A meta-analysis was performed to compare trapeziectomy with ligament reconstruction and tendon interposition (LRTI) vs prosthetic replacement for first carpometacarpal joint osteoarthritis. Seven prospective and retrospective comparison trials were retrieved. A total of 459 patients receiving trapeziectomy with LRTI and 374 patients receiving prosthesis replacement with a follow-up of 12 to 69 months were identified. There were no differences in visual analog scale scores or complications. However, the mean Disabilities of the Arm, Shoulder and Hand score was 3.73 points lower and the mean pinch power was 1.16 points higher in the prosthesis replacement group, and this was significant. Prosthetic replacement led to a superior clinical outcome compared with trapeziectomy with LRTI, with no difference in complications.