The new trend for the treatment of end-stage ankle athrosis is the ankle arthroplasty. Ankle arthroplasty addresses the functional daily activity pain. This never means for the patient to return back to heavy work and intensive sportive activities. The surgeon should very carefully and thoroughly answer the interests of the candidate before ankle arthroplasty surgery. Today, experienced surgeons, performing the third generation ankle prosthesis report satisfactory results of about 100% and 90%, five year and 10 year follow-ups, respectively. Nevertheless it is difficult to say that total ankle replacement is preferable to arthrodesis. It is possible that each implant design will have different short-, medium-, and long-term function and survivorship. Although total ankle replacement today may be a powerful tool in the treatment of end stage ankle arthrosis, many factors must be considered before the treatment.