Cartiva Hemiarthroplasty for the Treatment of Hallux Rigidus

Abstract

Category:Lesser Toes; Arthroscopy; OtherIntroduction/Purpose:Hallux rigidus, degenerative arthritis of the first metatarsophalangeal (MTP) joint, is the most common type of arthritis of the foot, affecting nearly 2.5% of the population over the age of 50. The standard of treatment is non-operative in nature followed by surgical intervention if pain is not alleviated. Currently, first metatarsal dorsal cheilectomy and proximal phalanx osteotomy remain the two most common surgical interventions. Recently, first metartasophalangeal hemiartshroplasty with synthetic cartilage implant has become more popular. This procedure involves the implantation of synthetic cartilage in order to preserve motion and maintain joint space of the first metatarsophalangeal joint. Due to the scarce amount of literature reported on this technique, the goal of this study was to examine its efficacy in patients treated for hallux rigidus.Methods:From 2017 to 2019 twenty patients underwent a synthetic cartilage implant hemiarthroplasty for the treatment of hallux rigidus. Functional outcome scores were assessed using the American Orthopaedic Foot & Ankle scoring system (AOFAS) and the Foot and Ankle Outcome Score Survey (FAOS). Outcomes, complications, and any reoperations were recorded through retrospective chart review, direct patient examination, and phone calls to patients and their families. A statistical analysis was performed using Fischer’s Exact Test. Results were deemed statistically significant if the calculated p-value was less than 0.05.Results:The mean follow up for our patient cohort was 17.16 months (range, 12 to 26). The average age was 55.61 years (range, 47 to 73). Mean pre-op AOFAS and FAOS were 56.37 and 55 respectively, compared to 91.89 and 88.84 after surgery (p-value<0.05). There were no significant complications or reoperations reported in any of the patients at the time of publication.Conclusion:The pre-op and post-op AOFAS and FAOS scores were deemed statistically significant. Synthetic cartilage implant hemiarthroplasty, although new, offers promising results and remains a viable treatment option to decrease pain, improve function, and maintain motion for advanced hallux rigidus. However, a prospective randomized controlled trial comparing the efficacy of this procedure to other surgical methods would be necessary to further evaluate and validate our findings.