The results of surgery upon the metacarpophalangeal joint damaged by rheumatoid arthritis at The Hospital for Special Surgery over the past fifteen years are reviewed. Surgery on the metacarpophalangeal joint of the thumb in patients with rheumatoid arthritis is successful and yields predictable results. Patients with early rheumatoid arthritis, in whom there is good joint stability and a normal arc of motion, should be considered candidates for synovectomy and dorsal-hood reconstruction. An alternative method, in those patients with dislocation and destruction of joint stability, is arthrodesis. The concept that "a little joint motion when painless and stable is better than no motion" favors an effort toward synovectomy and dorsalhood reconstruction before irreparable joint damage has occurred.