Total elbow arthroplasty (TEA) is technically demanding due to the elbow`s complex joint geometry, biomechanical characteristics, and thin soft-tissue envelope; nevertheless, in appropriately selected patients it is an effective treatment option that provides pain relief and functional improvement. Although TEA was widely performed for rheumatoid arthritis in the past, with the decline of inflammatory arthritis in parallel with biologic therapies, indications such as acute comminuted distal humeral fractures, posttraumatic arthritis, and fracture sequelae have become more prominent today. Implant designs have shifted away from fully constrained hinge systems toward semiconstrained linked (loose-hinge) designs that allow limited varus-valgus and rotational motion, and-in selected casestoward unlinked surface replacement and convertible systems. Surgical success depends on triceps management and the choice of surgical approach, protection of the ulnar nerve, accurate component alignment, meticulous cementing, and tailoring rehabilitation to the implant type. Aseptic loosening, infection, instability, periprosthetic fracture, triceps-related complications, and polyethylene wear are the main sources of morbidity. This review summarizes the historical development of TEA, current indications, implant options, key surgical principles, the complication profile, and the growing importance of revision TEA in light of the contemporary literature.