Various pathologies, notably rheumatoid arthritis and/or trauma, are all known to cause severe pain and/or reduction of functional motion at the elbow joint. Implantation of a total arthroplasty, in such cases, has emerged as the first choice for management. For acceptable clinical performance, such an arthroplasty should be designed fully cognizant of various germane aspects of the anatomy, kinesiology and biomechanics of the normal joint. These aspects, together with a critical appraisal of the different classes of arthroplasty designs and a discussion of areas for further research (aimed at improving the in vivo performance of the prosthesis), are the subjects of the present review.