Total ankle replacement was developed in the 1970s after the success of total hip and knee arthroplasty. The goal of total ankle arthroplasty is to decrease pain and improve function in the lower limb. Ideally, to be superior to an arthrodesis, the ankle replacement should provide the patient with good patterns of joint motion and the ability to walk and run and should have low complication rates. Unfortunately, total ankle arthroplasty has not been as successful as replacement of other joints. Published studies of early series with greater follow-up show that ankle arthroplasties did not provide lasting pain relief or improve function, and most ultimately failed. During the 1980s, many authors concluded that a total ankle arthroplasty was not warranted because of the generally poor long-term results and the high rate of complications. However, newer second-generation design techniques, innovative operative procedures, and dissatisfaction with the results of ankle arthrodesis have renewed interest in total ankle arthroplasties. This review describes the numerous types of ankle joint replacements, critically reviews the results, and reports on newer prostheses that incorporate more anatomic designs.