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Little is known about specific outcomes and early experiences of total talar prosthesis replacement surgery in the current literature, and ankle arthroplasty in Southeast Asia. This study reported on four patients with talar loss or ankle arthritis. Patients were treated with a custom total talar prosthesis (anatomic-metallic version) replacement (TPR, n=1) or with total ankle replacement (TAR, n=3). Baseline data, including Visual-Analog-Scale Foot and Ankle (VAS-FA) and Quality of Life scores via Short-Form-36 (SF-36), were collected for all patients. Mean follow-up time was 7.6 months. From preoperative to postoperative, VAS-FA score increased from 6.0 to 57.5, and SF-36 score increased from 19.3 to 73.7 in a patient with TPR. Mean VAS-FA scores increased from 51.5±15.6 to 85.7±4.7 (P=0.032), and mean SF-36 scores tended to increase from 65.2±13.3 to 99.3±1.2 (P=0.055) in TAR group. This study is the first report of anatomic-metallic TPR which appears to provide satisfactory outcomes for treatment of talar loss at a short-term follow-up. TAR also provides acceptable results for treatment of ankle arthritis at this point.