First MTP Joint Replacement Surgery

This surgery is indicated for big toe arthritis in its early stages, with predominantly pain with loading of the joint and still some joint space preserved. In end stage big toe arthritis – this operation may not be suitable. The advantage over this operation is that it maintains motion of the joint.

Figure 1: pre operative and intraoperative Xrays demonstrating a first MTP replacement

The operation is performed via an incision on the top of the big toe (dorsal), the joint is exposed and a space is made for the silicone hydrogel spacer implant which is placed in the head of the metatarsal bone.

 

Success rates: up to 88% of patients have a successful outcome with this procedure[1]

 

Post-operative

  • Surgery is a day-stay or overnight.

  • A block of the foot is performed to help with post-operative pain.

  • 0-2 weeks: elevation at home to reduce swelling, walk in post-operative flat shoe

  • 2-4 weeks: transitioning into comfortable wide fitting trainers such as HOKA or ASICS shoes

  • 4-6 weeks: return to walking normally

  • 6 weeks onwards: ongoing range of motion and strengthening

Download post operative care guide

Risks of surgery

  • Swelling, stiffness

  • Infection

  • Wound healing problems or infection

  • Scar sensitivity

  • Ongoing pain

  • Secondary surgery including conversion to MTP fusion later if disease progresses or implant loosens.

[1] Baumhauer JF, Singh D, Glazebrook M, Blundell C, De Vries G, Le ILD, et al. Prospective, Randomized, Multi-centered Clinical Trial Assessing Safety and Efficacy of a Synthetic Cartilage Implant Versus First Metatarsophalangeal Arthrodesis in Advanced Hallux Rigidus. Foot Ankle Int. 2016 May;37(5):457–69.