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Gout is the most common cause of inflammatory arthritis in men and older women. The purpose of this review was to assess prosthetic component stability, postoperative pain relief, functional outcome, and quality of life of patients with gouty ankle arthritis who were treated with total ankle replacement.Sixteen patients (nineteen ankles) with chronic gout and a mean age (and standard deviation) of 65.2 ± 5.5 years were treated with a non-constrained three-component total ankle arthroplasty because of painful ankle arthritis. The average duration of follow-up was 5.1 ± 2.5 years. Component stability was assessed with use of weight-bearing radiographs. Clinical outcomes were analyzed with use of a visual analogue scale (VAS) for pain, a 36-item short-form health survey (SF-36), and the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score.There were no intraoperative complications. In one patient, both arthroplasties were revised 4.7 years postoperatively because of painful prosthetic loosening. The average VAS score for pain decreased significantly from 7.5 ± 1.8 (range, 5 to 10) to 1.2 ± 1.3 (range, 0 to 3) (p < 0.001). All eight categories of the SF-36 score showed significant improvement (all p < 0.001). The average AOFAS hindfoot score increased significantly from 38 ± 15 (range, 15 to 77) preoperatively to 75 ± 13 (range, 54 to 92) postoperatively (p < 0.001).Total ankle replacement in patients with painful gouty ankle arthritis is associated with a low risk of intraoperative and postoperative complications and leads to significant pain relief, high patient satisfaction, and good functional results.Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.