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Background Recent advances in the design of the artificial ankle and changes in the way the operation is performed have made artificial ankle replacement a growing alternative to ankle fusion for the treatment of ankle arthritis.Objective The purpose of the current study was to evaluate results and present problems of total ankle replacement in patients with secondary ankle arthritis.Methods The study was designed to review 28 patients with ankle arthritis who had a total ankle replacement(DePuys Agility Total Ankle System) between 1999 and 2010 in Chinese.Patients were evaluated with an interview focusing on pain and activities of daily living,and clinical and radiologic examination.Results Mean follow-up was 5.4 years (range: 2-9 years).16 of the 28 cases (89%) reported a favorable outcome.Average AOFAS score was 41.5 pre-operative and improved to 74.6 at follow-up.VAS score improved to 2.3 from 8.4.No ankle converted to an arthrodesis or another Agility ankle implant.Radiographically,89%(16/18) of implants were stable without evidence of settling,migration of talar component of the prosthesis was noted in one patient.Conclusions Ankle replacements appear to offer a good alternative to ankle fusion for most arthritic conditions.Although intermediate results are promising,TAR is relatively new and does not have the information on long-term outcome.Further study involving randomized controlled clinical trials are necessary.