202 patients with advanced stage hallux rigidus were randomized to one of two treatments: synthetic hydrogel cartilage implant or standard first metatarsophalangeal (MTP) arthrodesis (joint fusion). The purpose of this study was to evaluate pain and function (active dorsiflexion motion) in comparison to one another, in addition to recording adverse events and requirement of secondary surgeries. Results demonstrated that both treatments resulted in significantly improved clinical outcomes when compared to baseline measurements, and that treatments were statistically similar to each other regarding the primary composite endpoint of treatment success after the follow-up period was completed.