The indications for total ankle replacement are limited to older patients with rheumatoid arthritis, especially those with multiple joint involvement and limited physical activity. The recommended surgical technique for total ankle arthroplasty includes an anterior surgical approach, minimal bone resection, and meticulous technique for cemented fixation of components. The results of published studies suggest total ankle arthroplasty should not be performed in patients who have had previous surgery on the ankle or foot, or who are younger than 57 years of age.