First Metatarsal Head Osteoarticular Transfer System for Salvage of a Failed Hemicap-Implant: A Case Report

Osteochondral defects are frequently seen in patients with hallux limitus. Historically, such patients have been treated with cheilectomy, arthroplasty, osteotomy, fusion, and other joint destructive procedures. We present a case of a 54-year-old man who presented with a failed hemicap implant of the first metatarsal head. Seven months after his initial implant surgery, the patient was still experiencing pain and limited function despite conservative treatment efforts. In an effort to salvage the joint, an osteoarticular transfer system procedure was undertaken. After removal of the 12-mm hemicap implant, a 15 × 12 mm osteochondral plug was taken from the ipsilateral femoral condyle and press fit into the defect in the first metatarsal head. At 6 weeks postoperatively, complete consolidation of the graft was observed radiographically. By 6 months postoperatively, the patient was able to walk more than 15 miles per week without pain while wearing regular shoes. He was subsequently discharged at 1-year postoperatively, at which time he neither described nor demonstrated any signs or symptoms related to hallux limitus/rigidus. To our knowledge, this particular technique has not been previously reported for lesions of this size in the first metatarsal head. Level of Clinical Evidence: 4