Cartiva

February 12, 2018

Arthritis of the great toe joint, or hallux rigidus, is a common disorder affecting 1 in 40 people over the age of 50. Hallux rigidus is characterized by pain, joint stiffness, and decreased motion in the great toe joint. The pain felt with hallux rigidus is worsened with activities, such as running or jumping. Patients often develop a dorsal bony prominence from arthritis formation that becomes inflamed and painful from constant rubbing in shoe gear.

Treatment of hallux rigidus begins with nonoperative management. The use of foot orthoses, modifications in shoe gear and activity, and corticosteroid injections are commonly used as first line treatments. Shoe gear modifications begin with increasing the room in the front of the shoe, or the toe box. A deep toe box can prevent irritation from rubbing the top of the great toe joint. Additionally, shoes with a rocker bottom sole prevent excessive motion of the great toe joint while ambulating and can aid in decreasing pain with activity. Custom orthoses with a rigid Morton’s extension can be useful in severe cases to prevent movement of the great toe. 

When conservative treatment measures fail to alleviate symptoms of hallux rigidus, surgery is considered. Surgical treatment options have varied from great toe joint implants to fusion. More recently, a novel surgical treatment for great toe joint arthritis has been developed. A synthetic cartilage implant, called Cartiva (Cartiva, Inc.), provides a motion sparing alternative to great toe joint fusion. Its composition gives the implant characteristics similar to healthy cartilage, making it resistant to compression and shear forces. Unlike great toe joint fusion, which requires several weeks of crutch ambulation, patients may bear weight on the operative limb immediately following surgery.

The Cartiva synthetic cartilage implant is FDA approved and received this approval through the MOTION study. This study was a multi-center, prospective, randomized study examining 236 patients and compared the Cartiva to fusion of the great toe joint. At 24 months post-op, Cartiva was found to have a clinical success rate of 80% for pain, fusion, and safety, compared to a clinical success rate of 79% in the fusion group. Moreover, the Cartiva group demonstrated a 93% reduction in pain, 65% improvement in activity, and 26% improvement in range of motion at the conclusion of the study.

Resources:

1. McNeil, Daniel S., Judith F. Baumhauer, and Mark A. Glazebrook. "Evidence-based analysis of the efficacy for operative treatment of hallux rigidus." Foot & ankle international 34.1 (2013): 15-32.
2. Yee, Gilbert, and Johnny Lau. "Current concepts review: hallux rigidus." Foot & ankle international 29.6 (2008): 637-646.
3. Baumhauer, Judith F., et al. "Prospective, randomized, multi-centered clinical trial assessing safety and efficacy of a synthetic cartilage implant versus first metatarsophalangeal arthrodesis in advanced hallux rigidus." Foot & ankle international 37.5 (2016): 457-469. 
4. https://cartiva.net

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