End stage arthritis of the first metatarsophalangeal joint has been treated surgically in the past by fusion and replacement. Fusion has remained the most commonly performed procedure and gives excellent pain relief but may interfere with activities in some patients. Joint replacement previously has had limited success. Problems include loosening, osteolysis, subsidence, and failure to regain motion. Osteolysis associated with wear debris has limited the success of silastic replacements. Polyvinyl alcohol (PVA) has shown promise as a material for hemiarthroplasty in the great toe. The material has better wear patterns than silastic and does not fragment. The hemiarthroplasty is inserted through a dorsal incision into a reamed bed in the first metatarsal head. The implant is available in two sizes, 8 mm and 10 mm. The PVA hemiarthroplasty has been the subject of a randomized controlled trial compared with fusion, with the results as yet to be published. Limited results to date have shown promise for this arthroplasty as an alternative to fusion for patients wishing to maintain joint motion and may avoid the fragmentation and loosening seen in prior replacements.