First Metatarsophalangeal Joint Polyvinyl Alcohol Hydrogel Implant Hemiarthroplasty: Current Operative Technique

Polyvinyl alcohol hydrogel implant hemiarthroplasty for the first metatarsophalangeal joint has been shown to be an effective, safe, motion-preserving, surgical treatment alternative to fusion for hallux rigidus in a level I, randomized controlled trial. To obtain optimal results, however, surgeons must be sure to perform the appropriate surgical technique as well as educate patients regarding pertinent risks, benefits, and the associated recovery process. Achievement of results commensurate with those published in the randomized controlled trial is predicated on an understanding of the various technical aspects of the surgical procedure, such as avoiding excessive heat during reaming, ensuring appropriate implant positioning, and appreciating the need for performing associated procedures when anatomically appropriate, as well as their potential effect on clinical outcome. This paper will review the initial technique described in 2013 and provide key clinical care suggestions resulting from the 10 years of experience with polyvinyl alcohol hydrogel implant hemiarthroplasty for the surgical treatment of hallux rigidus. Levels of Evidence: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence.