J Am Acad Orthop Surg, Vol 16, No 5, May 2008, 249-259. Loretta B. Chou, Michael T. Coughlin, Sigvard Hansen, Jr, Andrew Haskell, Gregg Lundeen, Charles L. Saltzman, and Roger A. Mann. This Symposium was presented at the AAOS 73rd Annual Meeting, Chicago, IL, March 22-26, 2006. Total ankle arthroplasty was developed to reduce pain and retain motion of the ankle joint in patients with osteoarthritis. The ankle joint has unique, complex anatomic and biomechanical characteristics that must be considered in a successful total ankle arthroplasty prosthesis. Initial designs from the 1960s to the 1970s had many failures. Current designs use two or three components, and recent reports on total ankle arthroplasty show consistent good to excellent intermediate clinical results, with up to 90% decreased pain and high patient satisfaction. The follow-up time of these studies is limited, however, and long-term studies with 10- to 15-year follow-ups are needed. Also, a wide variety of complications has been reported, including osteomyelitis and osteolysis. To limit the number of complications and improve clinical outcome of total ankle arthroplasty, careful patient selection and surgeon experience are important.