Four hundred and forty-one silicone-Dacron arthroplasties done since 1968 were reviewed. Results were influenced by both durability and immediate fixation of the prosthesis, disease characteristics, speed of progression, the amount of hand stress, the extent of soft tissue release, and postoperative dynamic and protective splinting. Dislocations were eliminated by a woven tie-in holding the prosthesis to bone; prosthetic buckling was eliminated by soft tissue release, sufficient bone removal, and suture of the dorsal capsule to the extensor mechanism. Early prosthetic models fractured easier than did current ones. Seventeen percent of the combined 4, 5, and 6 year follow-up prostheses fractured, and 30% of the 6 year prostheses have fractured. Function was not affected, however, and protheses have not been replaced. We continue to use silicone-Dacron protheses with immediate tie-in to bone.