Prosthetic replacement of the first metatarsophalangeal joint.

As an alternative to Keller bunionectomy, Silastic implant replacement, and cheilectomy of the first metatarsophalangeal joint, a custom implant was designed at the Hospital for Special Surgery. Between April 1985 and January 1987, 15 implants were placed in 12 patients. Of these patients, 9 were available for follow-up, 2 were lost to follow-up, and 1 patient had died. A high rate (54.5%) of loosening is observed. Subjective, good, and excellent results were seen in 4 of the 11 feet studied. Further modification of the prosthesis and its fixation method is currently being considered.