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Total ankle replacement is increasingly recommended for patients with end-stage ankle osteoarthritis. We analyzed the survivorship of 722 arthroplasties performed with one type of three-component total ankle prosthesis.Seven hundred and seventy-nine primary total ankle arthroplasties (741 patients) were performed between May 2000 and July 2010 with use of the HINTEGRA three-component prosthesis. A logistic multiple regression model was used to identify independent risk factors for prosthesis failure in 684 patients (722 ankles). The mean time to final follow-up (and standard deviation) was 6.3 ± 2.9 years.Seven hundred and twenty-two ankles (684 patients) were available for survivorship analysis at the latest follow-up. The overall survival rates were 94% and 84% after five and ten years, respectively. Sixty-one ankles had a revision arthroplasty (twenty-seven both components, thirteen the tibial component only, and fourteen the talar component only) or were converted to a fusion (seven ankles).There were no polyethylene failures. There were no amputations. The generation category of the prosthesis, the cause of ankle osteoarthritis, and the age of the patient were identified as independent risk factors for prosthesis failure.The midterm survivorship of the HINTEGRA implant was comparable with that of other third-generation total ankle replacements.Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.