The blood supply to the talus is vulnerable to damage, making the talus susceptible to osteonecrosis, with limited treatment options. » Talar bone replacement has been investigated as a treatment option to preserve ankle function and maintain limb length. » Successful talar bone replacements have been performed for the past .35 years, with variations in design, methods of fixation, materials, and manufacturing techniques.» The designs of talar prostheses range from custom-made partial (talar body) or total prostheses to prefabricated universal (non-custommade) prostheses.» Total talar prostheses have been demonstrated to function better than partial talar prostheses; however, there is a need for long-term studies regarding custom-made total talar prostheses and prefabricated universal talar prostheses in order to determine their long-term effectiveness.Disclosure: A.S.D. was supported by a summer studentship provided by Alberta Innovates Health Solutions. The funding source did not place a role in this investigation. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/ JBJSREV/A701).