The surgical treatment of osteoarthritis of the wrist secondary to pseudarthrosis of the scaphoid is presented in the light of twenty years experience, and with improved knowledge of the pathological anatomy of this problem. The condition is difficult to treat owing to the varied pathology, the different needs of the patients and the alternative treatments available. Where a pseudarthrosis exists with involvement of the scaphoid-radius joint only, we recommend radial styloidectomy and repair of the pseudarthrosis. Where the pseudarthrosis is associated with carpal collapse which can be corrected, and osteoarthritis is confined to the joint between the capitate and lunate bones, we recommend correction of the carpal collapse and an arthrodesis between the lunate, capitate, hamate and triquetrum, with either anatomical repair of the scaphoid or eventual replacement with a Silastic implant. Where there is irredicable carpal collapse or lunate dislocation, proximal row carpectomy is recommended as an alternative to arthrodesis. Pseudarthrosis of the proximal pole of the scaphoid is best treated by replacement of the small bone fragment with a Silicone rubber implant. For pseudarthrosis with a painful arthritic joint of radius, scaphoid and lunate without involvement of the other periscaphoid joints, we recommend arthrodesis of the affected joints only. Finally, in cases of pseudarthrosis with advanced degenerative changes in the radiocarpal and intercarpal joints with associated collapse and deformity, or following unsuccessful resection, we recommend arthrodesis of the wrist.