This Current Concept Review is presented by the American Academy of Orthopaedic Surgeons (AAOS) Ankle Arthritis Work Group. Its purpose is to review the evidence on the surgical procedures available to treat ankle arthritis while preserving the joint. This will include open and arthroscopic debridement, realignment osteotomies of the distal tibia and foot, distraction arthroplasty, interposition arthroplasty and allograft arthroplasty. This report is based on a recent systematic review of the published English language literature performed by members of the AAOS Ankle Arthritis Clinical Guideline Work Group. The work group is comprised of AAOS research staff and volunteer physicians.