100 patients were included in this meta-analysis comparing mobile-bearing and fixed-bearing implants in total ankle replacement. Outcomes of interest included pain on a Visual Analog Scale (VAS), American Orthopedic Foot and Ankle Society (AOFAS) scores, Short Form 36 (SF-36) scores, Foot and Ankle Disability Index (FADI) scores, Short Musculoskeletal Functional Assessment scores (SMFA) and radiographic outcomes. Follow up was performed for a minimum of 2 years. Results revealed similar VAS pain, AOFAS, SF-36, FADI and SMFA scores between the two implant types. However, the rates of heterotopic ossification, talar and tibial component malalignment, talar component lucency/cyst formation and talar component settling or subsidence were significantly higher in the mobile-bearing group compared to the fixed-bearing group.