Joint reconstruction or replacement. Health-care providers recommend orthopedic surgery in cases of severe osteoarthritis in which there has been significant deterioration of the joint. Surgery can be used to correct joint deformity, to reconstruct a diseased joint or to completely replace a diseased joint with a prosthetic device. This surgery is most often recommended for osteoarthritis of the hip or knee, because severe disease of these joints can impede movement. Joint replacement is definitive treatment for severe osteoarthritis, and hip replacement and knee replacement are among the most common surgeries performed in the United States. A replaced joint will last an average of 10 to 15 years (or even longer, because these estimates are based on operations performed at least 10 years ago).

Arthroscopy. Arthroscopy is another surgical treatment option for osteoarthritis, although it is usually limited to people whose knees also have torn cartilage or debris in the joint. But in contrast to joint reconstruction or replacement, arthroscopy is considered minor surgery, in that it generally does not require an overnight stay in the hospital. An arthroscope is an instrument with a tiny light, a camera and a variety of surgical attachments. The instrument is inserted into the joint to perform minor surgery using the attachments. Ragged joint edges, debris and loose material can be visualized and either smoothed over or removed. Depending on the condition of the joint, this can result in mild to moderate improvement that may last several months or perhaps a few years; however, for someone with severe osteoarthritis, this approach is unlikely to offer much benefit.

Cartilage transplant. Cartilage transplant is a method to replace damaged cartilage with healthy cartilage transplanted from elsewhere in the body or from a person who has died and donated their organs. Cartilage cells may be removed from a joint or some other area and grown outside the body to form a "patch." The patch is then inserted in an area of damaged or missing cartilage with an arthroscope. So far, these approaches have been used primarily in young people with sports-related knee injuries limited to the knee. But many experts believe that the time is soon coming when cartilage transplant will become a more common treatment for osteoarthritis.