Understanding the Different Types of Toe Implants for Big Toe Arthritis (Hallux Rigidus)

Big toe arthritis, or Hallux Rigidus, is a condition that can make everyday activities like walking and wearing shoes incredibly painful. It occurs when the cartilage in the big toe joint wears away, leading to stiffness, swelling, and limited mobility. For many patients, surgery involving toe implants is a game-changing solution to restore function and reduce pain.

In this post, we’ll explore the materials and types of implants available for the treatment of Hallux Rigidus to help you better understand your options.

Materials Used in Toe Implants

 Modern toe implants are crafted from a range of materials, each with its own advantages. It is important to choose a material that has a safe and proven history.

Cobalt Chrome

  • What it is: A metal alloy that is strong and resistant to wear.
  • Benefits: Excellent durability and proven to be the best wear surface for implants.1 It has been the material of choice for implants that have an articulating (moving) surface, such as hips, knees, thumbs, and toes.
  • Considerations: Cobalt Chrome is an excellent biocompatible material with a long history of safe use in joint replacements. However, as Cobalt Chrome contains a small amount of nickel, it may not be suitable for patients with nickel sensitivity. If you are unsure, you can take a blood test to confirm. Reactions to inexpensive jewelry, watches, belt buckles, etc., can be an indication of a nickel sensitivity, so be sure to discuss these with your doctor.

Titanium

  • What it is: A lightweight, highly biocompatible metal.
  • Benefits: Like Cobalt Chrome, Titanium provides excellent durability. It has been shown to provide great osseointegration (bone in-growth) properties and is a go-to choice for implants that need to in-grow into bone.
  • Considerations: Titanium is a great option for patients that have nickel sensitivity and can’t receive cobalt chrome implants. It has a long history of safe and effective use.

Silicone

  • What it is: A soft, flexible synthetic material.
  • Benefits: Silicone implants are soft and flexible, making them a good choice for implants. It is often used for patients with lower activity levels.
  • Considerations: It is not as durable as metal options and could wear down or break over time. It is mainly used in one piece implants that don’t articulate (move) against bone.

Polymer (Cartilage Replacement)

  • What it is: A synthetic material designed to mimic the natural cartilage in the joint.
  • Benefits: These implants provides a smooth, cushion-like surface for joint movement, causing minimal wear against the bone.
  • Considerations: While the thought behind the material is great, many studies have shown very high failure rates.5 As the cartilage on the opposite side of the bone wears down, the implants can start to fracture and create wear debris. Some of these implants are being pulled from the market due to the high failures.

Types of Toe Implants

Choosing the right type of implant depends on the severity of arthritis, lifestyle needs, and surgeon recommendations. Here are the main categories:

Hemi Implants

  • What it is: Hemi Implants replace one side of the joint with a smooth, durable implant. The BioPro Hemi Toe Implant for Hallux Rigidus has the longest clinical history with 70-plus years of use.
  • Who it’s for: These implants are ideal for patients with mild to moderate arthritis who still have some motion they are trying to preserve. It can be used in end-stage arthritis as well. However, it may be difficult to achieve an optimal range of motion.
  • Advantages: Hemi implants have several advantages including preserving natural joint movement, minimal bone removal, and proven durability. The BioPro Hemi Implant has clinical data with patients 20-30 years post-op.
  • Limitations: It may not be suitable for advanced arthritis cases.

Cartilage Replacement Implants

  • What it is: A synthetic polymer material is implanted to cushion the joint.
  • Who it’s for: It was designed for patients in the early stages of arthritis with minimal bone damage. However, it is no longer recommended.
  • Advantages: It requires minimal bone removal.
  • Limitations: While initial studies were promising, new studies show high failure rates resulting in removal from the market.5

One-Piece Silicone or Silastic Implants

  • What it is: A single-component implant that replaces the entire joint.
  • Who it’s for: Silicone implants are ideal for patients with significant arthritis who need full joint replacement and are not high demand.
  • Advantages: Most designs allow for good flexibility and range of motion.
  • Limitations: It may have to be replaced over time as the silicone material breaks down.

Total Two-Piece Implants

  • What it is: A two-part system with separate components for the base of the big toe (proximal phalanx) and the metatarsal head.
  • Who it’s for: Patients seeking maximum range of motion.
  • Advantages: Total two-piece implants allow for improved range of motion.
  • Limitations: While higher range of motion may be achieved with total implants, it comes at a cost. The failure rates for total implants are high and also requires more bone removal which can cause issues if it ever needs to be revised to a fusion.4

Which Implant is Right for You?

The ideal implant for treating Hallux Rigidus depends on:

  • The stage of arthritis.
  • Your activity level and lifestyle.
  • Surgeon recommendations based on imaging and clinical evaluation.

Things to Discuss with Your Surgeon:

  • What implant has the longest clinical history?
  • What can you expect in terms of recovery and implant longevity?
  • Are there specific lifestyle modifications you’ll need after surgery?

There are many treatments for Hallux Rigidus (big toe arthritis) on the market. Not all implants have strong clinical data. It is important to research your options and speak with an experienced medical professional. You can search for experienced surgeons in your area at bioproimplants.com/find-a-toe-surgeon.

If you’re struggling with big toe arthritis, don’t hesitate to consult with a foot and ankle specialist to explore whether a toe implant is the right solution for you. With the right care, you can step back into a pain-free life.

References

  1. https://pubmed.ncbi.nlm.nih.gov/8083256/
  2. https://www.arthroplastyjournal.org/article/S0883-5403(17)31030-6/abstract
  3. https://www.jfasap.com/doi/pdf/10.5005/jp-journals-10040-1316
  4. https://www.sciencedirect.com/science/article/abs/pii/S0958259216300360
  5. https://www.sciencedirect.com/science/article/pii/S2667396723000940