Advances in joint arthroplasty of the hand have transformed the lives of patients with pain, reduced function, and joint instability. Historically, such patients were offered resection arthroplasty. This was first recorded in 1536, when Ambroise Paré resected an elbow joint in a patient with a destructive infection. Autologous small joint arthroplasty presented a means of reconstructing a joint of the hand with complete biocompatibility. The first free non-vascularised autologous joint transfer occurred in 1913, and has been credited to Goebell. Buncke performed the first vascularised joint transfer in 1967. In the 1940’s, biologically inert Vitallium caps were introduced by Burman and Abrahamson for interposition arthroplasty of the MCP and IP joints. Although this improved range of motion, it also led to lateral joint instability. In 1959, Brannon and Klein developed total digital joint replacement. Although early results were encouraging, long-term follow up uncovered problems with implant loosening and fracture. This design was followed by several modified second-generation hinged prosthesis, but complication rates remained unacceptably high. In 1962, Swanson developed novel MCP and PIP implants comprising of a single silicone unit with tapered proximal and distal stems and a dorsal offset hinge region. This silicone implant underwent further alterations of the silicone polymer composition, and has remained the joint replacement of choice for many surgeons. Improvements in joint arthroplasty of the hand will likely depend on future developments in biocompatibility and osseointegration.