Severe ankle arthritis can present with severe pain, functional limitations and limb deformities, and the physical and psychological damage caused by severe ankle arthritis is as severe as that of end-stage hip arthritis. The causes of ankle arthritis include fracture trauma, chronic ankle instability, rheumatoid and hemophilia. With the aging of society and the increase of sports injuries, the incidence of severe ankle arthritis is increasing, causing great pain to patients’ life and work, and even loss of work capacity. In the past, the treatment of severe ankle arthritis mainly relied on ankle fusion surgery, but the loss of ankle joint movement after fusion caused accelerated degeneration of the surrounding joints, which not only restricted daily life such as squatting and climbing, but also caused new pain and other conditions due to secondary injury of the surrounding joints, and these phenomena were especially obvious in patients with rheumatoid and other ankle arthritis. Total ankle arthroplasty can remove the inflammation of the ankle joint and relieve the pain while preserving the mobility of the ankle joint, helping the patient to retain the maximum function of the ankle and foot and greatly improving the quality of life, which is an advanced surgical procedure commonly used in developed countries today to treat severe ankle arthritis. During the surgery, the inflammatory tissues and bony debris of the medial and lateral ankle joints are cleared, the affected foot is placed in a special custom-made brace, and the position of the ankle and guide pins are repeatedly adjusted under fluoroscopy for the highest precision. Under the positioning of the osteotomy guide, the tibia and talus of the ankle were osteotomized, the size of the prosthesis was trialed, and a matching ankle prosthesis and spacer were inserted to complete the total ankle prosthesis replacement. The total ankle prosthesis was precisely positioned, the design of the prosthesis was stable and firm, and the soft tissues of the medial and lateral ankle joints were balanced, achieving the expected results. The patient was able to walk on the ground after about four weeks of recuperation, removing the painful deformity of ankle arthritis while preserving the mobility of the ankle joint, providing great convenience for life and work. The success of the first INBONE total ankle prosthesis replacement surgery in China marks a new level of treatment for end-stage ankle arthritis in China, which will bring good news to millions of patients suffering from ankle arthritis.