Several treatments, conservative or surgical, have been proposed for painful arthritis of the base of the thumb with various outcomes. Swanson trapezium implant, arthrodesis of the trapezio-metacarpal (T.M.) joint and suspension arthroplasty are three of the most used techniques for treatment of this condition. Two hundred patients operated on using one of the three techniques were reviewed for a retrospective study to assess the advantages and disadvantages of each method of treatment and their indications. Patient satisfaction rate is high whatever the technique used. Complete pain relief was obtained more often with the Swanson implant (Alnot 0) but differences between the three methods decrease when patients with pain only for particular strains (Alnot 1) are included. Swanson implants (patient satisfaction Alnot 0 and 1: 85.5%) provide excellent subjective and objective results for patients with light activity of daily living causing little stress to the implant. Complication rate with reoperation is equal to other techniques. Surgical treatment is well come through and recovery is fast and not painful. Suspensioplasty (patient satisfaction Alnot 0 and 1: 78.2%) have a low complication and reoperation rate when the technique is well applied. Patient satisfaction rate is high but duration of recovery is long (strength, nimbleness). T.M. arthrodesis is the only type of surgery providing a good strength identical to the opposite side at the price of a limited decrease of range of motion. In conclusion, we propose the following algorithm: for patients over years of age: Swanson trapezium implant; for young and active patients presenting a radiological stage less than Dell III and an intact Scaphotrapezial joint: T.M. arthrodesis; for other patients: suspensioplasty using the A.P.L.