Long-term experience with total joint prosthetic replacement for the arthritic great toe.

A report on the use of 130 double-stemmed flexible hinge silicone elastomer implants as total joint replacements for the metatarsophalangeal (MTP) joint of the great toe in 98 patients since 1971. Of the total number of patients involved, 11 were men and 87 were women; the average age per joint was 57 years. The report is based on a minimum follow-up of 12 months, an average follow-up of 9.4 years, and a maximum follow-up of 16 years. Seven patients (10 joints) were lost to follow-up. In the 57 patients with osteoarthritis, 81 joints were replaced; in the 30 patients with rheumatoid arthritis, 37 joints were replaced. Five patients were revised from a failed excisional hemiarthroplasty, and four patients (with five joints involved) were revised from a failed silicone implant hemiarthroplasty. Two patients had a surgically arthrodesed MTP joint taken down and revised to a total joint arthroplasty. The results were graded excellent, good, fair, or poor based on relief of pain and cosmesis. The overall results were good. On the basis of these findings, the author concludes that there is a place for total joint prosthetic replacement with this device in the surgical reconstruction of the painful, destroyed MTP joint of the great toe.