BACKGROUND The aim of this study was to evaluate functional outcomes following ceramic arthroplasty used in the treatment of osteoarthritis of the hallux metatarsophalangeal (MTP) joint. METHODS Thirty-seven consecutive patients who underwent press-fit ceramic joint arthroplasty were identified. Joint movement, gait pressure studies, radiographs, patient's outcome based on the American Orthopaedic Foot and Ankle Society (AOFAS) scale, hallux metatarsal phalangeal-interphalangeal index (HMPI) and visual analogue pain scales were assessed. RESULTS Mean follow-up was 33 (12-60) months. Ninety-two percent of patients were satisfied with the surgery. AOFAS and HMPI scores were good to excellent in more than 90%. Six implants had lucent lines of greater than 2mm at 18 months. Three of these joints also had subsidence of both components. There was no correlation between implant loosening and patient outcomes. Mean hallux pressure at toe-off decreased from 7.1 to 3.5 N cm⁻² (p<0.01) equalising with normal contralateral toe pressure. Three patients required revision surgery and one patient had a transient wound infection. CONCLUSIONS Good to excellent results have been achieved following ceramic total MTP joint arthroplasty. The clinical relevance of progressive lucencies around the implant is uncertain and longer follow-up may identify subsidence and ultimate failure.