Background/Objectives: The interest in performing Total Ankle Arthroplasty (TAA) to address end-stage ankle osteoarthritis (OA) is continuously growing. Sports activity plays an important role in our world. There is sparse literature regarding return sports activity following TAA. Levels and types of sports in TAA are rarely reported. The purpose of this prospective case series study is to investigate sports activity in ankle osteoarthritis (OA) and TAA in terms of rate, frequency and type as well as clinical outcomes with a minimum 2 years of follow-up after surgery. Methods: 103 patients (105 implants, 52 female, and 51 male), mean age 60.5 years (range, 23-84 years) with end-stage ankle OA were treated using a three-component, uncemented, mobile-bearing VANTAGE Total Ankle System. The mean follow-up was 2.9 years (range, 2-5 years). Visual Analogic Scale Pain Score (VAS, 0-10 points), Ankle Dorsiflexion/Plantarflexion (DF/PF) Range of Motion (ROM; degrees), functional American Orthopedic Foot and Ankle Society (AOFAS) Ankle/Hindfoot Score (0-100 points), Subjective Patients' Satisfaction Score (0-10 points), Sports Activity Rate, Sports Frequency Score, and Sports Type were assessed. Results: Mean preoperative VAS Pain Score was 6.7 points (range, 3-10 points) and postoperative 0.2 points (range, 0-3 points) (p < 0.001). The mean DF/PF ROM was 24.9° (range, 0°-60°) pre-operative and was 52.9° post-operative (range, 15°-85°) (p < 0.001). The mean preoperative functional AOFAS Ankle/Hindfoot Score was 39.5 points (range, 4-57 points) and postoperative 97.8 points (range, 75-100 points) (p < 0.001). Mean postoperative Subjective Patients’ Satisfaction Score was 9.7 points (range, 7-10 points). The preoperative Sports Activity Rate was 31.1%, postoperative 85.4% (p < 0.001). All the groups exhibited substantial Sports Frequency Score increases (p < 0.001). The most practiced sports were hiking, biking, fitness, and swimming. Conclusions: Total Ankle Arthroplasty (TAA) is an effective treatment for end-stage ankle OA. TAA allows a noteworthy increase in sports activity. This research offers important sports insights to patients with ankle OA and TAA.