Between 1990 and 1997 we undertook 57 Kudo type-4 total elbow replacements in 45 patients with rheumatoid arthritis. A total of 34 patients (44 elbows) were evaluated at an average of 7 (4.4-11.2) years using the Mayo Clinic Performance Index. At review 29 elbows were excellent or good and four were fair or poor. The main complications were intraoperative fractures and ulnar neuropathy. No luxations were seen. Loosening of the ulnar component and breakage of the humeral component were most frequent indications for revision. Preoperative radiographic joint destruction was not correlated with revision rate.