For end stage arthritis in the 1st MPJ a few options exist, but most common are fusion or replacement. For twelve years I have been using the Reflexion by Osteomed for total joint arthroplasty. In fact I have performed the most in the country over the last 12 years. The implant closely mimics that used in the knee or hip. Recently more companies have developed different versions of the Reflexion. Patients commonly choose joint replacement when restoration of range of motion is desired. Such as women wishing to wear heels or older surfers needing motion for a bottom turn. This is not a good option for people wishing to return to high impact exercise like running or sports. Like other joint replacement surgeries the results can be great, but it is an artificial joint and expectations have to be realistic. More and more foot surgeons are opening up to total joint arthroplasty in the 1st MPJ, and I believe it popularity will grow.