Replacement of the First Metatarsophalangeal Joint

Osteoarthritis of the first metatarsophalangeal joint (MP1 joint) causes a painful dysfunction of the forefoot, substantial gait changes, limitation of patient's life quality, and work disability. Possible surgical therapy options for this joint degeneration are joint-preserving, joint-stabilizing, or joint-replacing techniques. Joint-preserving techniques have shown good results in the early stage of this entity but a high recurrence rate over the years. Joint-stabilizing and fusioning techniques have been the golden standard in the severe and end stages and show good to excellent long-term results. However, the use of MP1 joint replacement might be preferred in a few indications. In this paper a new modular implant system for MP1 joint replacement is presented. The Toefit-Plus (TM) system consists of nonconstrained implants for hemi-or total joint replacement. A noncemented, self-tapping fixation principle together with the osteophilic properties of the implants ensure excellent stability. Modularity allows intraoperative and secondary hemi-to total conversion and offers reasonable second lines of defense in case of failure. Indications, operative technique, and results after 48 months mean follow-up time are presented. Future research on implant design and functional rehabilitation is advised to improve the range of sometimes restricted dorsiflexion.