Hereditary multiple exostosis is a rare condition in which numerous benign osteochondromas form throughout the body, typically in areas of high bone turnover such as the metaphyseal plates of long bones. While many of these lesions remain clinically asymptomatic, other growth locations can lead to excruciating pain, limit a joint’s range of motion, and compromise neurovascular structures. These patients undergo multiple surgeries throughout their lifetime in order to remove symptomatic osteochondromas. Due to deformities and changes in bone structure, these patients also suffer from significant arthritis which may also require surgery. It is important that a skilled orthopedic surgeon follow these patients in order to help them make informed decisions and limit the number of surgeries within their lifetime. The purpose of this case report is to discuss one instance in which a patient’s significant arthritis was operatively managed in the setting of hereditary multiple exostosis.