The Mobility Total Ankle System (DePuy) is a three-component, mobile-bearing ankle replacement device composed of an articulating, ultra-high-molecular-weight polyethylene bearing inserted between separate cobalt chrome tibial and talar components. At the time of this publication, the Mobility ankle device is not approved for use in the United States. In this article, we describe our surgical technique for implantation of the Mobility ankle, including the incision made for insertion of the prosthesis and exposure of the ankle joint, planning of bone cuts for implantation of the device, techniques for enhancing foot-ankle alignment and balance, and approaches to correcting deformities of the ankle, hindfoot, or midfoot. Clinical considerations, indications, and contraindications for total ankle replacement are also discussed.