80 patients with trapeziometacarpal joint osteoarthritis were randomized to surgical intervention with either trapeziometacarpal joint arthroplasty with a pyrocarbon implant (PyroDisk; Ascension) or ligament reconstruction and tendon interposition. Patients were followed up over 12 months for outcome related to pain, patient-reported function the the Patient-Rated Wrist Evaluation, key pinch strength, lateral pinch strength, grip strength, and incidence of complications. Results demonstrated significantly poorer results in the PyroDisk group for VAS pain at 3-6 months, PRWE score at 3 months, and incidence of complications. Pinch and grip strength assessments demonstrated no significant differences between groups.