Summary The long-term results and the experience of 3-component total ankle replacement gained a new dimension in the concept to treat late stage rheumatoid and osteoarthritis of the talocrural joint. In general, the publications of the first and second generation of total ankle arthroplasties are well known. Thus, the more recent publications of the good long-term results and the shown survival rates of the new generation demonstrate an improved option to restore ankle function. Full weightbearing after woundhealing and relief of pain is achieved. In comparison to the standard operation with fusion of the talocrural joint, the arthroplasties present an advantage. The mobility of the ankle joint reduces the risk of progressive stress and osteoarthritis at the adjacent subtalar joints. The non-weightbearing period which is not tolerable in older patients and in patients suffering from multiple joint diseases is reduced. Revisional surgery due to non-unions and pseudarthrosis is reduced. Minimal resection for total ankle replacements offer the second line of defense on secondary ankle-arthrodesis. The replacement of the ankle joint is not yet a routine procedure in comparison to total knee or total hip replacements. Therefore, implantations of the total ankle arthroplasties have to be observed prospectively and carefully to avoid unattainable expectations and inadequate estimations. In a prospective study, we were able to control 76 out of 78 patients after total ankle arthroplasties (STAR) This represents a rate of 93.97% of the implanted arthroplasties with a follow-up time of 3.6 years on average (min. 6 to max. 60 months). The mean age at the time of surgery was 57.7 years (24 to 82 yrs). The overall range of motion was increased from 21.5° to 38.3° on average. Preoperatively the patients had a mean rate of 31.2 points using the Kofoed ankle score (max. 100 points) which was improved to a mean score of 91.6 points. The results after 78 TAA within the last 5 years show good functional restoration and have high degree of acceptance.