The clinically proven alternative to joint fusion. 

Suffering from arthritis in the big toe? Ask for the BioPro Hemi, the trusted toe replacement since 1952.3

What is Hallux Rigidus?

(Hallux): Bones that make up the big toe
(Rigidus): Rigid with little to no movement

Osteoarthritis in the big toe, known as hallux rigidus, occurs when the cartilage covering the ends of the bones (first metatarsal and proximal phalanx) wears down or becomes damaged, causing pain and limiting motion. If left untreated, eventually the bones may overgrow and fuse together on their own causing a complete loss of function.

Popular Treatment Options


A cheilectomy involves remodeling of the metatarsal head to remove painful bone spurs and is often used in mild cases. While pain relief can be expected the procedure doesn’t stop the progression of arthritis.1

Implant arthroplasty

Implant arthroplasty is primarily used in moderate to end-stage arthritis and involves resurfacing one or both sides of the joint therefore allowing motion and preventing the bones from rubbing against each other. Depending on the type of implant mixed results have been reported. A majority of studies support resurfacing one side of the joint, referred to as hemiarthroplasty.17


Fusion is used in end-stage arthritis and involves permanently fusing the two bones together, restricting any motion; thereby providing predictable pain relief. Since the bones will be permanently fused, patients are unable to wear various heel heights and gait changes can be expected.

Preserving the Big Toe Joint

The BioPro Hemi Toe Implant treats the arthritic joint by resurfacing the phalanx (low force, non-weight-bearing joint side) with a smooth, durable metal implant for the metatarsal head to articulate against. During the surgical procedure, osteophytes (bony outgrowths or bone spurs) are removed and the joint is smoothed out. This, along with minimal bone resection, allows for decompression of the joint and improved range of motion.

BioPro Hemi

  • Provides pain relief by removing bone on bone contact3,4,5
  • Immediate weight-bearing and early range of motion
  • Allows a variety of footwear choices3,5
  • Maintains normal gait by preserving or improving dorsiflexion3,5,9
  • Quick return to activity5
  • If pain persists, multiple options available including a simple revision to fusion15


  • Provides predictable pain relief once bones are fused
  • Immobilization for 6-8 weeks
  • Fused in a fixed position, which may limit footwear choices
  • Gait changes expected due to restricted motion
  • Activity levels may be affected due to restricted motion5
  • If pain persists, few options remain

Find a Surgeon

The BioPro implant has been in continuous clinical use since 1952 with numerous clinical studies averaging over 95% success. The design closely replicates the natural anatomy of the joint and removes the minimal amount of bone possible, only replacing the bone at the base of the proximal phalanx. When compared directly to fusion, BioPro patients displayed higher satisfaction rates, lower pain scores and quicker return to work and leisure activities.

How long will the implant last?

A common misconception is that implants often have to be revised after a few years. While this may be true with some implants, the BioPro Hemi has clinical data on patients over 20 years post-op.3

While our implant is recommended for moderate demand patients, it has proven to provide excellent durability even in very active patients. Listen to Philip share his experience, nine years after the procedure.

Am I a candidate?

The BioPro Hemi Is recommended for patients over the age of 50 suffering from hallux rigidus/limitus who wish to maintain motion in their big toe. BioPro cautions use if suffering from other conditions including hallux valgus and sesamoid arthritis.

Why resurface only the phalanx?

While walking or running the foot goes through a “gait cycle”. The cycle involves six main phases: heel strike, foot flat, mid stance, heel off, midswing, and toe off. Although the big toe joint is not a direct weight-bearing joint, during heel off and toe off, the metatarsal head is subject to 119% of the patient’s bodyweight2. Since the BioPro Hemi is placed on the proximal phalanx it avoids this force and simply glides up (dorsiflexion) the metatarsal head.3,4


Yes, most insurance plans cover the procedure. Unlike synthetic implants, the BioPro Hemi is considered medically necessary for patients suffering from hallux rigidus once conservative treatments have failed. It is still always recommended to get a pre-authorization from your insurance company prior to surgery.

Fill out our Find a Surgeon form to see if there is an experienced surgeon in your area. You can also download our guide to bring to your preferred foot and ankle surgeon.

Although new studies are beginning to favor hemiarthroplasty, the fusion is considered the “Gold Standard” procedure for treating Hallux Rigidus, so many surgeons prefer this procedure. Many surgeons are not aware of the clinical studies supporting our implant. Also, there are many other implants currently on the market for surgeons to choose from, so your surgeon may be using another implant.

The BioPro Hemi is a very durable implant with data on patients over 20 years post-op. While the range of motion may decrease over time, data shows it doesn’t result in meaningful discomfort or ambulatory dysfunction making the BioPro Hemi a true long-term solution.3

Just like with fusion, revision surgery may be required in cases of continued discomfort or irritation. This may be due to implant loosening, joint stiffness, or adjacent arthritis. Since the procedure removals very little bone, data shows that if revision is required, results similar to primary fusion can be expected.15

  1. Warren S. Taranow, DO and Judson R. Moore, PA-C, JD. Hallux Rigidus: A Treatment Algorithm. Techniques in Foot & Ankle Surgery   Volume 11, Number 2, June 2012
  2. Jacob HA. Forces acting in the forefoot during normal gait–an estimate. Clin Biomech (Bristol, Avon). 2001 Nov;16(9):783-92. doi: 10.1016/s0268-0033(01)00070-5. PMID: 11714556.
  3. Townley, MD, Taranow, DO. A metallic hemiarthroplasty resurfacing prosthesis for the hallux metatarsophalangeal joint. Foot & Ankle International 1994;15(11):575-80
  4. Giza E, Sullivan MR. First Metatarsophalangeal Hemiarthroplasty for Grade III and IV Hallux Rigidus Techniques in Foot and Ankle Surgery 4(1):10-17,2005
  5. Timothy Voskuijl, MD, Ron Onstenk, MD. Operative Treatment for Osteoarthritis of the First Metatarsophalangeal Joint: Arthrodesis Versus Hemiarthroplasty. The Journal of Foot & Ankle Surgery xxx (2015) 1–4
  6. Karin H. Simons, MD, Pieter van der Woude, MD, Frank W.M. Faber, MD, PhD , Paulien M. van Kampen, PhD , Bregje J.W. Thomassen, PhD. Short-Term Clinical Outcome of Hemiarthroplasty Versus Arthrodesis for End-Stage Hallux Rigidus. The Journal of Foot & Ankle Surgery xxx (2015) 1–4
  7. Clement, N. D., MacDonald, D., Dall, G. F., Ahmed, I., Duckworth, A. D., Shalaby, H. S., & McKinley, J. (2016). Metallic hemiarthroplasty for the treatment of end-stage hallux rigidus. Bone Joint J, 98-B(7), 945-951.
  8. Taranow, DO. et al. Contemporary Approaches to Stage II and III Hallux Rigidus: The Role of Metallic Hemiarthroplasty of the Proximal Phalanx. Foot and Ankle Clinics , Volume 10 , Issue 4 , 713 – 728
  9. Roukis TS, Townley, MD. BIOPRO resurfacing endoprosthesis versus periarticular osteotomy for hallux rigidus: short-term follow-up and analysis. Journal of Foot & Ankle Surgery 2003;42(6):350-8
  10. Juan C. Goez, DPM, Charles O. Townley MD, Warren Taranow, DO. An Update on the Metallic Hemiarthroplasty Resurfacing Prosthesis for the Hallux. Presented at the 56th Annual Meeting and Scientific Seminar of the American College of Foot and Ankle Surgeons. Orlando FL February 1998
  11. Charles G. Kissel, DPM, FACFAS, Zeeshan S. Husain, DPM AACFAS, Paul H. Wooley, PhD, Michael Kruger, MS, Mark A. Schumaker, DPM, Michael Sullivan, DPM, and Todd Snoeyink, DPM. A Prospective Investigation of the Biopro® Hemi-Arthroplasty for the First Metatarsophalangeal Joint. The Journal of Foot & Ankle Surgery 47(6):505–509, 2008
  12. Taranow, DO , Townley, MD. Metallic proximal phalangeal hemiarthroplasty for hallux rigidus. Operative Techniques in Orthopaedics 1999;9(1):33
  13. Christine C. Salonga, DPM, David C. Novicki, DPM, FACFAS , Martin M. Pressman, DPM, FACFAS , D. Scot Malay, DPM, MSCE, FACFAS. A Retrospective Cohort Study of the BioPro Hemiarthroplasty Prosthesis. The Journal of Foot & Ankle Surgery 49 (2010) 331–339
  14. Giza, E., Sullivan, M., Ocel, D., Lundeen, G., Mitchell, M., & Frizzell, L. (2010). First metatarsophalangeal hemiarthroplasty for hallux rigidus. International Orthopaedics, 34(8), 1193–1198.
  15. Garras, D. N., Durinka, J. B., Bercik, M., Miller, A. G., & Raikin, S. M. (2013). Conversion Arthrodesis for Failed First Metatarsophalangeal Joint Hemiarthroplasty. Foot & Ankle International, 34(9), 1227–1232.
  16. Voskuijl T, Onstenk R. Operative treatment for osteoarthritis of the first metatarsophalangeal joint: arthrodesis versus hemiarthroplasty. J Foot Ankle Surg 54:1085–1088, 2015.
  17. Robin T.A.L. de Bot, Hidde D. Veldman, Roxanne Eurlings, Jasper Stevens, Joris P.S. Hermus, Adhiambo M. Witlox, Metallic hemiarthroplasty or arthrodesis of the first metatarsophalangeal joint as treatment for hallux rigidus: A systematic review and meta-analysis,Foot and Ankle Surgery, 2021, ISSN 1268-7731,
  18. Gheorghiu, Daniel et al. Hemiarthroplasty for Hallux Rigidus: Mid-Term Results.The Journal of Foot and Ankle Surgery , Volume 54 , Issue 4 , 591 – 5932.