Objective: Arthrodesis as well as total ankle arthroplasty has been recently reported as an effective therapy for end-stage ankle arthritis. In this paper, we expand both surgical technique and retrospectively review our experience with evaluation of clinical effect of arthrodesis and total replacement for end-stage ankle arthritis.Methods: 14 patients after arthrodesis (A group) and 16 patients after total ankle arthroplasty (B group) for endstage osteoarthritis of the ankle joint were followed clinically and radiologically 5 years (range: 2.1-8.6) after surgery. To evaluate the outcome, a clinical scoring system (AOFAS, Kellgren and Lawrence) and by gait analysis (Vicon 612 System) were used. Results:The pre-and post-operative mean AOFAS score was 38.5 ± 2.3 and 74.3 ± 2.1 points in A group. The mean score was 38.1 ± 2.4 and 80.3 ± 2.2 points in B group, with statistical significance. Spatio-temporal parameters obtained with gait analysis showed a progressive recovery to normality. In A group, mean stride length normalized (%high) was 60.5 pre-op and exactly 70.5 both at 6 and 12 months; speed rose from 80.4 cm/s to 96.8 cm/s at 6 months and 99.1 cm/s at 12 months, In B group, mean stride length normalized (%high) was 62.6 pre-op and exactly 74.3 both at 6 and 12 months; speed rose from 81.5 cm/s to 97.9 cm/s at 6 months and 100 cm/s at 12 months. Both with statistical significance six patients in B group and three patients in A group showed radiological evidence of degeneration of the talonavicular joint and the subtalar joint. We noted only one case with degeneration of the calcaneocuboid joint in B group. Conclusion:Our study revealed arthrodesis as well as total ankle arthroplasty have been recently reported as an effective surgical technique for end-stage ankle arthritis.