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REPLACEMENT OF THE FIRST METATARSOPHALANGEAL JOINT

Method
Implantation of a replacement for the first metatarsophalangeal joint
Duration
60 to 90 minutes
Recovery time
6 to 12 weeks

Replacing the first metatarsophalangeal joint is a movement-preserving procedure for treating advanced osteoarthritis (hallux rigidus) of that joint. Unlike a fusion, the replacement preserves movement and allows a more natural roll-off when walking.

Modern implants are made of high-quality materials such as titanium, ceramic or special plastics and are designed to imitate the natural biomechanics of the first metatarsophalangeal joint as closely as possible. The operation is carried out in patients for whom conservative measures are no longer sufficient but who do not yet need a complete fusion.

How does a replacement of the first metatarsophalangeal joint work?

After an incision over the first metatarsophalangeal joint the joint is exposed and the destroyed cartilage removed. The joint surfaces are prepared precisely so that the components of the implant can be placed to best effect. The implant consists of two parts: one component for the metatarsal bone and one for the proximal phalanx of the big toe.

The components are fixed in the bone with special cements or by press-fit fixation. After implantation the movement of the joint is tested and the wound closed. Rehabilitation begins on the first day after the operation with careful mobilisation exercises.

Rehabilitation after a replacement of the first metatarsophalangeal joint

Aftercare following a replacement of the first metatarsophalangeal joint aims to restore movement and allow pain-free weight-bearing. Early mobilisation is important for long-term success.

Phase I (weeks 1 to 4): early mobilisation

The first phase of rehabilitation concentrates on restoring movement and reducing swelling. Gentle mobilisation exercises are possible on the very first day.

Phase II (weeks 5 to 8): building up load

The second phase comprises exercises to stabilise and strengthen the muscles of the foot and a step-by-step return to everyday activities.

Phase III (weeks 9 to 12): full weight-bearing

Phase III focuses on taking up normal loading again and on integrating the foot fully into everyday life. Sporting activities can be resumed step by step.

Phase IV (from week 13): long-term care

The final phase aims to restore full load-bearing capacity and to allow all activities without restriction. Regular check-ups are important for the long-term function of the implant.