The results of total joint arthroplasty are exciting but certainly they are not yet good enough to warrant complacency. Further advances in design and materials are required. It is also clear that there is a positive relationship between the technical expertise with which the surgery is performed and the long term functional results (especially with regard to the knee). Nonetheless, the benefits that this type of surgery can confer on the severely afflicted rheumatoid patient with regard to pain relief and function are such that there should be little hesitation in offering this form of treatment to all patients who fail conservative treatment. However, it has always to be remembered that the results of even the most sophisticated surgery can be improved by an intensive rehabilitation programme including pre- and post-operative occupational therapy and physiotherapy, the prescription of appropriate appliances and the optimisation of medical therapy.