Total ankle arthroplasty is a surgical treatment option for end- stage ankle arthritis that aims to reduce pain while preserving joint mobility. Although ankle arthrodesis has traditionally been considered effective for pain control, it results in loss of joint motion and may lead to degenerative changes in adjacent joints. Ankle prostheses have evolved from first- to fourth- generation designs since the 1970s. First-generation implants, which were cemented and highly constrained, were abandoned due to high rates of loosening and failure. With the development of second-generation prostheses, cementless fixation, bone- preserving surgical techniques, and both fixed- and mobile- bearing systems were introduced. Third- and fourth-generation modern implants have demonstrated significant advancements in terms of anatomical conformity, biological integration, and surgical precision. Furthermore, patient-specific implants, artificial intelligence–assisted surgical planning, and advanced biomaterials are expected to further enhance the clinical success of total ankle arthroplasty in the future.