Hallux rigidus is a term to describe osteoarthritis of the great toe
joint. This can occur due to wear-and-tear of the joint cartilage through
repetitive stress and can also occur from trauma. Severe arthritis of the
great toe joint can be treated with surgical options if conservative
treatment has failed. Traditionally the surgical options have included
joint fusion (arthrodesis) which eliminates pain but patients will lose
motion. Another viable option has been either a hemi or total joint
replacement which will improve motion but the lifespan of these joints have
not been clinically established. One of the newest implants that has
become available to surgeons is a polyvinyl synthetic implant known as
Cartiva (by Stryker/Wright Medical Group). It is made of a material similar
to that found in contact lenses. The advantage of this implant has been
based on the ease of application and relative fast return to walking and
physical activity.
In the clinical setting, however, foot and ankle surgeons like myself have
begun to see a concerning trend in patients who have continued or worsening
pain to the foot following surgical treatment with the Cartiva implant. It
appears the clinical indication for use of the Cartiva implant has been
quite broad from mild early osteoarthritis (stage 1 hallux rigidus) to
severe end-stage osteoarthritis (stage 3 hallux rigidus). Some of these
patients have required revision type surgery to address the Cartiva implant
failure including implant removal. In my experience, I have had to convert
patients with the failed Cartiva implant into either a different hemi or
total joint replacement as well as revision fusion (arthrodesis) using bone
graft. Orthopedic device companies have now even developed revision
systems dedicated specifically to address this growing need for treating
Cartiva implant failure.
For my patients whom I have treated with a failed Cartiva implant and who
wish to retain motion to the great toe joint my revision procedure of
choice is a joint arthroplasty system offered by Arthrosurface. It is
designed specifically to revise a failed Cartiva Implant and deal with the
technical challenge of a large bone void left after removal of the Cartiva
implant of the first metatarsal head. The Arthrosurface joint implant also
provides the option of a hemi or total joint implant system in cases in
which both sides of the great toe joint need to be replaced.
Overall, revision surgery to address a failed Cartiva implant can be
challenging but so far in my clinical experience patients have been content
with the outcomes provided by removing the Cartiva implant and treating the
hallux rigidus with a dedicated revision joint implant.
