We retrospectively reviewed 49 patients with primary osteoarthritis who underwent 59 trapeziometacarpal (TM) arthrodeses to assess the efficacy of this procedure with respect to patient satisfaction and radiographic evidence of peritrapezial arthritis. The average patient age was 54 years (range, 41-73 years) and the average follow-up period was 7 years (range, 2-20 years). All TM arthrodeses used K-wires; 61 had a supplemental distal radius bone graft. There were 10 bilateral arthrodeses. There were 4 (7%) nonunions. Three nonunions were painless and 1 was painful. There were 2 patients who required a second procedure; 1 had a painful nonunion that was successfully treated with a repeat arthrodesis and the other had a solid but painful thumb that was treated with trapezial excision and soft tissue interposition. The average pain score at the time of the follow-up examination was 1.5 of 10. Thirty-three patients had postoperative radiographs; 7 had radiographic evidence of peritrapezial arthritis. Based on our findings we believe that isolated, symptomatic TM osteoarthritis in patients older than 40 years old is an indication of TM arthrodesis.