Total joint replacement in the upper extremity has developed in step with that of the lower extremity. The indications for treatment, the place of total joint arthroplasty in contrast to other forms of arthroplasty, and the criteria for patient selection have recently been classified. A number of problem areas are under biomechanical and clinical study, and most investigators are proceeding cautiously. In properly selected patients, however, prosthetic replacement offers great improvement in both relief of pain and joint function, and improvement should continue. The patient and physician should recognize the limitations that are inherent in any "artificial joint" replacement. Realistic expectations would be for improvement that approaches, but rarely achieves, normal function.