1st Metatarsal Phalangeal (MTP) Joint Replacement

(Great Toe Joint Replacement, Great Toe Arthroplasty)

Edited by Gregory Waryasz, MD 

Procedure

End (late)-stage arthritis of the great toe (hallux rigidus) can be treated with a great toe joint replacement. The goal of this surgery is to reduce pain and help keep motion of the joint that would no longer be present after a fusion surgery. 

Many different implants are available for this procedure. Resurfacing implants are metal implants that provide a cover to one side of the joint. There are metal and plastic implants that replace both sides of the joint. There are also synthetic implants. Patients should review the risks and benefits to each type of surgery before deciding between implants or if fusion is best for the patient to meet the goals of having a surgery. Your doctor will be able to answer these questions for you to help make a good decision for your goals.  

Recovery

Different implant types require different recovery timelines, which should be discussed prior to having the surgery. The skin site is usually healed in 2-4 weeks after surgery. Each surgeon will have a different amount of time when the patient is not supposed to put weight on the foot (non-weight-bearing). Typically a 6-week period of rest from normal activities, with elevation of the leg recommended. Physical therapy is very important during the recovery period to work to improve motion and prevent stiffness, help with walking and increase strength. Patients can see improvements for around 1 year after surgery. 
Fracture 

Potential Specific Complications

Failure of the implant over time

Implant failure can occur at any point, but the risk increases with time. The implants can wear out and fail. The human body does not have a way to heal or change them since they are made of metal, plastic or other synthetics. Replacements involving the great toe can fail because the joint is subject to a large amount of pressure with each step. Unfortunately, failure can be difficult to treat with surgery due to loss of bone once the implant is removed. Options for surgeons to treat failed implants are a challenge and usually are treated with bone grafting and fusion of the joint. 

Deep infection of the implant

Infection can develop with these implants any time after surgery. Infection usually requires implant removal making treatment options difficult but similar to the options for a failed implant. The signs of infection are fevers, chills, redness at the surgical site, drainage from the surgical site, and/or an increase in pain in the foot. 

Patient Dissatisfaction

Patients usually select an implant surgery if they wish to have a combination of pain relief and have some motion at the joint. A patient may still have a stiff joint despite the implant surgery and can still have pain despite a well-placed implant. The range of motion despite physical therapy can be similar to before surgery. The amount of pain relief after surgery may also not be enough for the patient leaving them to be unhappy. The is a common reason for patients to decide to have the implant removed and undergo a fusion surgery


Edited April 18, 2018

Previously Edited by Sam Dellenbaugh, MD

mf/ 10.22.18

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