Ankle arthroplasty for post-traumatic tibiotalar arthritis remains controversial. The current literature strongly recommends arthrodesis, especially in those patients who will overload the joint: the young, the active and the overweight patients. The case described here is a 40-year follow up. A 31-year old man underwent talar dome resurfacing with a custom Vitallium implant for post-traumatic arthritis in 1962. He continued to work as a heavy laborer until retirement in 1987 and presently remains virtually asymptomatic with regard to his foot and ankle. The longevity of this individual implant has been remarkable. The unique design, minimal resection, surgical approach and remarkable success merit discussion in the light of publication of predominantly bleak reports of arthroplasty in this patient population.