A new type of total ankle arthroplasty developed with the use of a CAD-CAM computer was used in a series of 27 ankles between 1985 and 1989. Follow-up in 19 ankles ranging from 18 months to 5.5 years postoperatively indicates that the design of this implant appears to avoid the problems of subsidence and malleolar impingement. Based upon the results in this series, it appears that the best candidates for use of this type of total ankle implant are patients with rheumatoid arthritis.