Both total ankle replacement (TAR) and ankle arthrodesis do show some problems in long-term studies. To choose either of these surgical options is a delicate task. There are no randomized studies reported in the literature and no previous studies in which patients constitute the own controls.Patients with a TAR and a contralateral ankle arthrodesis were identified in the Swedish Ankle Register. A self-reported foot and ankle specific questionnaire (SEFAS) was sent to these patients who also were asked to report their grade of satisfaction from 1 to 5.The median SEFAS score was 32 (16–44) for the prostheses and 27 (14–47) for the arthrodeses. The median satisfaction score was 2 (1–4) for the prostheses and 2 (1–5) for the arthrodeses. There were no statistically significant difference between the prosthetic side and the fused side regarding these scores.Patients who had undergone ankle arthrodesis on one side and had the contralateral ankle replaced, were equally satisfied with both procedures.