The BioPro Great Toe Implant

John V. Vanore, DPM, Podiatry Institute Seminar, Atlanta 2002

Introduction: Over the past 30 years, numerous joint implants have been advocated for use in the painful and arthritic 1st metatarsophalangeal (MTP) joint. The Swanson silastic hemi implant was the first to have wide-spread clinical acceptance and usage. Later, a double-stem hinged implant and then various two-component devices were offered as alternatives. These devices had their successes and their difficulties

[1]. During this time period, several surgeon inventors also developed metallic versions of the hemi implant. Alfred Swanson’s version was very similar to his original silicone hemi implant. Townley, also a Michigan orthopedic surgeon, developed a metallic implant but with several unique features [2].

Conclusions: The author’s experience began with the Swanson silicone hemi-implant then progressed to the Swanson design and Sutter hinge implants. Two-component joint implant has been proposed, investigated, and utilized, but few investigators have found any clinical advantages to advocate use [13]. During this time, hemi metallic implants have also been in clinical use for end-stage arthrosis and joint pain. This paper demonstrates use in cases of hallux rigidus.

Over the years, the concept of joint preservation has been advanced. Today’s philosophy, compared to that of 20 to 30 years ago, is that lesser cases of joint arthrosis are treated with cheilectomy often combined with osteotomy to improve joint mechanics. First MTP joint arthrodesis is also a viable alternative for arthrosis or severe deformity. Many clinicians have been tainted by the mistakes of the past and need not condemn the judicious use of first MTP joint implants. Joint implants are still a useful clinical tool and due consideration should be given.