Cartiva Implant For Big Toe Arthritis

Dr. Baravarian on ABC News discussing Cartiva, the new treatment which offers joint flexibility for those suffering from toe arthritis.

Osteoarthritis of the big toe joint refers to the pain and stiffness caused by damage to the cartilage, resulting from the stress of taking thousands of steps day after day, year after year. The stiffness leads to frequent jamming of the toe, with bone spurs eventually forming upon the big toe joint.


Cartiva: A Fusion Free Solution to Big Toe Arthritis

Great toe arthritis is one of the most common conditions we treat at UFAI, which is why we are pleased to bring you Cartiva. Cartiva is a new surgical implant that our world-class surgeons have adopted to successfully treat joint immobility and restore foot function and quality of life to our patients.







Diagnosing Osteoarthritis of the Big Toe


Great toe arthritis, also known as hallux limitus and hallux rigidus, is diagnosed on a scale of severity ranging from level 0 to level 4:


  • Level 0: Normal joint, some damage to the cartilage
  • Level 1: Mild bone spur formation, but with no narrowing of the joint space
  • Level 2: Moderate bone spur formation, some narrowing of the joint
  • Level 3: Severe bone spur formation, narrowing of the joint, some obliteration of the joint
  • Level 4: Severe bone spur formation, complete joint obliteration


This scale is helpful to doctors when crafting a treatment plan. While levels 0 and 1 can usually be treated non-surgically with orthotics and shoe modification, level 4 typically requires a joint fusion – removing the joint altogether and fusing the bones.



Difficulty in Determining Course of Treatment


The difficulty in treatment usually arises with levels 2 and 3, when foot function could be restored, but not without some surgical treatment. In these cases, surgeons need to make treatment decisions at the time of surgery, and on a case-by-case basis.


For example, the surgeon may remove the bone spur, but find that the joint remains stiff and inflexible. In that case, an osteotomy may be performed by removing a fragment of the bone to restore some mobility. However, even this can be an insufficient treatment if there is substantial damage to the surface of the bone at the joint. Until now, there have been no surgical implants on the market that have adequately addressed the problem.



How Cartiva Works


Fortunately, the FDA has recently approved Cartiva, a gel-like implant that has worked wonders for arthritis patients across Europe and Canada, and now, here at UFAI as well. Cartiva is a synthetic cartilage implant designed to act as a replacement for arthritic joint tissue. The gel material mimics the quality and density of bone, eliminating the problematic side effects of metal implants, which can damage or become absorbed by the bone over time.


After the bone spur is removed from the big toe joint, a small (1cm) hole is drilled into the head of the first metatarsal – the longer bone connecting the mid-foot to the big toe joint. Next, the Cartiva gel is injected into the hole, which expands to fill the space and overflows just a couple millimeters over the edges of the metatarsal head surface, like a muffin in a pan. This acts as a cap on the joint, decreasing the bone-on-bone contact responsible for arthritic pain.



Recovery and Benefits of Surgery with Cartiva


Typical recovery time from surgery with Cartiva is about 2-4 weeks for the surgical wound and soft tissue to heal. This is a significant improvement to recovery times with metal implants.


Cartiva has been shown to reduce pain, and improve range of motion and foot function. Following surgery, patients should practice range-of-motion exercises early on in the healing process to prevent scarring.


Unlike metal implants, Cartiva does not cut into or damage the bone or joint surface over time. It is also durable, able to withstand loads similar to natural cartilage, and bio-stable, meaning it will not degrade in the body. If Cartiva does not completely relieve a patient’s symptoms, the gel-like substance allows for an easy conversion to a fusion procedure. For these reasons, Cartiva is a great option for treating moderate level hallux limitus.

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