Thirty-one patients who underwent thirty-six total elbow replacements between 1974 and 1977 were followed for a minimum of two years with an average of 3.7 years. A scoring system was used to quantitate results. Patients with rheumatoid arthritis and functional disability primarily related to pain benefited most from the operation. Patients with post-traumatic arthritis and disability secondary to loss of motion benefited least. The over-all complication rate was 53 per cent and the reoperation rate was 22 percent. However, only one-fourth of the complications adversely affected the final outcome. Total elbow replacement can give good results in carefully selected patients.