Prestressed concrete girder bridges are widely used worldwide due to their mature construction technology, economical cost, and low maintenance. After a certain number of years of service, prestressed concrete girders inevitably suffer from deterioration of their material properties, cracking, and reduced load-carrying capacity due to the natural environment and long-term vehicle loading. When the performance of a bridge declines to the point that it cannot meet the requirements of normal use, reinforcement and maintenance are required. In this study, a 5 × 45 m prestressed concrete continuous box girder bridge that has been in service for 25 years is taken as an example, and the causes of crack development and deterioration of the technical condition of the bridge are analyzed. Based on an analysis of the causes, reinforcement schemes for overall replacement of the girder and adding bridge piers are proposed. According to a comparison of the advantages and disadvantages, a decision analysis of the reinforcement scheme is carried out via the analytic hierarchy process (AHP). The vector weights of the two schemes were found to be 0.4288 and 0.5712, respectively, indicating that adding bridge piers is more advantageous than overall replacement of the girder. Thus, a scheme of adding five piers was adopted to reinforce the bridge. A load test was then performed after the reinforcement, and both the test deflection and strain calibration coefficients were found to be less than 1, indicating that the force state of the added piers and bearings was better than the theoretical calculations. The present study shows that the reinforcement scheme of adding piers can achieve the design goal. The working status of the box girder was significantly improved, the crack development of box girder was suppressed, and the service life of the bridge was prolonged.