Background: Surgical practice patterns in operative treatment of carpometacarpal (CMC-1) osteoarthritis (OA) have been evaluated in the USA repeatedly. This study evaluates the current surgical patterns in the treatment of isolated CMC-1 OA among hand surgeons in Europe. Methods: An online survey was distributed to hand surgeons of participating member states of the Federation of European Societies for Surgery of the Hand (FESSH). Information regarding country of practice, years of experience and surgical treatment of choice was collected. Statistical analyses of correlations between demographics and treatment preferences were done using chi-squared testing. Results: A total of 444 replies were recorded. Trapeziectomy with ligament reconstruction and tendon interposition (LRTI) was opted by 46% of the respondents as a procedure of first choice, followed by prosthetic joint replacement (25%) and trapeziectomy with interpositional arthroplasty (23%). Among surgeons practicing in the Netherlands, 35% mentioned trapeziectomy without any complementary procedures as a surgical treatment of first choice. Prosthetic joint replacement is chosen by respectively 96% and 72% of the respondents in Belgium and France as a preferred surgical procedure. Conclusions: This European-wide study provides insight in the prevailing surgical management for isolated CMC-1 OA. Trapeziectomy with LRTI is the most popular procedure among the participating hand surgeons in Europe. Geographical trends seem to play an important role in the choice of preferred technique. Factors influencing the decision-making among surgeons practicing in different countries should be explored more closely in future studies. Level of evidence: Level IV, prognostic study.