Cartiva Implant for Big Toe Arthritis

Updated 3/5/2019
Dr. Baravarian discusses Cartiva failure and what to do if the implant fails.

What is the Cartiva implant?

Cartiva is a synthetic cartilage implant that is used to treat great toe arthritis, also known as hallux limitus and hallux rigidus, one of the most common conditions we treat at UFAI.

 

The FDA has recently approved Cartiva, a gel-like 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.

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PLEASE NOTE: The physicians at University Foot and Ankle Institute have found that there is an unacceptably high risk of failure with the Cartiva implant at this time. We still have the Cartiva system but will only consider using it for very limited and unique patient use cases. Our preferred procedure is Arthrosurface. 

 

If you are suffering from a failed Cartiva implant, please read more here.

 

Diagnosing osteoarthritis of the big toe

 

Osteoarthritis of the big toe joint refers to the pain and stiffness caused by damage to the cartilage. The stiffness leads to frequent jamming of the toe, with bone spurs eventually forming upon the big toe joint.

 

Great toe arthritis, 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. 

 

 

How does Cartiva work?

 

The Cartiva implant is very much similar to the strength of bone and cartilage, which results in limited to no bone absorption or damage. Additionally, there is no breakdown of the bone overtime so there is less chance of cyst formation.

 

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.

 

Should the Cartiva implant wear out it can be replaced. And because the bone anatomy is kept intact, it is likely that the implant can be changed out with minimal downtime or risk.

 

The Cartiva implant procedure can be combined with bone spur removal procedures as well as bone realignment procedures, which is not often possible with other implant procedures. This allows the surgeon to reposition the bone and remove the spurs that limit motion for better results.

 

Should there be a need for future revision surgery to fusion of the joint, the anatomy is kept intact with the Cartiva implant system so there is no need for bone graft, and the surgical procedure is far less complicated than common revision implant surgeries today.

 

Recovery from the Cartiva procedure

 

Recovery from the Cartiva implant procedure is quite simple. Patients are kept in a boot for 2-3 weeks to allow the soft tissue and incision to heal. Subsequently, they are sent to physical therapy or given home exercises and placed in a comfortable tennis shoe.

 

Patients can to normal activity and regular shoes after 5-6 weeks at which point swelling has decreased and range of motion is improved. This is a significant improvement to recovery times with metal implants.

 

PLEASE NOTE: The physicians at University Foot and Ankle Institute have found that there is an unacceptably high risk of failure with the Cartiva implant at this time. We still have the Cartiva system but will only consider using it for very limited and unique patient use cases. Our preferred procedure is Arthrosurface.

 

If you are suffering from a failed Cartiva implant, please read more here.

  • Foot and Ankle Surgeon and Director of University Foot and Ankle Institute
    Dr Bob Baravarian, University Foot and Ankle Institute

    Dr. Bob Baravarian is a Board Certified Podiatric Foot and Ankle Specialist. He is currently a member of UCLA Medical Group, Chief of Podiatric Surgery at Santa Monica/UCLA medical center and Orthopedic Hospital and an assistant clinical professor at the UCLA School of Medicine. He also serves as Director of University Foot and Ankle Institute.

     

    Dr. Baravarian has been involved in athletics his entire life and played competitive tennis in high school and college. He has an interest in sports medicine, arthritis therapy and trauma/reconstructive surgery of the foot and ankle. He is also fluent in five languages (English, French, Spanish, Farsi and Hebrew),

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