Objective To review development of a nonconstrained total elbow replacement system for use in dogs and report the surgical technique used for implantation. Study Design Descriptive report. Animals Dogs with chronic elbow osteoarthritis (OA) unresponsive to medical management for at least 1 year. Methods A nonconstrained elbow replacement system (radioulnar and humeral components) was developed and used in dogs with medically nonresponsive elbow OA. The components were refined based on evaluation of clinical outcome. Changes in humeral stem design for composite fixation, the contours of the articulating surfaces, and in the humeral component to increase range of motion were incorporated. Drilling and cutting guides were developed to facilitate accuracy of implantation. Results With component refinement, more favorable long-term functional outcome was achieved. Conclusions Design improvements incorporated into the elbow replacement system should increase treatment success. Clinical Relevance Total elbow replacement in dogs is possible and good long-term outcome can be achieved.