BACKGROUND Total elbow arthroplasty is not commonly used in young patients with advanced arthritis because of concerns regarding implant loosening and clinical failure. Until now, to our knowledge, there have only been a few studies on the outcome in younger patients undergoing total elbow arthroplasty. METHODS Twenty-three elbows in patients forty years of age or younger who underwent total elbow arthroplasty were reviewed retrospectively. There were nine elbows with posttraumatic arthritis and fourteen elbows with nontraumatic arthritis. The mean patient age at the time of the surgical procedure was thirty-three years (range, twenty to forty years), and the mean follow-up duration was 129 months (range, eighty-five to 227 months). RESULTS At the time of the latest follow-up, pain during motion decreased from a mean visual analog scale score (and standard deviation) of 5.8 ± 1.8 cm preoperatively to 1.6 ± 1.1 cm postoperatively (p < 0.001), and the mean Mayo Elbow Performance Score increased from 32.0 ± 9.4 points preoperatively to 81.1 ± 13.7 points postoperatively (p < 0.001). The mean subjective patients' satisfaction score was 83.5 ± 11.7 points. The mean flexion-extension arc in the posttraumatic arthritis group increased from 37.8° ± 30.3° preoperatively to 120.6° ± 11.3° at the time of the latest follow-up, whereas that in the nontraumatic arthritis group increased from 24.3° ± 27.6° to 96.4° ± 21.2° (p < 0.001 for both). At the time of the latest follow-up, the loosening rate was 13% and mild-to-moderate bushing wear was observed in four elbows (17%). A revision surgical procedure was performed in five elbows (22%), of which three had revision surgery after fifteen postoperative years. The overall implant survival rates were 95% at the eight-year follow-up and 89% at the fifteen-year follow-up. CONCLUSIONS Despite concerns regarding the longevity of total elbow replacements in young patients, long-term follow-up after total elbow arthroplasty showed significant functional improvement and pain relief. Although a desirable range of motion after the surgical procedure was difficult to achieve in patients with preoperative ankylosis, total elbow arthroplasty in selected young patients showed acceptable loosening, reoperation, and implant survival rates. METHODS Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.