First Metatarsal Pathology: Can An Implant Provide A Long-Term Solution?

Author(s): 
By Kerry Zang, DPM, Shahram Askari, DPM, A’Nedra Fuller, DPM, and Chris Seuferling, DPM

A Closer Look At The Bio-Action Total Joint Implant
After a review of previous findings and a desire to avoid past implant failures, the Bio-Action® Total Joint Implant was created. The two-component implant was designed to address diseased cartilage surfaces and pain involving the first metatarsophalangeal joint. Made of titanium and cobalt chrome, the implant’s components act as intramedullary endoprostheses with the roughened stems applied into medullary bone.
The implant, which also features an ultra-high molecular weight polyethylene interface in the phalangeal component, replicates normal physiologic first MPJ biomechanics without sacrificing excessive articular cartilage or osseous contours. Utilizing the implant also does not require secondary fixation techniques.
The implant requires minimal osseous resection, preserves the flexor/extensor apparatus and does not interfere with the sesamoid apparatus. It maintains stable hallucal ground purchase and provides unaltered plantar articular surfaces to facilitate immediate postoperative motion and ambulation.
In the event of implant failure, surgeons are not left with a first metatarsal that is excessively short or extensively modified. Accordingly, one has options available for a successful joint salvage procedure. These options include the interposition of capsular tissue in the event of removal of both components or the use of the metatarsal component alone as an endoprosthesis, also utilizing the interposition of soft tissue. Arthrodesis of the first metatarsophalangeal joint with bone graft remains an option as well.
This system is designed to provide unchallenged, stress-free motion in all three cardinal planes for the following conditions and scenarios:
• hallux limitus or rigidus with degenerative joint disease;
• hallux abductovalgus with associated arthritis;
• rheumatoid arthritis with inflammatory joint disease;
• osteoarthritis;
• repair of subluxation and/or dislocation of the joint in conjunction with a repositional osteotomy and/or fusion of the first ray to repair metatarsus primus varus;
• a painful or unstable joint from prior surgery;
• revision of failed silicone arthroplasty; and
• difficult management situations in which clinical experience indicates that continued conservative efforts are likely to render unsatisfactory results.
The Bio-Action Implant is contraindicated in the presence of infection, inadequate vascularity, severe osteopenia, physiological or psychological patient compromise or irreparable tendon system function.

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