Metatarsophalangeal Prosthesis of the Hallux
Metatarsophalangeal arthroplasty with a spherical pyrocarbon implant is offered in cases of metatarsophalangeal osteoarthritis of the hallux, or hallux rigidus, when the joint cannot be preserved.
Why a metatarsophalangeal prosthesis of the hallux?
The metatarsophalangeal prosthesis of the hallux is a functional procedure, its goal is to reduce your pain while preserving mobility of the big toe, called the "hallux." The decision to undergo surgery is yours, and depends on your level of disability. Regardless of your age, gender, or activity level, the purpose of this procedure will be to improve your quality of life.
The procedure will help relieve pain in your joint, improve your functional performance, and allow you to stop pain medication. In some cases, it may also provide relief if you have pain in other joints of the foot and/or ankle.
You will play the main role in your recovery, and we will be by your side to guide you. Carefully following the advice you are given will help reduce the risk of complications, which are always possible after a surgical procedure.
What is a metatarsophalangeal prosthesis of the hallux?
We use a spherical prosthesis made of pyrocarbon or pyrolytic carbon. Pyrocarbon is a ceramic obtained from a graphite substrate heated to 1400°C; it has long been used in cardiac surgery, and for about twenty years in prosthetic surgery of the hand and wrist. It has exceptional characteristics such as a very low coefficient of friction, a modulus of elasticity almost equivalent to that of cortical bone, and it is considered "wear-resistant" and perfectly biocompatible.
With this implant, there is no osteointegration, which limits the post-operative risk of mechanical complications, notably prosthetic loosening.
Your consultation with the surgeon
Following an interview (where risk factors for scarring complications will be investigated: diabetes, smoking, obesity, corticosteroid use, etc.), and a clinical and radiological examination of your foot, the surgeon will tell you, depending on your disability, if a metatarsophalangeal prosthesis of the hallux could improve your quality of life. The consultation with the surgeon is an important moment to ensure your expectations match what the surgery can provide.
The alternative to the metatarsophalangeal prosthesis of the hallux is arthrodesis; your surgeon should explain to you the advantages and disadvantages of these two techniques. The details of this alternative will be explained to you during the consultation with your surgeon and at the time of signing the informed consent.
Your consultation with the anesthetist
The consultation with the anesthetist aims to learn about your medical history and to personalize your medical and surgical care. The anesthetist will choose the anesthesia and analgesia techniques best suited for you. They will tell you which treatments to continue and which must be stopped before the procedure. In general, care is provided on an outpatient basis, and the anesthesia is regional, meaning anesthesia of the foot and ankle. Sedation is offered for your comfort during the procedure.
This is the time to ask any questions you may have about pain management. There are several treatments and techniques that can be combined to address the temporary discomforts of the operation. An infectious screening assessment may be prescribed depending on your medical history: this involves searching for and eradicating dental, urinary, gynecological infectious sites, etc.
Surgical technique used
The placement of the prosthesis requires entry into the hallux joint; the anatomical pathway to access it is called the surgical approach. We usually use a medial approach to be able to release the entire joint if necessary, avoid the risk of adhesion of the hallux extensor, and achieve a satisfactory cosmetic result.
The placement of a metatarsophalangeal prosthesis of the hallux is a minimally invasive technique. The skin incision will measure between 3 and 5 cm depending on your body type, but also the stiffness of the tissues, mainly in cases of hallux rigidus (osteoarthritis of the big toe). The procedure is performed in the supine position (lying on your back).
This procedure is painless in 80% of cases; in 20% of cases, level 1 painkillers (paracetamol) and anti-inflammatories are enough to relieve the painful sensation.
At the end of the procedure, you will have a dressing with an orthopedic shoe that you will wear for 21 days, which you can start walking on from the first day.
Depending on the perioperative conditions, technical adjustments may be made.
During the procedure, and with your prior consent, we may take photographs that will be used for scientific purposes (presentations, conferences, publications).
Your preparation before the procedure
If you are overweight, losing weight, even just a few kilograms, will always be beneficial for your joints. Imagine that when you walk, the equivalent of 5 times your body weight passes through your ankle. We recommend consulting a dietitian or a nutritionist doctor to guide and monitor you.
If you are a smoker, take this opportunity to quit smoking. Tobacco greatly increases the risk of infectious complications, healing complications, and vascular thromboses (phlebitis). Quitting smoking 6 weeks before and 6 weeks after surgery reduces the rate of postoperative complications.
Your surgeon will show you self-rehabilitation exercises to help maintain the muscles of your lower limb before and after the procedure.
Your stay at the Saint George clinic in Nice
You will be admitted as an outpatient for the placement of your metatarsophalangeal prosthesis of the hallux at the Saint George clinic. Our goal is to help you quickly become independent.
You must fast 6 hours before the time of the procedure (no solids, no liquids, no smoking).
It is completely normal to feel a little anxious before your operation. If you are very anxious, you must let us know, and we will offer you a treatment to help you relax before the operation.
The operation will last between forty minutes and one hour, and you will leave the operating room with your dressing.
After the procedure, you will be monitored in the recovery room until you are fully awake, in case sedation was used during the intervention.
Your first time standing will take place on the same day as the procedure with the help of another person (nurse, surgeon, or physiotherapist).
Upon your return to the room, you will be offered a snack, then a meal. Eating reduces nausea, improves the return of bowel function, and gives you the necessary energy for healing. Afterwards, your diet should be balanced, without increasing your intake of dairy products. Your surgeon will give you precautions regarding certain positions of your operated limb.
This is not a speed contest, but it is in your best interest to start moving around in the first few days after the procedure with the help of another person if necessary. Remaining still out of fear of pain eventually makes any movement painful. Moreover, the regular walking that has been recommended to you facilitates blood circulation and minimizes the risk of thromboembolic complications.
The physiotherapist and your surgeon will advise you on actions to take and those to avoid before your discharge home on the same day.
The return home
Returning home can be done the same day or after a 24-hour hospitalization in some cases.
Rehabilitation by a local physiotherapist may be necessary.
Anticoagulant treatment will be prescribed for 1 to 3 weeks to prevent the risk of phlebitis.
Resumption of activities
Driving can be resumed after the 6th week for the right foot, or immediately if you had surgery on the left foot and you have an automatic car. Your surgeon will give you the green light.
Resuming sports activities will be possible under certain conditions, starting from 45 days.
You may continue to make functional progress for up to 1 to 2 years after the procedure, which is when you’ll reach the final result of your hallux metatarsophalangeal implant.
Finally, you will be able to lead a normal life and will be monitored by your surgeon. The schedule for follow-up visits during the first year will be given to you by your surgeon, and then you will need check-ups every 2 years, including X-rays and possibly a scan. You should be careful in case of infection risk (promptly treat any urinary, gynecological, dental, skin, or ENT infection…), and avoid brushing your teeth too vigorously to limit gum bleeding that could cause bacteremia.
Hallux metatarsophalangeal prostheses are currently being evaluated by the orthopedic learned societies. After your procedure, you may be contacted to answer a satisfaction questionnaire and have X-rays of your feet taken.