Treatment of ankle varus with total ankle replacement (TAR) lacks consensus regarding the limits of deformity that can be managed successfully without recurrence. With newer anatomic prosthetic designs and a comprehensive surgical approach, treatment of frontal plane deformities with implant arthroplasty has gained acceptance. The purpose of this retrospective study was to determine the outcome and compare correction of large frontal plane varus deformities with TAR using 2 different replacement systems. Also, a stepwise surgical approach for consistent correction was determined. TAR was performed on 26 patients with varus ankle deformity and a mean age of 63.85 ± 9.33 (range 48-86) years. Duration of follow-up was 16.69 ± 7.26 (range 7-37) months. The difference between the immediate postoperative frontal plane radiographic alignments was compared with the preoperative deformity, and reevaluated after at least 1 year of weight-bearing function. The preoperative mortise view varus deformity was 16.8° ± 6.79° (range 6°-28°), whereas at final follow-up the degree of varus was 0° ± 2.64° (P < .0001) on the anteroposterior view and 0.5° ± 2.7° (P < .0001) on the mortise view. All but one patient was corrected to within 4° of frontal plane neutral. Overall, correction was maintained throughout the study period. In conclusion, surgical treatment of the varus ankle arthrosis with TAR can be successful.