TechniquesFirst Metatarsophalangeal Joint Polyvinyl Alcohol Hydrogel Implant Hemiarthroplasty: Current Operative TechniqueYounger, Alastair S.E. MB, ChB, ChM, MSc, FRCSC*; Glazebrook, Mark A. MSc, PhD, MD, FRCSC†,‡; Daniels, Timothy R. MD, FRCSC§; Wapner, Keith L. MD, FAAOS, FACS∥; DiGiovanni, Christopher W. MD¶,#; Baumhauer, Judith F. MD, MPH** Author Information *Department of Orthopaedics, Division of Distal Extremities, University of British Columbia, Vancouver, BC †Department of Surgery, Dalhousie University ‡Queen Elizabeth II Health Sciences Center, Halifax, NS §Division of Orthopaedic Surgery, St. Michael’s Hospital and University of Toronto, Toronto, ON, Canada ∥Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, and Pennsylvania Hospital, Philadelphia, PA ¶Department of Orthopaedic Surgery, Massachusetts General Hospital & Newton Wellesley Hospital, Boston #Harvard Medical School, Cambridge, MA **Department of Orthopaedics, University of Rochester School of Medicine and Dentistry, University of Rochester, Rochester, NY All authors received consulting fees, speaker fees, and/or support for travel expenses from Wright Medical Technology (Cartiva Inc.) relevant to the work under consideration for publication. A.S.E.Y. received research funding and consulting fees from Acument Inc.; research funding, consulting fees, and speaker fees from Ferring Pharmaceuticals; education, consulting, and speaker fees from Wright Medical Technology; research funding and consulting fees from Zimmer Inc.; speaker fees from CONMED Linvatec and Stryker; and research funding from COA—Hip Hip Hooray, University of British Columbia, St. Paul’s Hospital Foundation, American Orthopaedic Foot and Ankle Society; Canadian Orthopaedic Research Legacy Fund, Orthopaedic Research Excellence Fund, Integra Life Sciences Corporation, Smith and Nephew, Synthes, DePuy, and Amniox Medical Inc.; all outside the scope of the submitted work. M.A.G. received research/institutional support and consulting fees from Wright Medical Technology (BMTI) outside the scope of the submitted work, research support, and consulting fees from Stryker, and consulting fees from Bioventous, 3M, and ConMed outside the scope of the submitted work. T.R.D. received grants, consulting fees, and royalties from Integra, an unrestricted research grant, consulting fees, and support for travel expenses from Stryker, and an honorarium from the Journal of Bone and Joint Surgery (American) outside the scope of the submitted work. C.W.D. received royalties for devices and stock options from Extremity Medical Inc. outside the scope of the submitted work. J.F.B. received consulting fees outside the scope of the submitted work from DJO, Stryker, Nextremity Solutions, and Wright Medical Technology. Address correspondence and reprint requests to Alastair S.E. Younger, MB, ChB, ChM, MSc, FRCSC, Footbridge Centre for Integrated Orthopaedic Care, 181 Keefer Place, Suite 221, Vancouver, BC, Canada V6B 6C1. E-mail: [email protected]. Techniques in Foot & Ankle Surgery: March 2022 - Volume 21 - Issue 1 - p 30-39 doi: 10.1097/BTF.0000000000000294 Buy Metrics Abstract Polyvinyl alcohol hydrogel implant hemiarthroplasty for the first metatarsophalangeal joint has been shown to be an effective, safe, motion-preserving, surgical treatment alternative to fusion for hallux rigidus in a level I, randomized controlled trial. To obtain optimal results, however, surgeons must be sure to perform the appropriate surgical technique as well as educate patients regarding pertinent risks, benefits, and the associated recovery process. Achievement of results commensurate with those published in the randomized controlled trial is predicated on an understanding of the various technical aspects of the surgical procedure, such as avoiding excessive heat during reaming, ensuring appropriate implant positioning, and appreciating the need for performing associated procedures when anatomically appropriate, as well as their potential effect on clinical outcome. This paper will review the initial technique described in 2013 and provide key clinical care suggestions resulting from the 10 years of experience with polyvinyl alcohol hydrogel implant hemiarthroplasty for the surgical treatment of hallux rigidus. Levels of Evidence: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.