Between 1987 and 2005, 165 patients with rheumatoid arthritis of the elbow, four with psoriatic arthritis, and eight with osteoarthrosis of the elbow were treated with total elbow arthroplasty using 126 semiconstrained GSB III elbow replacement prostheses; 46 semiconstrained Coonrad-Morrey prostheses; 24 Souter-Strathclyde unconstrained, unlinked prosthesis; four constrained link hinge prostheses; two custom-made prostheses; and one Pritchard elbow replacement. All implant procedures relieved pain and improved functionality. The complication rate was 34.4%. Revision surgery was needed in 27.2% of elbows because of infection, dislocation, or aseptic loosening. Survival of the semiconstrained implants with ventral or epicondylar flanges for load transfer was better than that of the other implants. Component linkage with the Coonrad-Morrey implant prevents dislocation without increasing the risk of loosening; therefore, semiconstrained implants are our choice for advanced arthritis of the elbow. Total elbow replacement is associated with a high complication rate and therefore may be warranted only for seriously disabled patients.