Four corner arthrodesis and proximal row carpectomy are the most common techniques for the management of advanced radiocarpal arthritis due to longstanding scapholunate instability and scaphoid nonunion. The advantages and short comings of each technique have been well defined in the literature. Advancements in joint replacement and arthroscopic surgery have resulted in new operations to manage radiocarpal and midcarpal arthritis. Most of these new procedures are modifications of the two classical operations, but some use modern implants and newer materials. New individualized options, like osteochondral grafting in combination with proximal row carpectomy or (arthroscopic) distal resection of the scaphoid, allowed us to improve our treatment and offer patients less invasive but equally effective procedures. We consider that four corner arthrodesis and proximal row carpectomy should not always be standard management for advanced radiocarpal arthritis.