Forty-six patients (fifty hands) had replacement of the trapezium by a silicone implant that incorporated a local tendon strip to stabilize the device. The patients had intractable pain due to degenerative changes of multiple facets of the trapezium. The over-all rate of subluxation and dislocation was 10 per cent. In all hands, pain-free improved movement resulted. The pinch strength approximated the normal, averaging six kilograms for women and eight kilograms for men.