Background: Rheumatoid arthritis (RA) frequently affects the ankle joint, resulting in pain, swelling, and functional impairment. Total Ankle Arthroplasty (TAA) is a viable treatment option for end-stage arthritis. Arthroscopic synovectomy, a minimally invasive procedure aimed at reducing synovial inflammation, may potentially enhance the outcomes of TAA. This study aims to evaluate the short-term and long-term functional outcomes of arthroscopic synovectomy performed before TAA in patients with rheumatoid arthritis. Materials and Methods: A total of 120 rheumatoid arthritis patients (aged 35–75 years; 70 females, 50 males) with advanced ankle arthritis were enrolled in a randomized controlled trial. Patients were divided into two groups: Group A (n=60) underwent arthroscopic synovectomy followed by TAA after 6 weeks, and Group B (n=60) underwent direct TAA without prior synovectomy. Functional outcomes were assessed using the American Orthopedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Score and Visual Analog Scale (VAS) for pain at baseline, 6 months, 1 year, and 2 years postoperatively. Radiological assessment and complication rates were also recorded. Results: Group A demonstrated significant improvement in AOFAS scores from a preoperative mean of 45.3 ± 6.7 to 85.2 ± 7.1 at 6 months, 87.5 ± 6.4 at 1 year, and 85.9 ± 6.9 at 2 years. In contrast, Group B showed improvement from 46.1 ± 6.9 to 78.4 ± 7.5 at 6 months, 81.2 ± 7.0 at 1 year, and 78.8 ± 7.3 at 2 years. VAS scores decreased significantly in Group A from 7.4 ± 1.2 to 2.6 ± 0.9 at 2 years, whereas Group B demonstrated a reduction from 7.3 ± 1.1 to 3.4 ± 1.0. Radiological evaluation revealed better implant alignment and reduced periprosthetic inflammation in Group A. The incidence of complications was lower in Group A (10%) compared to Group B (18%). Conclusion: Arthroscopic synovectomy prior to TAA provides better short-term and long-term functional outcomes in rheumatoid arthritis patients, with enhanced pain relief, improved functional scores, and reduced complications. This pre-TAA intervention may be a valuable approach to optimizing surgical outcomes in this patient population.