Patients who have disabling osteoarthritis of the hand are frequently given the wrong diagnosis, poor professional advice and inadequate treatment programmes. The exact cause of primary osteoarthritis remains unknown; however, an interplay of genetic factors, mechanical factors and biomechanical alterations in cartilage seems to be important. The incidence of primary osteoarthritis in the general population is very high. These patients should receive the benefits of good professional advice and reconstructive surgery when necessary. They may respond very well to moderating their activities and simple physical and medical therapy methods. Patients with destructive joint disease in the digits can have excellent results with arthrodesis and implant arthroplasty for the DIP and PIP joints and with implant arthroplasty for the basal thumb joints. Surgical reconstruction is an important method in the rehabilitation of this group of individuals. The term 'osteoarthritis' is preferred to 'osteoarthrosis'.