The Agility Total Ankle System can be used in most arthritic conditions that involve the ankle joint, including many angular deformities that result from trauma or degenerative wear. The surgeon must be prepared to realign the ankle and to achieve soft-tissue balancing at the time of the surgery to avoid late failures. Proper patient selection is very important, and certain conditions, including diabetes with peripheral neuropathy, poor skin quality or poor circulation, and deficient bone stock, must be avoided to achieve a successful outcome. The surgical procedure must be done in a precise manner, with selection of the proper size of prosthesis and accurate insertion of the components in all directions. Proper tensioning of the joint is also paramount to achieve long-term stability. The precise degree of tensioning is still somewhat controversial, although with experience the deltoid end point can be readily determined in most patients. The follow-up care of these patients is very important, not only from the standpoint of compliance but also because any long-term problems must be recognized and treated before the implant is lost.