Arthroplasty has become increasingly popular as a solution for end-stage ankle arthrosis. Good results, with a 90% survival rate at ten years, have been reported with use of recent prostheses. However, the role of ankle arthroplasty needs to be more clearly defined. Due to its particular nature and specific biomechanical aspects, the ankle joint presents a real challenge for arthroplasty. Patient selection and surgical technique need to be optimized to improve long-term results. Careful clinical and biomechanical studies need to be conducted to objectively determine the long term benefit in terms of quality of life. To better address these points the authors of this manuscript have coordinated their expertise in a collaborative approach, so as to optimize surgical indications, prosthesis implantation, postoperative rehabilitation and research.