Aims. The Cartiva synthetic cartilage implant (SCI) entered mainstream use in the management of first metatarsophalangeal joint (MTPJ) arthritis following the positive results of large trials in 2016. Limited information is available on the longer-term outcomes of this implant within the literature, particularly when independent from the originator. This single-centre cohort study investigates the efficacy of the Cartiva SCI at up to five years. Methods. First MTPJ arthritis was radiologically graded according to the Hattrup and Johnson (HJ) classification. Preoperative and sequential postoperative patient-reported outcome measures (PROMs) were evaluated using the Manchester-Oxford Foot Questionnaire (MOXFQ), and the activities of daily living (ADL) sub-section of the Foot and Ankle Ability Measure (FAAM). Results. Patients were followed up for a mean of 66 months (SD 7.1). Of an initial 66 cases, 16 did not return PROM questionnaires. A total of six failures were noted, with survival of 82%. Overall, significant improvement in both objective scores (MOXFQ and FAAM ADL) was maintained versus preoperatively: 18.2 versus 58.0 (p > 0.001) and 86.2 versus 41.1 (p > 0.001), respectively. The improvement was noted to be less pronounced in males. Subjective scores had deteriorated since early follow-up, with an interval decrease in patient satisfaction from 89% to 68%. Furthermore, a subset of cases demonstrated clinically important interval deterioration in objective scores. However, no specific patient factors were found to be associated with outcomes following analysis. Conclusion. This study represents the longest-term independent follow-up in the literature. It shows reassuring mid-term efficacy of the Cartiva SCI with better-than-expected survival. However, deterioration in scores for a subset of patients and lower satisfaction may predict ongoing failure in this group of patients. Additionally, males were noted to have a lower degree of improvement in scores than females. As such, ongoing observation of the SCI to assess durability and survivability, and identify predictive factors, is key to improving patient selection. Cite this article: Bone Jt Open 2024;5(9):799–805

Introduction. Osteoarthritis commonly affects the first metatarsophalangeal joint. Stress across this joint has been postulated to increase the incidence of osteoarthritis. Certain foot structures have been associated with a higher incidence of osteoarthritis of the big toe. Utilizing finite elemental analysis, bone stress across the first metatarsophalangeal joint was calculated during mid stance phase of gait and compared in different foot structures. Method. A geometrically accurate three dimensional model of the first metatarsophalangeal joint was created utilising a high resolution 7 tesla MRI and Mimics v14 imaging software. Planus, rectus and cavus feet were simulated by varying the metatarsophalangeal declination angle to 10.1, 20.2 and 30.7 degrees, respectively. A non-manfold computer aided design technique in Mimics v14.2 and finite element method in ANSYS v12 FE were utilised to create the boundary conditions, representing the double support stance phase of gait. Using information from 61 asymptomatic patients with different foot types walking over a Novel emed-x plantar pressure measuring system, plantar loading conditions were applied. Finite elemental analysis was used to predict stress in the first metatarsophalangeal joint in the different foot types. Results. The peak stresses in the distal first metatarsophalangeal joint cartilage were 1.1×10(6) Pa, 6.0×10(5) Pa and 9.7×10(5) Pa for planus, rectus and cavus foot types, respectively. This corresponds to 83.3 percent and 61.6 percent increases in first metatarsophalangeal joint contact stress for the planus and cavus feet relative to the rectus foot. Conclusion. The results suggest there is a higher contact stress of the first metatarsophalangeal joint in patients with pes planus and pes cavus compared to the rectus foot. This may account for the increase risk of first metatarsophalangeal joint osteoarthritis in patients with pes planus. Further work has been initiated utilising this model to measure first metatarsophalangeal joint stress with different hindfoot loading

Purpose: To report concomitant dorsal dislocation of first metatarsophalangeal joint and divergent Lisfranc dislocation, a uniquely “floating forefoot” and analyse clinical pathodynamics. Methods & Results: We treated concomitant dorsal dislocation of first metatarsophalangeal joint and divergent Lisfranc fracture-dislocation in an intoxicated patient as a heavy weight fell on foot. Closed reduction of first metatarsophalangeal joint was unstable until after open reduction and fixation of first tarsometarsophalangeal joint. First to third tarsometatarsal joints were stabilised with cannulated screws and lateral two rays with Kirschner wires. Prophylactic fasciotomies were performed to preempt potentially high risk of failure of recognition of compartment syndrome in intoxicated patient. Clinical pathodynamic analysis suggests that natural tendency to withdraw the foot contributed to primary medial loading with forced hyperextension of hallux metatarsophalangeal joint and enhanced complementary hyperflexion of midfoot. The former resulted in dorsal dislocation of first metatarsophalangeal joint. Then load shift toward secondary axis of lateral divergent loading became the operative force to produce divergent Lisfranc dislocation, which effectively resulted in a floating forefoot. Conclusions: Floating forefoot is a unique injury after high-energy trauma, although floating metatarsal and association between Jahss Type I complex dislocation of first metatarsophalangeal joint and Lisfranc injury were described. Floating forefoot also represents Grade V in the modified classification of metarsophalangeal injuries (Kodali Siva R K Prasad et al Modification of Clanton’s classification) as progression of injury pattern transcends the local barrier and raises the spectrum of dynamic cascade of multidirectional transmission of the operative forces with the resultant unique injury

First Metatarsophalangeal joint fusion has been successfully used to treat Hallux rigidus. We have attempted to evaluate commonly used methods of fixation and joint preparation. To the best of our knowledge, this is the single largest comparative study on first MTPJ fusion. We aimed to evaluate the radiological union and revision rates. We included 409 consecutive MTPJ fusions performed in 385 patients. We collected demographic, comorbidities and complication data. We evaluated the radiographs for the status of the union. Logistic regression was used to calculate the Odds ratio (OR) of non-union for the collected variables. Our union rate was 91.4% (34/409). 29.4% of our non-unions were symptomatic (10/34). Hallux valgus showed a statistically significant relation to non-union (Odds ratio 9.33, p-value 0.017). Other potential contributing factors like sex (OR1.9, p-value 0.44), diabetes (OR 0, p-value 0.99), steroid use (OR 2.07, p-value 0.44), inflammatory arthritis (OR 0, p-value 0.99) and smoking (OR 2.69, p-value 0.34) did not attain statistical significance. Further, the methods of fixation like solid screws (OR 0, p-value 0.99), plate (OR 3.6, p-value 0.187) or cannulated screws (OR 0.09, p-value 0.06) showed no correlation with non-union. We compared two techniques of joint preparation and found no significant difference in union rates (Chi-Square 1.0426, p-value 0.30). Our crude cost comparison showed the average saving to the trust per year could be 33,442.50£ by choosing screws over plate. Only Hallux Valgus had a statistically significant relation to non-union. Solid screw could be economically the most viable option and a valid alternative

First metatarsophalangeal joint (MTPJ) arthrodesis plays a significant role in the management of symptomatic hallux rigidus. Several open and very few percutaneous techniques have been described in the literature. The authors present a new minimally invasive technique along with patient reported outcome, radiological parameters and a discussion on this novel technique. A total of fifteen cases of first MPTJ arthrodesis were included in this prospective continuous series from September 2011 to June 2012. Mean age was 56 years and the indication for surgery was hallux rigidus in 13 of 15 cases. All patients underwent the same minimally invasive procedure by the same primary surgeon (AHS), 13 of 15 as day cases. Clinical outcome and patient satisfaction were assessed by the Manchester-Oxford Foot Questionnaire (MOXFQ) preoperatively and at most recent follow up. Radiographic and clinical evaluation of fusion was also assessed. No patients were lost to follow up and all scores were collected by an independent surgical practitioner to avoid bias. Mean follow up was six months (range 1 to 9 months). The MOXFQ score for cases where fusion was achieved (n=14) improved from a mean 40/64 preoperatively to a mean 15/64 at last follow up (p=0.001). Patient satisfaction was overall very good. This minimally invasive technique for first MTPJ arthrodesis is simple and can achieve results similar or better than open techniques in experienced hands. Further cases are needed to expand this series and evaluate for further complications

A retrospective analysis of first metatarsophalangeal joint arthrodesis with a minimum two year follow up was carried out. Twenty-four patients (33 feet) with an average age of 54 years (range, 31–68) were followed up at an average of 28 months (range, 16 to 40). All patients had first metatarsophalangeal joint fusion using a vitallium plate as described by Coughlin (1994). Patients were evaluated using the American Foot and Ankle Society clinical (Kitaoka 1994) and radiographic guidelines. They also completed a patient satisfaction questionnaire. Twenty three patients (32 feet) went on to complete fusion of their first metatarsophalangeal joints. One patient had an infected non-union, his fusion was repeated successfully after one year. One patient required plate removal because of prominence. There was one case of deep infection which went on to a non-union. Overall, hallux valgus angle was reduced by a mean of 11 degrees and intermetatarsal angle by a mean of two degrees. Clinical evaluation showed marked improvement in pain and functional scores. Patient satisfaction was high with relief of symptoms and improved appearance of the foot. First metatarso-phalangeal joint arthrodesis using a vitallium plate is a successful procedure with a high fusion rate, low complication rate and a high level of patient satisfaction

Aim: One of the issues of metatarsophalangeal joint (MTPJ) replacements is that they do not restore full range of movement (RO M). However, full RO M is not needed for functional walking. The aim of this study was to measure the difference between the functional and maximum ROM of the first metatarsophalangeal joint. Materials & Method: The functional and maximum ROM of 32 MTPJs in 16 normal adults were measured with a video imaging system. The system first measured the ROM as the subject walked past the camera. It then measured the ROM as standing maximum extension tests were performed. Results: During functional walking tests the mean ROM was 37.9 degrees (SD 12.2). During maximum standing extension tests the mean ROM was 64.9 degrees (SD 11.3). Therefore the functional walking ROM was only 58% of the maximum standing extension ROM, with a mean difference of 27 degrees. A paired t-test comparison showed P< 0.0001. Discussion: MTPJ arthroplasty has previously been criticised because it does not restore full RO M. However, the results of this study suggest that the functional movements required in normal gait are significantly less than what can be maximally achieved in clinical standing extension tests. Therefore arthroplasty can be a suitable treatment if it can provide an adequate functional RO M. Conclusion: The results of this study show that the functional range of movement required for walking is only 58% of the maximum extension ROM of the first MTP joint. Therefore, MTP joint replacements do not need to restore maximum extension, as normal gait can be achieved without this

Introduction:. This study evaluates the mid-term results of first metatarsophalangeal joint replacement (MTPJR) for hallux rigidus using the Toefit-Plus™ prosthesis. Methods:. We prospectively studied the outcomes of 86 MTPJR in 73 patients using the AOFAS-HMI score and radiological follow up over a period from 2006 to 2013, with surgeries performed by a single surgeon at two centres. Patients were reviewed, scored and radiographs obtained pre-operatively and then at intervals of 6 weeks, 6 months, 12 months and then yearly. The mean follow up was 33 months (2–72). Results:. The mean AOFAS score of the patients not requiring revision at 1 year was 92, at 2 years was 94, at 3 years was 91, at 4 years was 99, at 5 years was 93, at 6 years was 100 and at 7 years was 97. 18 joints have either been revised or listed for revision giving a revision rate of 21%; this occurred at a mean of 33 months post-surgery. Reasons for revision included loosening of components in 13, infection in 1, dislocation in 2, malalignment in 1 and persistent pain in 1. Eight patients sustained intra-operative fractures requiring circlage wiring, of which 7 went on to union and one required revision. 25 patients had evidence of radiological loosening of which 22 were around the phalangeal component and 3 were around the metatarsal component. Conclusions:. First MTPJ replacement resulted in improved outcomes in patients with hallux rigidus who do not require revision in the medium term, however the revision rate is unacceptably high and as such we have discontinued use of this prosthesis. Radiological loosening of the components is high and needs monitoring for progression which may necessitate revision

Purpose: To assess moderate-term outcomes of silastic joint replacements of the first metatarsophalangeal joint. Method: The thirty-two patients (37 feet) that had silastic implants inserted were reviewed at an average of 2 years and 4 months (ranging 7 months to 5 years and 4 months). The mean patient age was 63 years. These patients answered a subjective questionnaire, had their feet examined clinically and radiographically and a pre-operative and post-operative AOFAS score was calculated for each. Results: The follow-up assessment revealed that every patient described that their pain had decreased after surgery and 17 feet (46%) were completely pain free. There was a significant improvement in patients’ subjective pain scores after surgery (t value = < 0.0001). Pre-operatively, the mean pain score for all 37 feet was 8.14, whereas post-operative the mean pain score was 1.32. The mean AOFAS score before surgery was 39.97. This increased to a mean score of 87.40 after surgery (P = < 0.0001). This again is a significant improvement. No patient was dissatisfied with the outcome with their surgery. Conclusion: These moderate term results are encouraging, with good subjective and objective results. However, long-term follow-up will be required to assess the longevity of this implant

Introduction/Purpose

A randomized clinical trial of first MTP joint hemiarthroplasty with a synthetic cartilage implant demonstrated equivalent pain, function and safety outcomes to first MTP joint arthrodesis at 2 years. Recognizing that many hemiarthroplasty and total toe implants have initially good results that deteriorate over time, the purpose of this study was to prospectively assess the safety and efficacy outcomes for the synthetic cartilage implant population and to determine if the excellent outcomes were maintained at >5 years.

Arthrodesis of the first metatarsophalangeal joint (MTPJ) has been recommended for various big toe deformities. We present a new technique of internal fixation for achieving dynamic compression at the first metatarso-phalangeal joint arthrodesis using memory compression staples. The memory compression staple is fabricated from equiatomic Nickel-Titanium (Ni-Ti) alloy. This alloy has a property by virtue of which it becomes easily malleable at a low temperature and reverts back to its original shape at a higher temperature. This property is known as the Shape Memory Effect. This principle is employed to provide compression at the arthrodesis site. Thirty feet were operated in 27 patients. There were 24 females and 3 males with a mean age of 61.2 years. Two memory compression staples were used at right angles to each other to achieve compression at the fusion site. The post-operative regime allowed full weight-bearing in a rigid sole shoe. A standard questionnaire was used for the subjective assessment, which included questions regarding level of pain, ambulation and patient satisfaction. Objective assessment was performed by a clinical and a radiological examination. Post-operatively there was a reduction in the pain score from 4.6 to 1.6 (p< 0.0001). Ambulation ability improved from 4 to 2.5 (p< 0.0001). There was 96.7% of radiological fusion with an average fusion time of 8.2 weeks. Patients reported 86.6% excellent to good results. The only significant post-operative complication was a single non-union. We advocate memory compression staples for the internal fixation of the first metatarsophalangeal joint arthrodesis, which is a low profile implant, does not require post-operative cast immobilisation and has a predictable success rate comparable to previously reported methods

We present our technique for arthrodesis of the failed Keller’s excisional arthroplasty and the results of postoperative follow-up in a series of eight patients [nine feet]. Arthrodesis of the first metatarsophalangeal joint was performed with a tricortical interposition bone graft stabilised between the first metatarsal and proximal phalanx with a mini dental plate. In all cases the indication for the procedure was for chronic pain at the first meta-tarsophalangeal joint and transfer metatarsalgia of the lateral rays. Post-operative follow-up ranged from 13– 70 months and patients were evaluated using a custom-made satisfaction questionnaire, clinical examination and evaluation of pre-and post-operative x-rays. All patients were female. The mean age of the patients was 53.2 years [range 32–69]. The post- operative questionnaire revealed that five patients [six cases] were highly satisfied with the surgery. However, we do report complications associated with the procedure including one case of deep infection and four cases in total of radiological non-union of the graft. The majority of patients were highly satisfied with the surgery, but this technique for the revision of failed Keller’s procedures has a significant risk of complications, so patients should receive appropriate counselling pre-operatively. Although the mini dental plate was low profile, its decreased rigidity may have been responsible for the four cases of non-union

Introduction. Studies have compared outcomes of first metatarsophalangeal joint (MTPJ1) implant hemiarthroplasty and arthrodesis, but there is a paucity of data on the influence of patient factors on outcomes. We evaluated data from a prospective, RCT of MTPJ1 implant hemiarthroplasty (Cartiva) and arthrodesis to determine the association between patient factors and clinical outcomes. Methods. Patients ≥18 years with Coughlin hallux rigidus grade 2, 3, or 4 were treated with implant MTPJ1 hemiarthroplasty or arthrodesis. Pain VAS, Foot and Ankle Ability Measure (FAAM) Sports and ADL, and SF-36 PF scores were obtained preoperatively, and at 2, 6, 12, 24, 52 and 104 weeks postoperatively. Final outcomes, MTPJ1 active peak dorsiflexion, secondary procedures, radiographs and safety parameters were evaluated for 129 implant hemiarthroplasties and 47 arthrodeses. Composite primary endpoint criteria for clinical success included pain reduction ≥30%, maintenance/improvement in function, and no radiographic complications or secondary surgical intervention at 24 months. Predictor variables included: grade; gender; age; BMI; symptom duration; prior MTPJ1 surgery; preoperative hallux valgus angle, ROM, and pain. Two-sided Fisher's Exact test was used (p< 0.05). Results. Patient demographics and baseline outcome measures were similar. Success rates between implant MTPJ1 hemiarthroplasty and arthrodesis were similar when stratified by hallux rigidus grade, gender, age, BMI, symptom duration, prior MTPJ1 surgery status, and preoperative VAS pain, hallux valgus and ROM (p0.05). Conclusion. Synthetic cartilage implant hemiarthroplasty (Cartiva) is an appropriate treatment for patients with hallux rigidus grade 2, 3 or 4 and is a reasonable choice in hallux rigidus in patients with < 20 degrees HVA, with a high degree of preoperative stiffness, irrespective of gender, age, BMI, hallux rigidus grade, preoperative pain, or duration of symptoms, in contrast to what might have been expected

Arthrodesis of the 1st metatarsophalangeal joint (MTPJ) is a common procedure used for the treatment of end stage arthritis. We studied a cohort of patients who underwent an isolated 1st MTPJ Fusion for the treatment of hallux rigidus. Here we report the 10-year clinical outcomes, complication rate, requirement for further surgery and patient experience.

All patients, who underwent an isolated 1st MTPJ Fusion for osteoarthritis from June 2008 until November 2011 were included. Demographics, clinical outcome data and subsequent procedures performed were collected from a departmental database (Bluespier). Patients were contacted and asked to complete the MOxFQ questionnaire and rate their satisfaction using pain, function and if they would undergo the surgery again. Mean follow up was 10.85 (range 9–12) years.

A total of 161 patients (183 feet) underwent an isolated 1st MTPJ fusion during this time period. 156 of the feet showed a successful arthrodesis (85.2% fusion rate); 27 patients required revision surgery, 19 (10.4%) for a symptomatic non-union and 8 (4.4%) for mal-union. Those patients with co-morbidities (diabetes and gout) required revision earlier than those without (p<0.01). Average MOxFQ score was 16.6 (0–64) and 28 out of the 38 (73.6%) said they would have the operation again.

Overall, the long-term results of the 1st MTPJ fusion had good outcomes with a successful fusion rate and minimal complications, both in line with the corresponding literature. In this series, fusion provided high patient satisfaction with the majority of patients opting to undergo fusion with the gift of hindsight.

Abstract

Materials and Methods: Consecutive 39 patients who underwent first metatarsophalangeal joint (MTPJ) arthrodesis for hallux rigidus were assessed clinically, radiographically and functionally at a mean follow up of 21.45 months. Clinical assessment was performed by two blinded assessors in a specially arranged research clinic. Radiological examinations were performed separately by two independent researchers on digitalised weight bearing radiographs. Functional outcome was assessed using American Orthopaedic Foot and Ankle Society (AOFAS) hallux score and a short form-12 (SF-12) questionnaire. Results: There were 19 patients who had dorsal contoured titanium plates and 20 patients who had single inter fragmentary screw fixation. Both the groups were comparable preoperatively. All except 5 patients achieved radiological fusion at a mean of 7.64 weeks. Over all rate of fusion in the present series is 87.1%. There were 4 non-unions in the plate group and one in screw group. Mean AOFAS score was 74.94 in the screw group and 70.63 in the plate group. There were no hardware problems in the single screw group. However in the plate group one patient with non-union broke the plate and another patient had back out of screws. There were no statistically significant differences in terms of pain-relief, activity-limitation, cosmetic appearance, foot wear requirements, dorsiflexion angle, hallux-valgus angle and inclination angles and SF 12 scores. Four patients in the plate group and one in screw group were unsatisfied with the surgery. Conclusions: Solid fusion has resulted in good pain relief and patient satisfaction in both groups. In the dorsal plate group 4 patients (21.6%) had non-unions, two patients had metal problems. We have stopped using the plate alone technique for the fixation of first MTPJ fusion

Introduction: In spite of the common occurrence of hallux valgus deformity and the multiple corrective procedures that have been proposed, only few studies have been published about the anatomy of this joint. None of these studies mention the existence of a meniscal structure in the first MTP joint. The fact that this structure is often seen during bunion surgery evoked this study.

Material and methods: A hunderd and two human cadaveric feet were dissected primarly to study the anatomy of the first metatarsophalangeal (MTP) joint. The anatomical findings on the specimens were correlated with clinical findings on 100 consecutive hallux valgus procedures. Particular attention was paid to the localization and histology of this meniscal structure. Based on this study, possible associations between the presence of this structure and the pathophysiology of the hallux valgus deformity and chondral lesions are proposed.

Results: A meniscal structure was present in 19 percent of the cadavers. A striking negative correlation is found between the presence of a meniscus and the extent of chondral lesions (P < 0.05). The presence of the meniscus was higher in cadavers with hallux valgus deformity (33%), however no significant correlation is found between the occurrence of hallux valgus deformity and the presence of this meniscus (P = 0.2). In our clinical study this meniscus was seen in 40% and was particularly high in younger patients with mild -painful-bunions.

Conclusions: The presence of this meniscal structure seems to stabilize the MTP joint, preventing hallux valgus (or rotational ) deformities. Once the rotational deformity increases the meniscus tears becomes painful and slips into the joint. In the more advanced hallux valgus deformity this meniscus plays little function and seems to disappear, leading to arthrosis.

Purpose of the study: The choice between preservation of the joint shape and straight cuts for arthrodesis of the metatarsophalangeal joint (MPJ) remains a subject of debate.

Material and methods: Sixty patients (74 feet), mean age 67 years, underwent fusion of the first MPJ. There were 52 women and 8 men. Follow-up was 38 months. The operation was performed with a tourniquet and locore-gional anesthesia. The procedure consisted in resection of the remaining cartilage and subchondral bone with preservation of the joint shape. Axial reduction was achieved with back-and-forth pinning the compression stapling on the dorsal aspect. The patient wore a postoperative boot for six weeks.

Results: mean time to healing was 15 weeks (rate of fusion 94.6%). The AOFAS score improved from 29.2/100 preoperatively to 77.1/100 postoperatively. 83% of patient resumed their normal activities. The mean M1P1 angle improved from 34.7° preoperatively to 23.8° postoperatively. Dorsal flexion was 26.8° postoperatively. 79.7% of patients were completely satisfied and 13.5% partially satisfied.

Conclusion: Arthrodeis of the first MPJ is a good technique for selected patients. Use of two dorsal staples for compression is more economical and gives the same rate of fusion as more sophisticated methods. Preservation of the joint shape has no influence on the rate of fusion. There is no mid-term impact on the interphalaneal joint.

Aim When first metatarsophalangeal (MTP) joint fusion is performed in the presence of a high first intermeta-tarsal angle (IMA), an important question to arise is whether the first metatarsal varus will correct with MTP fusion alone or whether an additional basal osteotomy is necessary. We compared the pre-operative IMAs to the post-operative angles to answer this question.

Method Twenty patients had a first MTP fusion for severe hallux valgus deformity performed by the senior author over a 2-year period. All were female. Mean age was 54.2 years (range 42–78). Seven patients had rheumatoid arthritis. Their IMAs were retrospectively measured on weight bearing X-rays taken pre-operatively and 6 weeks post-operatively. They were recalled for an additional measurement at a mean of 13.72 months (range 6–30).

Results Pre-operatively the mean hallux valgus angle was 46.55 degrees and the mean IMA was 16.65 degrees (range 12–26). The mean 6 week post-operative IMA was 10.35 degrees (range 6–15) with a mean improvement of 6.3 degrees (range 0–12). The mean IMA at final follow-up was 8.67 degrees (range 5–12). The mean final improvement was 8.22 degrees (range 4–14). In eight patients with a pre-operative IMA of 15 degrees or less the mean improvement was 6.13 degrees. In 10 patients with an pre-operative IMA of 16 degrees or more, the mean improvement was 9.9 degrees.

Significance First MTP joint fusion in hallux valgus deformity permanently reduces the IMA. As the pre-operative IMA increases from moderate to severe, there is a significant increase in post-operative correction. An additional basal osteotomy is not indicated.

Introduction

A randomized clinical trial of first metatarsophalangeal (MTP) joint hemiarthroplasty with a synthetic cartilage implant demonstrated equivalent pain, function and safety outcomes to first MTP joint arthrodesis at 2 years. The implant cohort continues to be followed under an extension of the original study and we report on prospectively determined 5+ year outcomes for subjects assessed to date.