Sixty-two women with stage II–III trapeziometacarpal osteoarthritis were randomized to receive either total joint arthroplasty (TJA, n=31) or trapeziectomy (n=31). The primary outcome was the Michigan Hand Outcomes Questionnaire (MHOQ) total score at 1 year. Secondary outcomes included MHOQ subscale scores, Disability of the Arm, Shoulder and Hand (DASH) questionnaire scores, active range of motion, strength, return to work, patient satisfaction, and complications. Outcomes were assessed at 3 and 12 months. Overall, the results revealed no statistically significant or clinically relevant superiority of TJA over trapeziectomy in the primary outcome at 1 year, although TJA had advantages in strength and some aspects of motion. These findings suggest that while TJA may offer some functional advantages, it does not significantly outperform trapeziectomy in patient-reported hand function after 1 year.