End-stage elbow arthritis in young, active patients presents a challenging problem to the upper extremity surgeon. Total elbow arthroplasty is not a viable option in this population because of functional restrictions, limited implant survivorship, and the lack of an adequate salvage option. With the appropriate surgical indication, interposition arthroplasty can relieve severe pain, affording a functional elbow without severely proscribing permitted activities. In addition, bone stock is preserved, as are other reconstructive options for the future.