Abstract The basal joint of the thumb is commonly afflicted with degenerative changes, especially in postmenopausal women. This can be debilitating because of the importance of the thumb to overall hand function. There are a variety of treatment options for the patient with arthritis of the basal joint of the thumb. Most patients can successfully be treated conservatively, which includes splinting, antiinflammatory medications, physical therapy, and activity modification. For those who fail conservative therapy, surgical treatment is based on clinical staging. Patients with early degenerative changes are candidates for ligament reconstructive procedures or arthrodesis. Those with more advanced disease may benefit from excision, tendon interposition arthroplasty, suspensionplasty, silicone implant arthroplasty, or total joint arthroplasty. The advantages and disadvantages of each procedure, as well as the relative indications and contraindications of each, are critically assessed.