Polyvinyl Alcohol Hydrogel Hemiarthroplasty of the First Metatarsophalangeal Joint Augmented With 3D-printed Baseplate

Hallux rigidus is the most common arthritic pathology of the foot and is a debilitating disease that causes pain, swelling, and reduced range of motion. Although arthrodesis is the gold standard treatment option, a soft hemiarthroplasty implant, the polyvinyl alcohol (PVA) hydrogel, has been designed to preserve motion in the first metatarsophalangeal joint and alleviate pain. Made from synthetic PVA and saline, the index noninferiority trial showed satisfactory clinical outcomes. However, this result was not reproducible by others with implant subsidence being a common concern. In this surgical technique, we describe a novel modified approach which involves PVA hemiarthroplasty of the first metatarsophalangeal joint, 3-dimensional-printed baseplate and Akin osteotomy to ultimately prevent likely implant failure.