The Adelaide Experience: Short Term Results with the Use of Cartiva Implant

Abstract

Category:Midfoot/ForefootIntroduction/Purpose:Hallux rigidus is the most common arthritic condition of the foot. There are only few surgical options that does not require fusing the 1st MTPJ thus allowing motion in the joint. A new first metatarsophalangeal (MTP) joint hemiarthroplasty with a polyvinyl alcohol (PVA) hydrogel implant (Cartiva) has demonstrated pain relief and functional outcomes equivalent to first MTP arthrodesis at 2 and 5 years postoperation in few studies done in North America. We would like to present the Adelaide short term result with the use of this implant.Methods:40 Patients who underwent first PVA hydrogel MTP hemiarthroplasty in Adelaide by two senior foot and ankle surgeons (C.B and P.S) and by two international foot and ankle fellow (G.G and J.P) between 2017 and 2019 were included in this study. The follow up period was 24 months postoperation. Patients underwent physical examination and radiographic evaluation and completed a pain VAS, the Short-Form-36 (SF-36), and the Foot and Ankle Ability Measure (FAAM) sports subscale and activities of daily living (ADL) subscale. At the time of this study, 40 patients had reached 2 year follow-up.Results:There were no lost to follow up, leaving 40 patients with mean age 63.4 (range, 40.1-79.9) years. Mean follow-up was 24 months (range, 6-30 months). Postoperative active MTP natural joint dorsiflexion and peak MTP dorsiflexion were mean 18.2 (range, 10.0- 30.0) and 29.7 (range, 10.0-45.0) degrees, respectively. Pain VAS, SF-36, FAAM ADL, and FAAM Sports scores demonstrated clinically and statistically significant improvements. Radiographically, no patient demonstrated changes in implant position, implant loosening or subsidence, or implant wear. One implant was removed because of persistent pain 7 months post surgery and was converted to fusion 3 months after the removal of the Cartiva implant.Conclusion:Short term results for the use of Cartiva implant in Adelaide show that functional outcomes improved significantly, pain was reduced significantly, and the implant demonstrated excellent survivorship. Our results are similar for those described in the North American literature