Treatment of primary elbow osteoarthritis in the young active patient less than 50 years old presents a treatment challenge to the practicing orthopaedic surgeon. Following failure of nonoperative management, surgical goals are aimed at reducing pain and improving joint mobility from bony impingement. Arthroscopic osteocapsular arthroplasty is a viable treatment option with few post-operative limitations. In contrast, total elbow arthroplasty is considered a salvage option in this patient population given the activity restrictions imposed. Osteocapsular arthroplasty combines soft tissue and bony debridement, osteophyte/loose body removal, synovectomy, capsular release, and bony contouring of the humerus and ulna to allow impingement-free range of motion.