The Discovery Elbow System (Biomet Orthopedics, Warsaw, Ind) is the latest generation of elbow replacement systems. Its minimally constrained design provides more closely matching articular surfaces, avoids use of a true hinge, and anatomically reproduces the axis of elbow motion. Improved instruments facilitate its implantation. The anatomic positioning of the humeral condyles allows for preservation of the ulnar collateral ligament to help share in implant loading. Elbow replacement reliably restores a painless functional arc of motion in almost all patients. Historically, elbow implant survivorship has been better in low-demand patients who have been functionally compromised by diffuse disease than in posttraumatic or osteoarthritic patients who otherwise are active and have no significant disabilities other than their elbows. The decision to proceed with elbow replacement should be made considering both age and activity level.