The number of studies on ultrahigh-performance concrete (UHPC) or ultrahigh-performance fiber-reinforced concrete (UHP-FRC) for more resilient and sustainable reinforced concrete (RC) structures has rapidly increased in recent years due to the superior mechanical and durability properties of UHPC. The application of UHPC as a replacement for conventional concrete materials in various RC elements necessitates a thorough understanding of the structural behavior of the reinforced UHPC (R/UHPC) components under various types of loadings. This paper presents a systematic review of the state-of-the-art developments in R/UHPC elements. It addresses various topics including beams, columns, beam-column joints, shear walls, bridges, structural retrofitting, and applications such as seismic and impact. Due to the ultrahigh tensile, compressive, and bond strengths, unique strain-hardening behavior, and ductility of UHPC, R/UHPC structures may exhibit substantially different behavior than conventional RC structures at both the component and system levels. This implies that particular attention must be paid when design and analysis approaches for conventional RC elements are applied to R/UHPC elements, and suggests that developing new design philosophies is warranted to take advantage of UHPC's unique mechanical properties. The present paper summarizes the developments in analysis and design approaches for R/UHPC elements under axial forces, shear forces, and bending moments, and highlights the advantages and limitations of these approaches. Important design considerations for effectively utilizing UHPC in structural elements are also suggested. In addition to normal-strength steel reinforcing bars, the potential for reinforcing UHPC with high-strength steel bars, fiber-reinforced polymer components, and structural steel shapes is discussed based on the results of pioneering studies. Finally, this paper identifies challenges and suggests future directions for research on UHPC in structural engineering.