Primary osteoarthritis of the elbow remains uncommon. It is most often secondary to overuse, traumatic history, lesions of osteochondritis dissecans, or synovial chondromatosis. Asymptomatic for a long time, the clinical presentation can be variable, resulting in a more or less painful loss of mobility. The imaging assessment allows the evaluation of the osteo-cartilaginous lesions and specifies the position of osteophytes and foreign bodies. If initially medical treatment is the rule to decrease pain and keep a functional range of motion, in case of failure a surgical treatment can be discussed. It consists of joint cleaning, with excision of the osteophytes and eventually capsule release. These can be performed arthroscopically or by an open procedure. In case of advanced alteration of the joint space, the choice is made between open arthrolysis with interposition or replacement with an elbow prosthesis.