Patients with nonunited or malpositioned ankle arthrodesis often present a challenge for the orthopedic surgeon. As most patients with ankle fusion develop degenerative changes in adjacent joints, rearthrodesis of the ankle may not be the optimal treatment to achieve pain relief and functional recovery. Takedown of joint fusion and conversion to total joint replacement has been shown to be efficient and have favorable results in patients with previously fused or ankylosed hip or knee joints. We use this surgical technique in patients with painful ankle arthrodesis. Taking down an ankle arthrodesis and performing a total ankle replacement is technically demanding and should be limited to an experienced foot and ankle surgeon. If performed by an experienced foot and ankle surgeon, this procedure shows promising results and low intraoperative or postoperative complications.