Background: Cartiva^® synthetic cartilage implant (SCI) was introduced in our department in 2016 as an alternative treatment for advanced degenerative disease of the hallux metatarsophalangeal joint (MTPJ) requiring fusion, but we would rather prefer to maintain joint movement. Method: A prospective audit was commenced to monitor clinical results limiting selection criteria to young patients with advanced disease with no hallux deformity and no inflammatory arthritis. Outcome measures include patient-reported outcomes using the Manchester-Oxford Foot Questionnaire (MOXFQ) and total range of movement. Result: Between 2016 and 2019, we performed Cartiva^® SCI in 19 toes in 16 patients. The 13 toes were grade IV, and six were grade III. Outcome data were collected at 3, 6, 12, and 24 months. We have complete follow-up data for 19 of 19 cases at 3 and 6 months, 14 of 19 at 1 year, and seven of 19 at 24 months. Results show significant improvement in MOXFQ scores compared to preoperative (pre-op) scores, with peak improvement at 6 months, followed by a slight decline but stayed significantly better compared to pre-op scores. This was observed in all components of the MOXFQ except for social interaction, which showed continuous improvement for up to 2 years. The total range of movement showed steady improvement from a mean pre-op baseline of 31–55° at 3 months (p ≤ 0.001), 63° at 6 months (p ≤ 0.00), 59° at 12 months (p ≤ 0.003), and 80° at 24 months (p ≤ 0.043). Two patients required further procedures for continuing pain and stiffness. One was converted to fusion after 2 years. One patient had a manipulation and steroid injection. One patient developed a “squeegee” sensation when walking and moving the toe, which spontaneously resolved after 6 months. Conclusion: Our results indicate good short-term results in 17 of 19 patients with Cartiva^® SCI based on patient-reported outcomes and the total range of joint movement. Level of evidence: IV–case series.