18 patients representing 20 uncemented hydroxy-apatite-coated total ankle arthroplasties (2 bilateral cases) were reviewed for 1-4 years. The diagnoses were primary arthrosis in 4 ankles, secondary arthrosis (following malleolar fractures) in 14 ankles, and haemochromatosis in 2 ankles. The patients were assessed preoperatively and at every follow-up, according to an ankle score system, giving 100 points for a normal ankle (50 points for no pain, 30 points for normal everyday life function and 20 points for normal mobility). Image intensification was used to assess loosening or subsidence of the prosthetic components and of the subtalar joint radiologically. The mean preoperative ankle score was 27.5 +/- 11.5 SE. At the latest follow-up the ankle score was 91.8 +/- 10.2 SE (P < 0.001) corresponding to 17 excellent, 1 good and 2 unacceptable clinical results. All tibial components showed firm radiological fixation without signs of loosening and with typical irradiating bony sclerosis adjacent to the component. The talar component cannot be assessed easily radiographically and subsidence was measured. In 1 patient both the tibial and the talar components showed axial settlement within the first month but not later. No infections occurred. No patient died during follow-up. There was 1 case of injury to the posterior tibial nerve. The clinical and radiological results at the first year follow-up remain satisfactory and have not changed for the worse in any of the cases.