Synthetic cartilage implant hemiarthroplasty versus cheilectomy for the treatment of hallux rigidus

Hoskins, Tyler; Barr, Stephen M.; Begley, Brian; Fitzpatrick, Brendan; Senat, Schamma; Patel, Jay; Heiman, Erick; Mazzei, Christopher; Miller, Justin M.; Wittig, James C.; Epstein, David

doi:10.1007/s00590-022-03469-8

Cited by 7 publications

(7 citation statements)

References 14 publications

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“…Regarding cheilectomy, the literature is largely split. Studies demonstrate significantly greater post-operative AOFAS functional scores and reduced rates of persistent postoperative pain in patients receiving SCI compared with cheilectomy [ 4 ]. However, converse studies demonstrate significantly greater function and pain PROMIS scores and reduced rates of postoperative infection in patients receiving cheilectomy [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, converse studies demonstrate significantly greater function and pain PROMIS scores and reduced rates of postoperative infection in patients receiving cheilectomy [ 18 ]. Ultimately, both procedures present similar outcomes with no significant difference in FAOS functional scores or need for additional conservative treatments, with no differentiation of outcomes of either intervention for grades of disease severity [ 4 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…In this study, 50% of participants reported a restricted ROM at the final follow-up. The literature reports a varied range of post-operative ROM with short-term studies demonstrating a mean 27.3% improvement in dorsiflexion at two years [ 11 ], with a further significant increase in active and peak dorsiflexion at later follow-up [ 4 , 19 ]. However, Lee et al reported mixed results with 68.8% experiencing better post-operative ROM compared to 24% experiencing a worsening ROM [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, Lee et al reported mixed results with 68.8% experiencing better post-operative ROM compared to 24% experiencing a worsening ROM [ 25 ]. The number of patients reporting functional restrictions and limited ROM at final follow-up varied from 9.5% [ 24 ] to 27.3% [ 26 ] with some studies demonstrating no significant improvement in pre- to post-operative ROM [ 27 ] and reported gain only in dorsiflexion with no benefit to plantarflexion [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…Joint sparing options include cheilectomy, resurfacing, and arthroplasty. Cheilectomy involves dorsal osteophyte excision to improve pain and functional limitation driven by dorsal impingement but is often associated with persistent symptoms and high failure rates in advanced disease states [ 4 , 5 ]. Both MTPJ resurfacing and arthroplasty have debated success with notable reports of subsidence, osteolysis, and loosening [ 6 ] contributing to high rates of revision to arthrodesis [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

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Surgical Outcomes of Synthetic Cartilage Implant Hemiarthroplasty for Metatarsophalangeal Arthropathy

Schapira,

Johnson,

Faroug

2023

Cureus

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Introduction Metatarsophalangeal joint (MTPJ) arthropathy in the great toe causes considerable pain and debilitation, severely impacting quality of life. Traditional management options included conservative measures, steroid injections, and arthrodesis. New options include Cartiva, a synthetic cartilage hemiarthroplasty for the MTPJ. This prosthesis has evidence of improved pain and function without the sacrifice of joint movement seen with arthrodesis. However, the implant itself has mixed reviews. This study aims to identify the pre-, peri, and short-term post-surgical outcomes of Cartiva surgery and review the literature for existing reported outcomes. Methods We retrospectively reviewed a cohort of 22 consecutive Cartiva procedures between 2016 and 2022 in a single UK institution. Hospital records were analyzed for peri-operative complications, implant survival, additional operative interventions, patient-reported outcomes, and functional improvement. Results Twenty-one patients underwent Cartiva for the first MTPJ pathology and one for the third MTPJ pathology. Prior to surgery, 40.9% of patients had undergone alternative therapies, including MTPJ steroid injections (seven patients), cheilectomy (four patients), and bunionectomy (one patient). Total complication rates, inclusive of medical, surgical, and implant complications were 45.5% (10/22). Total reoperation rates were 18.2% (4/22) including two revisions to arthrodesis and two manipulations under anesthesia (MUA) with local anesthetic injection. At the final follow-up, 55% were still experiencing pain, 15% neurovascular symptoms, 10% swelling, and 50% stiffness or reduced range of movement. However, 85% of patients returned to usual activities of daily living within two years. Conclusion Cartiva surgery for metatarsophalangeal arthropathy has demonstrated outcomes of persistent pain, limited range of movement, and restricted function at short-term follow-up. Rates of reoperation and revision to arthrodesis were comparable with similar studies.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Surgical Outcomes of Synthetic Cartilage Implant Hemiarthroplasty for Metatarsophalangeal Arthropathy

Schapira,

Johnson,

Faroug

2023

Cureus

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Synthetic cartilage implant vs. first metatarsophalangeal arthrodesis for the treatment of hallux rigidus

Budde,

Claassen,

Plaass

et al. 2024

Arch Orthop Trauma Surg

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Background This study evaluated the outcome of the Cartiva synthetic cartilage implant (SCI) in the treatment of hallux rigidus. Methods In the present retrospective matched case-control study, we compared 18 patients with Cartiva SCI (mean follow-up: 17.7 months) to 18 patients with metatarsophalangeal joint arthrodesis (mean follow-up: 20 months) using multiple function measures, along with four specified visual analog subscales for pain. Pre- and postoperative radiographs were compared, and radiographic abnormalities were documented. Results We observed no significant differences in function measures between groups. While both groups experienced significant pain reduction, the arthrodesis group reported significantly lower exertion pain than the Cartiva SCI group (p = 0.004). Radiographic abnormalities, including implant site enlargement (6/18, 33.3%), erosive changes of the metatarsal bone (11/18, 61.1%) or articular surfaces (10/18, 55.6%), and bright sclerotic margins (12/18, 66.7%), occurred in the Cartiva SCI group. Conclusion The present study showed good functional results and a high satisfaction rate after MTP joint arthrodesis, which is considered the gold standard surgical treatment for higher grade hallux rigidus. While the Cartiva SCI group did not show significant differences from the arthrodesis in most aspects of function and clinical scores, the arthrodesis group tended to have better results in terms of satisfaction, residual pain, and revision rate. Even after the short follow-up period, there were some remarkable radiographic findings in the Cartiva SCI group, the long-term effects of which are not yet evident, but which may lead to implant loss. Cartiva SCI has advantages for patients who prioritize postoperative mobility, but the potential risks should be considered in the patient’s informed consent. Therefore, the present study highlights the importance of MTP joint arthrodesis for the treatment of hallux rigidus. Level of evidence Level IV – Retrospective matched case-control study.

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Polyvinyl alcohol hydrogel implant for the treatment of hallux rigidus is associated with a high complication rate and moderate failure rate at short-term follow-up: a systematic review

Butler,

Dhillon,

Wingo

et al. 2024

Eur J Orthop Surg Traumatol

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Synthetic cartilage implant hemiarthroplasty versus cheilectomy for the treatment of hallux rigidus

Cited by 7 publications

References 14 publications

Surgical Outcomes of Synthetic Cartilage Implant Hemiarthroplasty for Metatarsophalangeal Arthropathy

Surgical Outcomes of Synthetic Cartilage Implant Hemiarthroplasty for Metatarsophalangeal Arthropathy

Synthetic cartilage implant vs. first metatarsophalangeal arthrodesis for the treatment of hallux rigidus

Polyvinyl alcohol hydrogel implant for the treatment of hallux rigidus is associated with a high complication rate and moderate failure rate at short-term follow-up: a systematic review

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