A multitude of disease processes can affect the small joints of the hand, including osteoarthritis, posttraumatic arthritis, rheumatoid arthritis, and neuromuscular disorders. Tendon incompetence and ligamentous laxity can also lead to deformities of the digital joints, such as mallet finger, swan neck deformity, and boutonnière deformity. However, although these pathologies affect joint function in a variety of ways, many of them can be treated nonsurgically. Surgical treatment becomes necessary when the patient’s symptoms are intolerable, or when joint deformity or instability compromises hand function. The purpose of this review is to elucidate the roles of arthroplasty and arthrodesis in the treatment of degenerative arthritis and other pathologies affecting the digital joints of the hand.