The first carpometacarpal (CMC) joint plays a significant role in everyday activities such as pinch grip, grasping, pinching and manipulation of objects. Due to the aforementioned activities of the first CMC joint over a long period of time, it is very common to develop degenerative changes in it, which is called osteoarthritis (OA). OA of the first CMC joint leads to a significant functional limitation and reduced quality of life of the patient. Treatment of OA of the first CMC joint can be non-operative or surgical. Non-operative treatment includes rest, activity modification, taking oral analgesics, local application of analgesic creams, application of orthoses or splints involving the first CMC joint, physical therapy and intra-articular application of corticosteroids or hyaluronic acid. In case of advanced OA of the first CMC joint and lack of effect of non-surgical treatment, surgical treatment is indicated: partial or complete trapeziectomy with or without reconstruction of the ligaments with possible interposition with a biological or synthetic interpositum, joint arthroplasty or joint fusion (arthrodesis). Arthroplasty of the first CMC joint has been increasingly used in recent years as a treatment option for advanced OA. The operation involves replacing the anatomical joint with an artificial (prosthetic) one with the aim of restoring normal joint function and relieving pain. A prosthetic joint usually consists of metal and plastic components that are designed to mimic the movement of a natural joint while providing stability. The aim of this review is to investigate the outcomes of trapeziectomy with ligament reconstruction and tendon interposition versus arthroplasty in the treatment of advanced OA of the first CMC joint. Existing literature suggests that arthroplasty of the first CMC joint provides better upper extremity function and symptom improvement compared to trapeziectomy with ligament reconstruction and tendon interposition, but such improvement does not appear to be clinically significant.