A high rate of complications and failure have limited the indications for total ankle replacement to older patients with rheumatoid arthritis, especially those with multiple joint involvement and limited physical activity. Recommended surgical technique for total ankle arthroplasty includes proper patient positioning, an anterior surgical approach, meticulous bone resection, and cemented fixation of components. Results of published studies suggest total ankle arthroplasty should not be performed in patients with posttraumatic arthritis who are younger than 60 years of age.