A durable total wrist arthroplasty has proven an elusive goal for over 120 years. Present results are not yet comparable to arthroplasties of other joints, such as the hip, knee, and shoulder. Due to the wrist’s long and convoluted evolutionary history, it is anatomically and functionally complex and exhibits significant morphological variations among individuals. This complicates the development of anatomical prostheses. Current biomaterials limit the possibilities of implant design, compelling engineers to come up with nonanatomical but practical solutions to provide durability and acceptable function. This chapter reviews wrist joint biomechanics and presents the challenges of designing wrist arthroplasties. It considers the history of wrist arthroplasty, analyzes its failures, and presents the author’s view of a viable arthroplasty, considering currently available biomaterials.