This study assesses long term performance of the Souter-Strathclyde elbow arthroplasty. From 1984 to 1999, 68 Souter-Strathclyde prostheses were inserted in 53 patients; nine patients died, one was lost and 38 (88%) had full clinical examination. Mean survival was 72 months (range 8 to 187), 25 elbows survived to 5-year follow up, with improvement in pain, motion, stability and function. Mayo score was satisfactory in 92% of all 68 elbows. Complications occurred in 13 elbows (19%) and 14 elbows were revised for instability (six), fracture (three), loosening (three) and intraoperative problems (two). Survivorship at 10 years was 74% (95% Confidence Interval ± 7. 7).