OBJECTIVE Total elbow arthroplasty (TEA) is a treatment option for end-stage arthritis in low-demand patients willing to accept the limitations of TEA. Concern remains regarding the longevity of TEA implants, especially in younger patients. The purpose of this study was to determine the failure rate and complication profile of TEA performed in patients aged less than 50 years. METHODS Between 2009 and 2013, 11 linked TEAs were performed in patients aged less than 50 years (mean age, 37 years; range, 22-47 years). Outcome measures included pain; range of motion; Disabilities of the Arm, Shoulder, and Hand scores; Mayo Elbow Performance scores; complications; and reoperations. Elbows were observed for a minimum of 2 years or until mechanical failure. Mean follow-up was 3.2 years. RESULTS At follow-up, 82% of TEAs had experienced a complication. Six elbows sustained mechanical failures (5 had ulnar loosening and one had humeral loosening). Pain improved from 8.0 to 4.9. Extension improved from 34° to 22° and flexion increased from 113° to 128°. Mean Disabilities of the Arm, Shoulder, and Hand score for surviving implants at follow-up was 42.9 (range, 17.5-56.7). Mayo Elbow Performance scores for surviving implants were rated as excellent (2), good (1), and fair (2). CONCLUSIONS High rates of early mechanical failure, predominately ulnar loosening, were observed in TEA in patients aged less than 50 years. Surgeons should remain cautious in performing TEA in young patients who can be expected to use the TEA in a more demanding fashion, placing them at higher risk for mechanical failure. METHODS Therapeutic V.