The follow-up of 42 patients with 50 symptomatic elbow joints [average age at operation: 66.1 years (46-79 years)] with rheumatoid arthritis at an average of 6.8 years (SD: 3.5 years) after joint-preserving open operation is presented in this study. Synovectomy was mandatory. Open synovectomy with facultative additional soft tissue techniques (AS) was performed on 17 elbows, while in 33 elbows joint surface remodeling (SR)-radial head excision included-was performed. There was only a slight progression in the overall Larsen staging from 3.70 to 4.02 in the operated joints, while the non-operated joints were nearly unchanged (3.43 vs 3.56). Especially in the SR group a nearly significant ( p=0.06) increase of 31.0 degrees for the total elbow ROM as a sum of extension/ flexion and pronation/supination could be detected, while the AS group slightly decreased with -1.1 degrees. Both groups gained a comparable average Morrey score result (AS 77.6 points vs SR 75.6 points). Poor results were not noticed at all. A mild collateral instability was seen in 40% of the AS and in 20% of the SR cases, respectively. Moderate instability was found in 10% in the AS vs 5% in the SR group. Both groups showed an excellent benefit in terms of pain relief, function, and satisfaction according to the patients' self-assessment on a visual analog scale.Joint-preserving operations on the rheumatoid elbow proved to be safe and efficient methods on a medium term even at late stages. Especially joint surface remodeling guarantees a noticeable increase for the elbow ROM without provoking marked collateral instability. The patients' expectations for pain relief and functionality can be fulfilled completely with these methods.