Total joint arthroplasty of the hip and knee are successful orthopedic procedures that reduce pain and improve mobility in patients. As the implanted materials used in these procedures have improved, the lifetime of the implants has now reached more than 20 years. Younger patients are undergoing total joint arthroplasty at increasing rates, which has increased the need for improvements in materials for extended implant longevity. In this review, we aim to provide historical perspective on the evolution of ultra-high-molecular-weight polyethylene in total joint arthroplasty. We review this material with respect to its structure, mechanical properties, wear rates, sterilization effects, crosslinking, and other new polymer innovations. Ultra-high-molecular-weight polyethylene (UHMWPE) has been a cornerstone for total joint arthroplasty and with continued design improvements will continue to be vital to this successful orthopedic operation.