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Old 06-10-2011, 10:07 AM   #1
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coffeegal377 HB User
Big Toe Fusion or Implant?

Hello,
I have certainly learned alot from reading other posts on this board, but I would also like to get feedback on my question of whether to have big toe fusion or the implant.

Both of my big toes have degenerative arthritis, but the left toe is by far the worst. It really got worse when I got a new job (big box retail) two years ago. I saw a podiatrist then and he gave me a note for work and recommended surgery, but the health insurance through work wouldn't cover it. Ten months ago I had to quit that job because I could no longer work on my feet all day and the manager refused to move me to a different, less strenuous department. I am fighting UI for a 'medical quit' determination; I figured my future ability to walk was worth more than minimum wage.

Anyway, that's beside the point of this post. I have been unemployed for ten months and am now so destitute that I qualify for a state program, so I signed up. The first orthopedic surgeon I saw two months ago discussed my options as either a joint replacement or a fusion. She thought I'd be a good candidate for the joint replacement because I am in general good health, am 61 and very active, and I have a high expectation of post-surgery mobility. I told her I would like the surgery in early summer because I felt getting around post-op would be easier. When I saw her again earlier this week to schedule and discuss the surgery in more detail, she told me she was moving to a new city and wasn't taking any new surgery patients.

She referred me to another orthopedic surgeon at the same hospital and I was able to see him the next day. I thought I was just going to meet a different surgeon who would do the surgery that the first DR recommended. But he was skeptical about the implant and ordered additional x-rays. When he looked at them, he said the two small bones underneath the big toe joint were also arthritic and he felt the implant wouldn't have a high success rate and his recommendation was fusion. He said if he did the joint and it later failed, there wouldn't be enough bone left for a fusion and he would have to go into my hip to get a bone graft for the fusion, which would be a much more complicated surgery and longer recovery. Argh!

I was pretty upset. Why hadn't the first DR told me all this? I had already got my head around the joint replacement, which for someone who doesn't doctor much was no small thing. I also liked the shorter recovery of the implant vs. fusion, since you are not waiting for bone to grow (fuse) and you can do minor weight-bearing exercises right away after the implant.

As I said, I'm pretty active and I'm going back to school this fall so I don't have to work for minimum wage any more. But I'm in constant pain and cannot do many of the things I love to do (like walk my dog) or need to do (like go to school or work.) Even minor house work leaves me in such pain I'm popping Tylenol like mints. I live alone and am generally pretty independent. The prospect of eight to ten weeks of immobility (and not driving!) after the fusion scares me. I am totally confused.

The second DR recommended I get a third opinion, because I kept pushing him on the implant and he was holding fast for the fusion. He gave me a referral and I agreed, but now I'm not so sure. If DR #3 says implant, who will do it? And do I want to go against DR #2's advice? If DR #3 says yep, fusion, well, there you have it, and I've wasted everyone's time. It feels hard to get straight answers and lay out the pro's and con's of each option.

Re: Fusion vs. implant. Why did you choose one or the other? Did you have a choice? What did your DR say w ere the advantages/disadvantages? Are you happy with your decision? Ay input on the relative recovery rates of the two options?

Thanks and love,
coffeegal377

 
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Old 06-10-2011, 11:46 AM   #2
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Re: Big Toe Fusion or Implant?

As a person who is facing her second cheilectomy next week and then a redo on a previous one, let me give you some advise. DO NOT DO THE IMPLANT. The success rate is very low for this procedure.

Another alternative is resurfacing, which is a relatively new procedure for the toe. They have been doing this on knees and hips for a long time. The specific one that I am looking into is called Arthrosurface and you can do a search for it. I am very definitely going to go this route for the redo on my left foot. I have done a lot of research on this and the doctor so am comfortable with it.

Another suggestion, your profile doesn't say exactly where in WI you are so I'll have to be somewhat generic here. Contact the closest professional football or basketball team or major college athletic department (Packers, U of WI, etc) or professional ballet company and ask who they use for foot issues.

Good luck and come back with any questions.

 
Old 06-10-2011, 06:32 PM   #3
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Re: Big Toe Fusion or Implant?

I would also not recommend the implant. I got one 4 years ago, and now am in the process of making plans to getting it removed.
it's causing me to walk on the outer edge of my foot. it also has caused bone loss.
if a doctor pushes for it..run the other direction

 
Old 06-12-2011, 08:00 PM   #4
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Re: Big Toe Fusion or Implant?

Quote:
Originally Posted by coffeegal377 View Post
Hello,
I have certainly learned alot from reading other posts on this board, but I would also like to get feedback on my question of whether to have big toe fusion or the implant.

Both of my big toes have degenerative arthritis, but the left toe is by far the worst. It really got worse when I got a new job (big box retail) two years ago. I saw a podiatrist then and he gave me a note for work and recommended surgery, but the health insurance through work wouldn't cover it. Ten months ago I had to quit that job because I could no longer work on my feet all day and the manager refused to move me to a different, less strenuous department. I am fighting UI for a 'medical quit' determination; I figured my future ability to walk was worth more than minimum wage.

Anyway, that's beside the point of this post. I have been unemployed for ten months and am now so destitute that I qualify for a state program, so I signed up. The first orthopedic surgeon I saw two months ago discussed my options as either a joint replacement or a fusion. She thought I'd be a good candidate for the joint replacement because I am in general good health, am 61 and very active, and I have a high expectation of post-surgery mobility. I told her I would like the surgery in early summer because I felt getting around post-op would be easier. When I saw her again earlier this week to schedule and discuss the surgery in more detail, she told me she was moving to a new city and wasn't taking any new surgery patients.

She referred me to another orthopedic surgeon at the same hospital and I was able to see him the next day. I thought I was just going to meet a different surgeon who would do the surgery that the first DR recommended. But he was skeptical about the implant and ordered additional x-rays. When he looked at them, he said the two small bones underneath the big toe joint were also arthritic and he felt the implant wouldn't have a high success rate and his recommendation was fusion. He said if he did the joint and it later failed, there wouldn't be enough bone left for a fusion and he would have to go into my hip to get a bone graft for the fusion, which would be a much more complicated surgery and longer recovery. Argh!

I was pretty upset. Why hadn't the first DR told me all this? I had already got my head around the joint replacement, which for someone who doesn't doctor much was no small thing. I also liked the shorter recovery of the implant vs. fusion, since you are not waiting for bone to grow (fuse) and you can do minor weight-bearing exercises right away after the implant.

As I said, I'm pretty active and I'm going back to school this fall so I don't have to work for minimum wage any more. But I'm in constant pain and cannot do many of the things I love to do (like walk my dog) or need to do (like go to school or work.) Even minor house work leaves me in such pain I'm popping Tylenol like mints. I live alone and am generally pretty independent. The prospect of eight to ten weeks of immobility (and not driving!) after the fusion scares me. I am totally confused.

The second DR recommended I get a third opinion, because I kept pushing him on the implant and he was holding fast for the fusion. He gave me a referral and I agreed, but now I'm not so sure. If DR #3 says implant, who will do it? And do I want to go against DR #2's advice? If DR #3 says yep, fusion, well, there you have it, and I've wasted everyone's time. It feels hard to get straight answers and lay out the pro's and con's of each option.

Re: Fusion vs. implant. Why did you choose one or the other? Did you have a choice? What did your DR say w ere the advantages/disadvantages? Are you happy with your decision? Ay input on the relative recovery rates of the two options?

Thanks and love,
coffeegal377
I would also tell you not to do the replacement implant, they have a very high failure rate and a lot of doctors will not even do them because of the high failure rate.

I'm telling you this firsthand--I had an implant done in Dec 2009 and in March 2011 I had the implant removed and had my MTP joint fused, with a bone graft. FYI--I'm 47 yrs old, very active.

I had problems with the implant from day one--the swelling never went down (requiring more cortisone shots 5 months post op!), constant pain, even worse than before the surgery.

Went for 2 more opinions, both said fuse it, and I had one of them do just that. I've had virtually no pain since surgery, didnt need pain meds past 3 days post op, and even though I am not yet fused, the swelling is a bare minimum.

Yes, the immobility for the first 6-8 weeks is tough to go through, and you will need help at home for the first 2-3 weeks most definitely. Not driving is also a big deal. But I can tell this will work out in the long term. And I was never a stiletto wearer anyway, so not being able to wear a 2 inch + heel isn't a big deal to me.

Save yourself a second surgery and just fuse it.

Hope this helps....

 
Old 06-13-2011, 12:50 PM   #5
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Re: Big Toe Fusion or Implant?

i would do the fusion. i had it done. all i read on these boards are failures of implants. keep posting and good luck.

 
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Old 07-06-2011, 08:32 PM   #6
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Re: Big Toe Fusion or Implant?

go with the fusion. a little inconvience not be able to drive for maybe 4 weeks after the fusion, but is a great long term fix. I'm a runner so fusion was necessary over implants. The implant may be referring to a rubber piece put between the joint, and that can maybe wear out again.
glenn

 
Old 07-10-2011, 08:26 PM   #7
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Unhappy Re: Big Toe Fusion or Implant?

I had a hemi implant done in May of 2010...podiatrist recommended this instead of fusion because I was active and would have more movement in the joint... BIG MISTAKE! It has given me nothing but trouble since I got it. I now have bone loss from implant and don't know if it can be taken out successfully because it is the screw type that has little barbs on the sides to anchor it into the bone better. Having it removed could shatter the toe bone... I now limp and my second toe has drifted over to the big toe to take its place. My big toe does not lay flat it is elevated... I'm in a lot of pain. I am 63 and very active like to go to the gym and like taking long walks. I'm unable to do any of this any more....PLEASE anyone thinking of joint replacement go to orthopedic surgeon M.D. that specializes in foot and ankles problems. Wish I had!

 
Old 07-14-2011, 07:16 PM   #8
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Re: Big Toe Fusion or Implant?

I am so sorry I had a joint replacement. I have had nothing but trouble since I had mine May of 2010. F

 
Old 08-11-2011, 08:39 PM   #9
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Metal Toe HB User
Re: Big Toe Fusion or Implant?

My advice to anyone and everyone is do NOT get the implant! I got one last year from a podiatrist and my toe was much worse afterwards than it had ever been prior to surgery.

A month ago I finally did what I should have done at the start....went to see one of the best orthopedic foot surgeons in the upper midwest. He has done over 5000 fusions, many of which were repairs of failed implants. He told me he had never seen a successful implant!

Last week he removed the implant and fused my toe using a bone graft from my hip. Too early to know how it'll all work out but I wish I had done more research before getting that bogus implant from the pod. Do not make the same mistake that I did.

 
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Old 08-12-2011, 07:56 PM   #10
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Re: Big Toe Fusion or Implant?

Thanks for the info. Would like to know the name of your orthopedic surgeon. Hope everything works out well for you...Please keep me posted...

 
Old 10-20-2011, 06:06 PM   #11
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Re: Big Toe Fusion or Implant?

Hi Coffeegal377 Please before you have implant do some research on toe implants...I had one last year and have had nothing but trouble with it from the day after surgery....Consulted orthopedic foot specialist(surgeon) That is the only Foot Dr. I would let touch my foot again...Implants are not perfected yet and have a very high failure rate....Hope all goes well for you.

 
Old 10-25-2011, 07:25 PM   #12
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Re: Big Toe Fusion or Implant?

I had a joint implant done in 1992, so it has been almost 20 years. It has not failed, it still seems to be going strong, but that doesn't mean there haven't been subsequent problems. Joint implants aren't exactly precisely your size, so I lost about 1/3 - 1/2 inch of big toe length. Having a shorter metatarsal changed how the weight was distributed, and the second toe then started to have to work harder. So it then started migrating sideways and 10 years ago I had to have surgery on the 2nd toe to straighten it out and fuse a joint. That seems to be holding its own, but I still have to wear orthotics and deal with low level chronic pain in that 2nd toe.

Meantime, the cartilidge has now worn out on my other foot so I had a great joint fusion about 10 days ago. Reason I didn't have an implant this time is the research shows than the implants typically have trouble after 5-8 years, whereas fusion has more than a 90% success rate. Don't know when I will get to be weight bearing on it, but I can tell you 1) Pain has been minimal (with lots of elevation) and 2) I LOVE my knee scooter - I haven't had to use crutches at all.

Good luck with your decision!

 
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Old 10-27-2011, 09:45 PM   #13
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Re: Big Toe Fusion or Implant?

Hoki Poki, Thank you and
Good luck with your recovery. Please let me know how you are doing...

 
Old 07-24-2012, 02:33 PM   #14
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Re: Big Toe Fusion or Implant?

My dilemma seems to be the reverse of what I have read on the posts. In Jan 2012 I had a fusion of the great toe and second toe. The joints had been destroyed by a very large neuroma which had been removed 10 months earlier. The fusion was supposed to relieve the pain in the joints. I was completely compliant wi the 8 weeks of no weight bearing, and also could not drive for that time period because it is my right foot. X-rays showed no fusion after 8 weeks, so then I used a bone stimulator for 600 hours, with zero effect. The pain is bad, I am limping, my knee and hip are being affected. My pod who did the two prior surgeries now wants to do a HemiCAP arthrosurface joint implant. Does anyone have advice/ experience with this procedure?

 
Old 07-24-2012, 02:43 PM   #15
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Re: Big Toe Fusion or Implant?

I know this type of joint resurfacing is the up and coming thing. You can also have cadaver cartilege impanted or use the capsule material in your own toe. My ortho wants to do the resurfacing next one me (both my big toe joints have had cheilectomies). I would find a sports med ortho who is foot and ankle board certified rather than a pod though.

 
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