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Great Toe Replacement with Synthetic Cartilage

What is Great Toe Replacement with Synthetic Cartilage?

Great toe replacement with synthetic cartilage is a surgical procedure for the treatment of great toe arthritis in which damaged sections of the great toe joint are removed and replaced with an artificial component (synthetic cartilage implant). This is done to relieve pain and restore normal range of motion and function of the great toe and foot. The great toe is also referred to as “big toe” or “hallux.”

Great toe arthritis (hallux rigidus) is a form of degenerative arthritis at the metatarsophalangeal or MTP joint where the base of your big toe attaches to the foot. Arthritis is the inflammation of joints as a result of degeneration of the smooth cartilage that lines the ends of bones in a joint. This degeneration of cartilage leads to painful rubbing of the bones, swelling, and stiffness in the joints, resulting in restricted movement. Hallux rigidus is also called stiff big toe.

Indications for Great Toe Replacement with Synthetic Cartilage

Great toe replacement with synthetic cartilage is mainly indicated for the treatment of hallux rigidus and conditions such as:

  • Pain and stiffness of the great toe
  • Swollen and inflamed toe
  • Damaged or worn-out cartilage
  • Formation of bone spurs on the great toe joint
  • Narrowing of joint space
  • Rubbing of the raw bone ends
  • Eventual non-flexion of the great toe  
  • Foot pain is interfering with daily activities
  • Failure of non-surgical approaches such as physical therapy and medications to provide relief

Preparation for Great Toe Replacement with Synthetic Cartilage

Preoperative preparation for great toe replacement with synthetic cartilage may involve the following steps:

  • A thorough examination is performed by your doctor to check for any medical issues that need to be addressed prior to surgery.
  • Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and imaging to help detect any abnormalities that could threaten the safety of the procedure.
  • You will be asked if you have allergies to medications, anesthesia, or latex.
  • You should inform your doctor of any medications, vitamins, or supplements that you are taking.
  • You should refrain from medications or supplements such as blood thinners, aspirin, or anti-inflammatory medicines for 1 to 2 weeks prior to surgery.
  • You should not consume any solids or liquids at least 8 hours prior to surgery.
  • Arrange for someone to drive you home after surgery.
  • A written consent will be requested from you after the surgical procedure has been explained in detail.

Procedure for Great Toe Replacement with Synthetic Cartilage

  • Great toe replacement surgery with synthetic cartilage is performed under general anesthesia. 
  • During the procedure, an incision is made over the great toe to expose the joint. 
  • Your surgeon will remove only the damaged portions of the joint. Utilizing special instruments, your surgeon will then prepare the articulating surfaces of the bone joint for insertion of the synthetic cartilage implant. The synthetic cartilage implant is a tiny cylindrical plug with physical properties similar to those of articular cartilage with a compressible and low friction surface and is placed in between the two sides of the arthritic joint. 
  • Once the synthetic cartilage implant is confirmed to have been properly fixed in place, your surgeon closes the incision. 
  • The synthetic cartilage implant provides a smooth surface to the joint, allowing it to move freely, relieving pain and stiffness and improving function.

 Postoperative Care and Instructions

In general, postoperative care instructions and recovery after great toe replacement with synthetic cartilage may involve the following steps:

  • You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs as you recover.
  • You may notice some pain, swelling, and discomfort in the foot area. Pain and anti-inflammatory medications are provided as needed.
  • You are advised to keep your foot elevated as much as possible while resting to reduce swelling and pain.
  • Your foot will be secured with a dressing. Later, assistive devices such as a boot or a cast are applied for protection and to facilitate healing, along with instructions on restricted weight-bearing.
  • You may need to stay in the hospital until you are able to safely walk with a cane, walker, or crutches.
  • Keep the surgical site clean and dry. Instructions on surgical site care and bathing will be provided.
  • Refrain from smoking as it can hinder the healing process.
  • Refrain from strenuous activities for the first few months and lifting heavy weights for at least 6 months. Gradual increase in activities over a period of time is recommended.
  • An individualized physical therapy protocol may be recommended to help strengthen foot muscles and optimize foot function.
  • Most patients are able to resume their normal activities in a month or two after surgery; however, return to sports may take at least 6 months or longer.
  • Refrain from driving until you are fully fit and receive your doctor’s consent.
  • Periodic follow-up appointments will be scheduled to monitor your progress.

Risks and Complications

Great toe replacement surgery with synthetic cartilage is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:  

  • Damage to surrounding tissue
  • Bone or joint irritation
  • Bone loss
  • Pain and discomfort
  • Joint stiffness
  • Infection
  • Numbness
  • Swelling and inflammation
  • Scarring and delayed healing
  • Thromboembolism or blood clots
  • Revision surgery
  • Need for additional surgery