Fifty-six patients with united ankle fractures requiring implant removal were randomized to receive WALANT (n=28) or general anesthesia (n=28). The primary outcome was pain (11-point VAS) measured repeatedly postoperatively. Secondary outcomes included anxiety (VAS), patient satisfaction, blood loss, operating-room and skin-to-skin times, recovery-room time, and adverse events; wounds were followed to 8 weeks and complications to 1 year. Overall, the results showed lower pain at 2 and 6 hours with WALANT, lower postoperative anxiety, markedly shorter recovery-room stays, and less nausea, with no differences in operative efficiency metrics or blood loss. These findings suggest WALANT is a safe, effective alternative to general anesthesia for ankle hardware removal, improving early recovery without compromising surgical conduct.