One-year Follow-Up Results with Hydrogel Implant in Therapy of Hallux Rigidus: Case Series with 44 Patients

Abstract

Background The Cartiva implant (CI) is being increasingly used in the surgical therapy of hallux rigidus. Despite a growing number of studies, numerous questions regarding patient selection remain unanswered. Patients and Methods As part of a retrospective case series with prospective follow-up (average follow-up period: 12 months), a total of 44 patients (male/female = 16/28; mean age at the time of surgery: 55.4 years) with 44 CI were analysed (VAS, EFAS-, AOFAS-score). Using a correlation analysis and a machine learning algorithm, risk factors for therapy failure were investigated. Results The overall survival rate of the CI was 93% at 12 months. The VAS, EFAS and AOFAS scores showed a significant improvement in comparison to the preoperative condition. The mobility of the metatarsophalangeal joint showed no increase. Patients with a medium osteoarthritis grade and a medium level of clinical restraint showed the greatest improvement in relation to their preoperative condition. Conclusion The CI can be seen as an effective therapy for hallux rigidus. Nonetheless, realistic patient expectations must be communicated.

Surgical Outcomes of Synthetic Cartilage Implant Hemiarthroplasty for Metatarsophalangeal Arthropathy

“…However, Lee et al reported mixed results with 68.8% experiencing better post-operative ROM compared to 24% experiencing a worsening ROM [ 25 ]. The number of patients reporting functional restrictions and limited ROM at final follow-up varied from 9.5% [ 24 ] to 27.3% [ 26 ] with some studies demonstrating no significant improvement in pre- to post-operative ROM [ 27 ] and reported gain only in dorsiflexion with no benefit to plantarflexion [ 4 ].…”

“…Functional assessment varied between studies in their use of different rating scales (Table 4 ). At both short and mid-term follow-ups, there is strong evidence to demonstrate a significant improvement in physical function, abilities in activities of daily living, walking, standing, sports, and social interaction [ 4 , 11 , 13 , 17 , 18 , 20 , 24 , 27 ] with one study presenting 96% of patients reaching normal or nearly normal levels of function at five years follow-up [ 19 ]. Conversely, An et al reported their PROMIS scores at final follow-up to equate to a moderate physical dysfunction [ 15 ] with others demonstrating no significant difference in sporting abilities or PROMIS physical function scores from baseline to final follow-up [ 23 , 25 ].…”

“…It is unclear from these documents who would have benefited most from Cartiva surgery. The evidence fails to show a significant difference in the benefit of SCI surgery based on Coughlin and Shurnass grade [ 27 ] with other studies demonstrating no difference in benefit between Cartiva and arthrodesis regarding hallus rigidus or hallux valgus severity, gender, age, BMI, symptom duration, prior procedures or intensity of pre-operative pain [ 30 ]. The consensus as to who would benefit the most from SCI surgery is still debated and further clarification is required.…”

“…The number of patients reporting functional restrictions and limited ROM at final follow-up varied from 9.5% [24] to 27.3% [26] with some studies demonstrating no significant improvement in pre-to postoperative ROM [27] and reported gain only in dorsiflexion with no benefit to plantarflexion [4].…”

Update Hallux rigidus

“…Sowohl das Schmerzniveau als auch AOFAS- und EFAS-Score zeigten eine signifikante Verbesserung. Eine signifikante Zunahme der MTP-I-Beweglichkeit konnte postoperativ nicht festgestellt werden 37 .…”