Total elbow arthroplasty (TEA) is a critical surgical procedure employed in the management of pathologies that impair the functional integrity of the elbow, such as rheumatoid arthritis, primary osteoarthritis, and complex distal humerus fractures. Historically, the developmental trajectory began with fully constrained hinged designs; however, due to high rates of loosening and mechanical failure, these have been superseded by semi-constrained and unlinked implants. Modern unlinked prostheses offer the advantages of preserving bone stock and mimicking native elbow biomechanics, yet they necessitate robust ligamentous support for stability. Conversely, linked semi-constrained systems (e.g., Coonrad- Morrey, Nexel) minimize stress at the bone-cement interface by allowing controlled varus-valgus laxity, yielding successful functional outcomes particularly in cases with high instability. Contemporary designs, including condylar-bearing systems like Discovery and convertible modular implants like Latitude, aim to reduce revision rates by providing surgeons with the intraoperative flexibility to determine the optimal coupling mechanism. While literature data indicate high survival rates for TEA in patients with inflammatory arthritis, complications such as aseptic loosening, infection, and polyethylene wear remain significant challenges in younger and post-traumatic patient populations.