Surgical options for end-stage ankle arthritis include below-knee amputation, ankle arthrodesis, and total ankle arthroplasty. Although total ankle arthroplasty possesses the theoretical advantages of preserving a mobile joint, better limb function, and less adjacent joint degeneration, its use was abandoned in Taiwan due to poor outcome of the ”first-generation” designs. Based on recent favorable reports of the ”second-generation” prostheses for certain patient populations, a 78-year-old female patients with rheumatoid arthritis and destructed ankle joint was elected to receive the newly introduced total ankle arthroplasty, and achieved successful short-term result. The clinical course and pictures were presented, and recent medical evidences of total ankle arthroplasty were discussed.