During a 21-year period at the authors' institution, 93 primary implants of the first metatarsophalangeal joint were performed on 79 patients (12 men and 67 women). Their mean age was 56 years (range, 19 to 75 years). The average duration of follow-up evaluation in 75 patients who were alive and without reoperation was 12 years (range, two to 17 years). With the proportional hazards general linear model, young age was identified as a significant risk factor for poor survival: at ten years, implant survival was 82% in patients 57 years of age or younger, and 90% in patients older than 57 years. The overall probability that an implant would not have been removed was 86% at ten years after arthroplasty and 82% at 15 years.