Severe destruction of the cartilage and bone of the ankle joint results in pain, stiffness, and decreased mobility of the patient’s ankle joint. So-called end-stage ankle lesions can only be treated with joint replacement or joint fusion surgery. Ankle fusion surgery immobilizes the joint and relieves the joint pain by the loss of ankle movement, which is effective. However, when the ankle joint is immobile, the adjacent joints are subjected to greater stress, leading to degeneration of the joint, which is particularly detrimental to younger patients. Ankle joint replacement is a treatment method that replaces the original diseased joint surface with an artificial joint surface to achieve pain-free and preserved mobility, and it has significant advantages in preserving ankle mobility. The prosthesis has evolved to the third generation and with the continuous improvement of the prosthesis and the advancement of the surgeon’s surgical technique, ankle replacement has become a good option for the treatment of severe ankle lesions. It is still important to ask the specialist to analyze which surgery is suitable for the patient before deciding on a plan.