Total ankle arthroplasty with second-generation prostheses is gaining popularity. Complications do and will occur with this group of replacements, just as they do with all other arthroplasties, whether at the knee, hip, elbow, shoulder, or wrist. Even if the complications are understood and the preventative measures or solutions are well thought out, there is occasionally no clear-cut answer to the problem. Although there are many obstacles to a successful outcome, most of the complications reported here are preventable with good patient selection and technique or at least treatable once they occur.