This randomized prospective study compared the results of trapeziectomy alone, or combined with tendon interposition or ligament reconstruction in 76 women with basal thumb osteoarthritis. At 3 month and 1 year follow-up the results of the three procedures were indistinguishable in terms of pain relief, hand function and thumb strength. In the short term at least, tendon interposition and ligament reconstruction do not improve the results of trapeziectomy.