscopic debridement will not give good pain relief but can aggravate the symptoms. Most of the times one has to consider either fusing the joint or replacing the ankle joint.
Fusing the ankle joint means resecting the worn out joint surfaces, mending the bones together and holding them with metalwork. A fusion of the joint (also called arthrodesis) tends to remove the pain and is a very good operation to allow patients to walk again without a limp.
Some surgeons also have experience with ankle joint replacement which is a good alternative for some patients, especially those who still have a good range of movement of the ankle joint. In this case, the worn out joint surfaces are replaced with implants that heal into the bone, like a knee replacement. This allows to preserve the range of movement and reduces the stress on other joints in the foot. Biomechanically this seems to be the better option but a decision on which operation will be the favourable one depends on many factors which will be discussed with the patient to find the optimal solution.