Great Toe Hemi-arthroplasty implant for First Joint

Hi, In June 2007 I had surgery on my right great toe.  An implant was put into my right great toe due to arthirtis.  It was called a First Metarsophalangeal Joint Hemiaroplasty with the Arthrosurface HemiCap Implant.  I was told that in a few months I would be dancing at my daughter's wedding.  That was never to be b/c of the severe pain in the big toe.   It is now March 2008 and I still have bad pain in that toe.  I cannot walk for exercise.  It doesn't matter if I have sneakers or low heeled shoes on.  The doctor said I would be able to wear my heels again - no way.

The toe gets stiff & hurts in a pair of shoes or sneaks but when I take the shoe off - it is stiff & stuck and to move it - it really is extremely painful.

Does anyone know if this is normal to still feel this way?  I was better off without the implant, in my opinion.  Any advise is greatly needed.
Thanks,
Tonice

[MikeD828]

I've had exactly the same experience.  I had an implant 7 1/2 weeks ago and am in more pain than ever.  I go to PT 2-3 times a week, take Naproxen, pain killers, ICE--you name it, it hurts!  I feel the same way--I should have lived with the arthritis.  I love to play golf and I can hardly walk.  I wake up at night in extreme pain.  It's also complicated by pain in my Achilles so the foot won't flex correctly.  I truly sympathize with your frustration.  Did you get any other comments?

Michael

[jpic]

Okay now you're scarring me I just had hemi toe implant last week, I went back to work after 3 days.  It's actually more painful now, I  think because of the healing,  What is your doctor telling you? it sounds so wrong that you can't wear a dress shoe yet - Do you still have swelling? I actually drove after 3 days, of course I can't imagine at this point even putting a sneaker on that that foot but I am only a week post surgery.

[PeePo]

Hi Tonice,
I wish I had an encouraging word for you about the Hemi Implant.
I had one place in my Left Great Toe 3 years ago, and have been in more constant and severe pain since the anesthetic wore off than I ever was before.
I had my Right ankle completely replaced 7 years ago and have very little discomfort by comparison, and that was a far mor invasive proceedure.

If anyone knows of a solution, please pass it on.
Thanks

[Longo]

Hi!
Had the full-blown Left Great Toe implant as well! I had Dr. Anderson; he did a great job considering how bad my joint was once he got inside. The implant was 5/23/08, so far all is as Dr. Anderson had mentioned but I still have stiffness and pain as well. I’m thinking that it’s just part of the long-term scope of the procedure. Unfortunately I had to come back to work to soon, (believe me my wife let me know about that), but in all since May the scar has healed-some improvement in toe movement but still fairly stiff-much shooting pains & aches both day and night. The only time I’m like new is in the morning for about an hour. Still on the pain meds due to the high frequency of shooting pains and somewhat constant aches. I predict all should be good in another 6-8 months. Progress is kind-of slow but it is the foot, on it all the time, no doubt if in Jacksonville I recommend Dr. Anderson. Don’t get discouraged all will heal just give it time – some heal different than others.

[Tonice]

Hi,
This is Tonice writing to up-date you on my toe.  Another summer has gone by and I have been unable to do any walking for in my sneakers for exercise.  When I try to walk, I need to stop b/c of the pain and then when I take the sneaker off - I can't move the toe it is so very painful.  I wore a pair of heels (2") and I had to take them off.  I could not move my toe as it hurt and was swollen.  ..  I wonder if this is ever was FDA approved for the toe.  .. I truly don't know what to do.  I went back to the doctor and he took an X-ray of the toe, never called me and when I called him he said, "oh, you now have arthirtis in the upper joint of the toe causing pain.  That is wrong as I read the radiogist's report - saying it was no different from the first X-ray before the surgery.  Does anyone feel any better?  I don't know what to do, but if we all feel worse than before - something should be done for us!!  
Tonice

[gygo2]

Ihad hemi implant on great toe June 5, 08 and my toe is totally stiff and numb. The pain is really mostly gone, but the toe does not move. If I try to move it, it is very painful. I made appt. with Dr. for 12/2. I don't know what he can do. Physical therapy did nothing.It seems like I had toe permanetly welded together. I don't believe Dr., he says it's unusual for this to occur. I was out of work for 15 weeks, so I had plenty of rest

[delman2711]

I had Arthrosurface Hemicap surgery 3 weeks ago,I am sorry to here about the suffering that many of you are going through.All I can say is that I am driving walking etc. I do get slight pains after walking but that is to be expected. I can walk three /four miles unaided and in normal shoes and trainers. A weekly psysio session as helped with the movement and relief of the stiffness of the toe.  I have 55 degree bending of the toe joint. So overall I am very impresed with the operation and results. Before the operation i had almost no movement due to the cartilage worn away and arthritis, the pain was so bad i wished they would have cut off the toe. But now I am very pleased with the results.

[lbf23]

I've had hemi toe implants in both big toes and the most important step post op is manually moving the toe to prevent the joint from becoming stiff.  It hurts like heck but in the long run it's the only way to prevent build up of scar tissue that would limit your range of motion.  I still do have some discomfort but compared to the pain I had before the surgeries I am much better.  My joints were completely fused from osteoarthritis and when the toe would get forced to bend little bony pieces would break off and add to my discomfort.  The surgery enabled my joints to move freely again and the Podiatrist was able to clean out all the bone chips.  Hope this helps!

[whultsma]

Very sorry to hear about all the pain some people are having after hemi implant surgery.  I had the implant last Friday afternoon...was off pain meds by Sat afteroon and driving by Monday.  Almost no swelling.  My doctor was superb and I followed his protocol which meant manual range of motion exercises on the toe 6 times a day...10 reps each time...forward and back...working THROUGH the pain.  I was off the crutches on Sunday...regular walking in a soft low surgical boot.  Although I will not do much walking until after the stitches come out Monday...I have been able to walk the 1/4 mile to my office....train my puppy in agility (I was not running)....and do every day house hold things with very little pain.  the key has been the range of motion exercises from the start.  I can easily imagine wearing a shoe in another week and plan to be back to competing in agility full out the first weekend in MArch.  With a good doctor I would highly recommend this surgery!  I had less than 65% off the cartlidge left and large bone spurs...so this has been SUCH a relief.   Over and out from Phoenix, AZ

[kat2020]

I had surgery - hemi-implant plus bunion,bone spurs removed and a section of bone on the long bone to big toe removed so hemi-implant wouldn't be prone to "catching" when moving.   Never hurt much in recovery stages - the arthritis,stiffness in my toe hurt so much worse before so I guess the little pain here and there during recovery wasn't a big deal.   Followed doctors orders per recovery, fifth week was told I could start wearing shoes with alot of cushioning, didn't do so well - had swelling in foot.   Went back to a surgical boot, doctor put me on prednisone pack, swelling gone and back in a SAS shoe without a problem.  It has been eight weeks  since surgery.  I love that I can bend my toe and walk without pain in that toe.  I am so glad I had this surgery.

[Sonia804]

I had the surgery done Sept 16,2009 at the va hospital bklyn...It hurt so bad could not move the big toe (great toe) sharp shooting pains .  could not excersie, walk well, drive well, or wear shoes.  Only sneakers and my toe still hurt..March 10 2010 I went under the knife again and had the implant removed and replaced with BONE CHIPS...March 25,2010 the stiches will come out and we will see what happens now.  all the best to every one.    

[jo689]

i had a bunionectomy on my left big toe 10-08 still in great pain can only were sneakers, that even hurts.,I am going back to have surgery on the 26 of may .i am haveing another dr in the group do the surgery.he told me my opitons 1st either put a smaller implant or leave it out all together ,or fuse the toe .i am really nervous. did anyone every have a law suit with this problem? what if i have more pain ,or can,t walk on it at all/?
                                                thanks joann

[sscru]

I have had both hemicaps installed on both big toe's. I was in so much pain after 3 surgeries, they finally removed the hemicaps to install a silicone implant on both. The bad part is, I still have constant pain. The only option left for me is to have a fusion done on both big toes. I also heard that the hemicap big toe implants have been removed off the market, has anyone heard about this??

[haysey]

My husband had both big toes done with hemi-cap implants over 2 years ago,and he is walking fine now, and has no pain. Before the surgery, he always was in pain walking. His doctor, Dr Ludden in Red Bank,NJ, was excellent. I am thinking of having this done now , because I have bone spurs on my big toe joints and they're getting worse now.
I guess it depends on each individual case, because he is very happy he had it done.

[GeorgeD1234]

I had the Hemi implant on my right big toe and was glad that I got it done.  Recovery involved therapy and stretching the joint so as to break up the scar tissue.  It took about a year and a half before I was able to walk with no pain at all.  I am still glad that I got it done.  Only complaint is that toe is a little shorter now. LOL

[SoreToes]

I had the hemicap surgery on my left foot great toe. My intent was to have surgery on both great toes but after nearly two years post op on the left foot I am sorry I had this surgery. My range of motion is less than before the surgery and at time it is more painful to walk than before the surgery. I feel I was mislead about what this implant would do for both my pain and range of motion.  I would never recommend this surgery to my worst enemy.

[grace1961]

looking to do the big toe implant, can i get some feedback on this surgery????????????/

[rightfoot]

Just returned home from having outpatient joint replacement on my right big toe.  No pain, no crutches, just the shoe.  Laying here applying ice packs now with little swelling.  I have a follow-up visit to my Doctor on Thurday, so I'll keep you posted.  

[slackeribew]

had a big toe replacement, cause cartilage was completely gone, it's been a year and a couple months, no relief, i.m about to the point and have  it cut off, I' ve had injections on meds nothing works, my day is laying on couch all day.hope your's comes out a lot better.

[Frostie3]

I had a partial joint replacement in the big toe.  The doctor also shortened the long bone leading to the toe.  To tie the bone together, he used a bone plate and 4 screws.  The bone plate doesn't seem to bother me.

This surgery was done nearly 10 weeks ago.  After 8 weeks, I was given the ok for applying weight, beginning to walk (in the boot cast) and to start physical therapy.

The foot is still horribly swollen.  Swelling increases as the day goes on.  The whole foot is an unnatural purple color.  The big toe will not bend at all and it hurts really bad.  At physical therapy, they are trying to get motion back into the toe.  However, by trying to force move it, I get intense pain so bad that I nearly throw up.  And the cannot get the toe to move.

Prior to surgery, I had great pain when putting on shoes or if I moved wrong.  I had to walk flat-footed.  The joint was completely worn out and I was "bone-on-bone".  But, I was learning to adapt.  Surgery was recommended to correct it and give me back my life.  Unfortunately, I'm in constant pain now as compared to intermittent.  I'm less mobile now than prior to surgery.

The doctor says that if I don't get relief from pain and some motion with physical therapy, he can do another surgery and put in the second half of the joint replacement.  If that fails, he can fuse the joint.

Considering the "down time" as well as bad reports from friends/family on multiple surgeries for the same problem, I will not consider another surgery.  My mother went through several and now she is completely lame.

I just hope and pray that things improve.  

[Frostie3]

I saw the original surgeon several weeks ago.  He stated that this was a failed surgery and that my body isn't reacting well to the implanted joint.  He said only option is to remove the joint and fuse it permanently with plates & screws.

I went to another doc for a second opinion.  The new doc felt that he could surgically free up this painful, frozen implant followed up with immediate range of motion exercises to keep it free.  I had surgery about a week and a half ago.  It feels incredible!  The nauseating pain is gone and the joint moves!!!  I'm doing range of motion exercises on a daily basis.  Each day, the toe moves just a little farther.  It was a complete success!!  I'm very grateful to this surgeon as I feel I will get my life back in very short order.

The new doc also has me elevating the foot above heart level.  There is very little swelling.  I will be seeing him tomorrow and hopefully, I will be given the "ok" for a little walking.

[berryman]

I had left big toe joint replacement 4 years ago this month. At the same time, I had the other 4 toes fixed for hammer-toes.  I'll have to say at the time that the big toe joint replacement gave me no trouble at all compared to the other middle 3 toes with pins in them. Now the 4 toes do not bother me (much) - although one is turned weird and hurts sometimes after walking, BUT the big toe hurts with every step.  I don't let that stop me - I walk at least 4-5 miles every day, and am an avid golfer. The big toe has good range of motion and does not hurt when I bend it all around, but it definitely hurts after walking - which is every day - does not usually hurt when I am off of it, but does hurt with every step.  If I had it to do over, I would not do any of this foot surgery.

[gwjdevans]

I had the exact same surgery of the right great toe in February of 2006.  After several years of misery, in Sept. 2011 I had the artificial joint removed, had bone graft to replace bone where the joint was removed, and then had the joint fused. NO MORE PAIN!  -- and now (1-1/2 years after fusion) I can wear lots of different kinds of shoes, just not stilettos.  So there is hope.  But had I done more reserarch before the surgery, I know I would not have had the hemiarthroplasty in the first place.

[sky23]

I had the hemi toe implant done on my big toe left foot back in Oct. 2011.
I also had bone spurs removed, I was told this was the best fix because I have arthirtis in my joint. I knew they very next day something was terribly wrong. I have had rods put in my back and this by far the worst surgery I have ever had. My doctor said no boot no crutches get up and walk immediately after you leave the hospital. OMG ....Its been almost 5 months and there is no relief in site. They keep taking xrays nad saying everything looks good  , hmmm well it sure doesnt feel good. The everyday pain is depressing, I just made an appoinment with a new doctor for a second opinion. I can see how someone could get addicted to pain meds. My arch has now collapsed causing even more problems along with ankle problems.
If I had read these comments I too would NOT of EVER had this surgery. :(

[pam_i_am]

I had this surgery on my great toe on January 11, 2012.  Having read this discussion thread before the surgery, I was worried about making this choice.  I'm 39 years old and a runner. I wanted to have several decades of distance running left in me.  My podiatric surgeon told me that just shaving the bone spurs would help but the more I run, the quicker the arthritis will build back up.  He said I could have it fused, but that would involve 6 weeks of non-weight bearing which I just couldn't consider because I have a 2-year-old.  The middle-of-the-road option was the hemicap which he felt would offer me relief now and give me 10 years before I needed something else, even if I ran long distances again.  I started a blog on WordPress about it called Great Toes Shrink Alike.  I posted regularly after the surgery so that people considering it would know what one person's post-op experience was.

It's now been 13 weeks, I believe.  It's far from perfect.  And I have yet to make a final determination about whether it was the right decision.  The swelling is gone.  The scar is still very visible.  The toe is stiffer than it was pre-surgery, but gradually loosening up.  I am trying to be better about "working it."  I just had my left toe done last week, but this time my podiatrist recommended the less invasive option because it wasn't nearly as arthritic as the right.  So now the hemi-cap foot is the "strong" foot and it's having to work harder than it ever has, which I think will help to loosen it up.  

I'm still optimistic that I'll get back to running by fall, if only a 5K distance.

[Sweetpea1615]

Hi Sonia, how did your surgery go with the bone chips??  I just had a plastic joint replacement in my right big toe last September.  Since then I've had nothing but problems.  My toe is 1/4'' shorter and is very painful. All of my toes hurt and my toe will not touch the ground. I'm walking on the side of my foot and only a couple pairs of shoes fit.  I just found out from another doctor that plastic joints are very really used because the material that they're made from can break down and get into your limph nodes.  I want it taken out and the doctor tells me the only thing he can do is remove it and perform a bone graft.  That sounds like what you had done.  How is your toe now???

[Sweetpea1615]

Hi, going through the same thing...I would NEVER have had a joint replacement knowing how much pain it would cause me.  I'm going to have it removed and a bone graft like you had.  I'm a little scared.  What really pisses me off is that my right big toe is 1/4" shorter than it used to be.

[Marsha1980]

I seriously need to know what Doctor you went to for the repair work, I am in so much pain after 7 months of my Hemi Implant.

Thanks!!

Marsha

[WayneBh]

I had the surgery in April 2011, I have been is so much pain. I did a year of physical therapy and I am in more pain then before the doctor has made 3 different types of orthotics to help with the pain nothing is working. I am really tired of the pain. The doctor is now talking about fusing the joint. Had anyone done it the fusion asnd does the pain get any better?

[PattyMarie]

I would like you to keep me updated on how the "bone chips" worked on your failed partial big toe replacements (hemicaps). I had hemicaps surgically placed into my right big toe Nov. 2009 and the left in Jan. 2010.  My feet go into spasms because it hurts so much to put weight on my big toes ....the big toes are over lapping my second toe are not supporting any of my  weight, thus the spasms from too much weight on the ball of my feet.

A podiatrist did the surgery and I went to a very competent orthopedic foot specialist who is recommending I have bone chips taken from my hip bone and used to fuse the big toe joint to relieve my pain.  I "think" this is what you just had done.  

I hope you are doing well and I would love to have you keep me updated on you progress.  Thanks.  Patty

[PattyMarie]

It has been recommended forme to have the bone graft, removal of the hemicaps that are in both big toes.  I have been told the hemicap surgeries failed.  I had them in 2009 and now I what would be called deformed feet.

I have gone to one of the best orthopedic foot specialists on the west coast and he is recommending the bone graft to fuse my big toe joints.  My big toes hurt so and they are overlapping my second toes and pointing into the air 3 years AFTER the hemicap implants.  the big toes do not support me and I have had "balance" problems since the hemicap surgeries. The "new" doctor is recommending removal of the hemicaps and getting bone chips from my hip bone to use to fuse my big toe joints.  

I am going to get a 2nd opinion from the orthopedic foot specialist for a professional basketball team(the Portland Trail Blazers in Portland, OR).  I am certainly NOT an athelete but I thought another orthopedic foot specialists opinion wouldn't hurt at all.

I am SO GUN SHY about any kind of foot surgery now...I may get a 3rd and 4th opinion as well.

It was very encouraging to hear that your pain has been eliminated after the toe fusion and bone graft process.

Do you have any more specifics that could help those of us considering the removal of hemicaps for bone chip grafts to fuse our big toes?  Recovery time...pain during recovery.  Does age impact recovery?  

Thanks, Patty

[snowmobiler]

How are you doing now?  I am scheduled for hemi cap surgery on my right large toe on Nov. 20, 2012.   Reading pros and cons and wondering if you are still pleased with the surgery.

[snowmobiler]

Is your husband still happy with the results from his hemi caps?  Wondering because I am scheduled for surgery on 11/20/12.  Thank you.

[9toes]

Over thirty years I have dealing with foot problem due to failed bunionomy. The surgeon cut out half the joint and cut the tendon. That was my first problem, 1977. I was 27. At that time there was two things that could be done. Either an implant (Podiatry) or a fusion with bone from the hip (Orthopedic). At that time the implant sounded less barbaric, so I had that done in 1978. They knew at that time that the implant would fail in about 10 years and it does. The pain was better and I could walk. In 1978, he did another implant and also he worked on all the toes. Man everything was screwed up!

I searched for years for good orthopedic surgeon. Little did I know that was a world class foot and ankle clinic in my back yard, in Seattle. . My doctors worked in their own system to refer patients. And it may not be in thei patint's best interest. Do not stay at home to take care of your feet even if you have to go thousands of miles to get a good doctor.

Unfortunately,. I went to the doctor in town that had been referred to me many times. Fatal error for my big toe. He insisted not only taking bone from hip to put in my big toe joint, he also put bone in the second toe joint. Then he put screws in my second, third, fourth toes. He forgot about the tourniquet that was on too long. My big toe got blood blisters all over it and turned black! Ugh! After eight months of pure terror and pain, my toe was amputated. I am still healing from it now. My toes are sticking up in the air. I think I need still another surgery to take the screws out.......

My advice to you woul be you need to get a referral to big hospital like cedar Sinai and they will help or refer you to good doctor in your area but maybe not in your town. Only let them work on one part of the foot and do not do any part until that is healed and fixed.

[PattyMarie]

Sorry it has taken me so long to reply.

What a terrible thing to face when you were 27 years old.  And it sounds like you could write a book about all you have gone through with your feet.  Losing your big toe must have been so discouraging.  So sorry that happened.  It sounds like you still are facing challenges.  Do you have doctors helping you now that you have confidence in and can trust?

A local doctor referred by more than one of my doctors ruined my toes with those hemi cap toe implants; that was 3 years ago. In our little town of 8,000 this doctor has messed up 3 other peoples' feet that I am aware of.  It is definitely referrals done by this doctor buddies.

I did as you suggested and went to doctors far and near, got the same advice to fix my sore feet from 4 different doctors.  Ended up with the orthopedic foot specialist for the Portland Trail Blazers.  He certainly does NOT exclusively do just sports medicine.  40% of this doctor's surgeries are fixing failed foot surgeries of other foot doctors.  He does 3-4 of these hemicap removal surgeries every year.  

The last doctor I went to said they needed to consult their mentor, which happened to be the Trail Blazer doctor that I had seen two days before.  That last doctor was quite relieved that I had seen the Trail Blazer doctor.

I just had the surgery on March 20th to remove the left big toe hemicap and the doctor used my hip bone material to repair the joint with the reinforced metal plate.  I had this surgery done in Vancouver, WA...I went out of state, not too far I live in Oregon.  Very nice hospital....my doctor uses a hospital in Portland and one in Vancouver.

I feel very confident in my chosen doctor's abilities.  I actually have 6 people I know that have specifically had him do their foot surgery and they think he is a genius.  A couple of them were my students, one had surgery that was born with a deformed foot and she is a dancer now.  

After surgery and I could "feel" my foot....I could tell it was successul because my foot didn't hurt any more.  My other foot that still has a hemicap hurts worse than the foot that just had surgery.  But...my hip hurts like heck but the doctor said the hip incision would hurt worse than the foot that had surgery.

I think I will wait a year before I have the other foot fixed.  Your advice to do ONE PART of your foot problems at a time was very good.  Same advice the doctor gave me last Friday at my post op appointment.

Thank you for replying to my message.  

Keep me posted on your progress.