PURPOSE: We reviewed the results of ankle arthritis with advanced deformity treated with open arthrodesis. MATERIALS AND METHODS: Seventeen patients who had painful ankle arthritis with advanced deformity underwent open arthrodesis using chevron osteotomy or transfibular approach and were followed for an average of 4.2 years (range, 1.5 to 9.7 years). The average age was 51.4 years and the most common cause was traumatic arthritis (13 patients). Postoperative outcome was evaluated using Mazur's grading system for ankle function. we also checked time to union, patient satisfaction, complications, position of arthrodesis and degenerative changes of adjacent joints. RESULTS: Clinical score was improved to 76.4 points from 46.7 points. Average time to union was 4.3 months and the rate of satisfaction was 88%. Complications included 1 nonunion, 2 malunion, 1 superficial infection and 1 combined delayed union and malunion. There were 14 cases within 5 degrees valgus in frontal plane and 13 cases within neutral to 5 degrees dorsiflexion in sagittal plane. 3 cases in chevron osteotomy revealed valgus and plantarflexed position over 5 degrees. Degenerative changes of adjacent joints was seen in 2 patients. CONCLUSION: Open arthrodesis for ankle arthritis with advanced deformity shows favorable clinical outcome. Transfibular approach shows more consistent results than chevron soteotomy for desired position of arthrodesis.