Big Toe Joint Replacement

How does it work?

Using guidance of intra-operative x-ray machines and special tools (burrs instead of saw-blades), many traditional foot and ankle procedures can now be performed through smaller incisions. This allows less violation to the soft-tissues and therefore a better preservation of the joint movement and a faster post-operative recovery.

The application of these techniques now involves bunion surgery, big toe arthritis surgery, surgery for the ball of the foot pain, surgery to correct the bunionette deformity and many more.

Your post-operative period

You must keep your foot raised for the first two weeks and when necessary afterwards
You can put your full weight on your foot
Use crutches if needed
Exercise big toe when dressings are removed
The swelling may last for up to six months.

Your follow-up

Nurse-led clinic at two weeks to reduce dressing and remove stitches
Consultant clinic at six weeks for x-rays
Off work for up to six weeks, depending on your job
No driving for up to six – eight weeks.

What are the possible complications?

Infection
Ongoing pain
Loosening of the implant
Need for further revision surgery
Sensitive or painful scar
Big toe permanent numbness
Joint stiffness
Clots in the leg (DVT)
Clots in the lung (PE)
Chronic Regional Pain Syndrome

Smoking, diabetes, rheumatoid arthritis or being on steroids or blood-thinning medication increases possible risks significantly.

Fusion vs Replacement

The gold standard treatment of the advanced wear and tear in the big toe joint remains the fusion. However, the fusion causes loss of the movement completely and can leave the patient with some limitations. The recovery after the fusion also usually takes a bit longer as we wait for the 2 sides of the joint to heal together.

The replacement was therefore thought of as an alternative is selected cases. The full replacement of the joint has yielded discouraging results in the literature. It also entails resection of a lot of bone and therefore makes any future surgery in this area more difficult.

The hemi-arthroplasty means replacement of only half the joint. We are performing more of this procedure now with very good results in selected cases