Thumb carpometacarpal arthritis is a common condition treated by hand surgeons. This condition most frequently affects the elderly and postmenopausal women. Nonoperative treatment options include activity modification, orthoses, and injections. Although many patients can be treated conservatively, those with persistent and recalcitrant symptoms may benefit from surgical intervention. There are myriad surgical options, and the best option often depends on the patient’s goals and functional demands, surgeon experience, and patient preference.