Treatment of first metatarsophalangeal joint arthritis using hemiarthroplasty with a synthetic cartilage implant or arthrodesis: A comparison of operative and recovery time

Glazebrook, Mark; Younger, Alastair; Daniels, Timothy R.; Singh, Dishan; Blundell, Chris; Vries, Gwyneth de; Le, Ian; Nielsen, Dominic; Pedersen, M. Elizabeth; Sakellariou, Anthony; Solan, Matthew; Wansbrough, Guy; Baumhauer, Judith F.

doi:10.1016/j.fas.2017.05.002

Cited by 14 publications

(10 citation statements)

References 18 publications

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“…With regard to recovery from surgery following synthetic cartilage implantation vs hallux MTP arthrodesis, Glazebrook et al found improved Foot and Ankle Ability Measure sport/ADL and SF-36 Physical Function subscores in SCI patients vs fusion patients at 2 and 6 weeks postoperatively. 10 These scores leveled out between groups at 3 months, and the Foot and Ankle Ability Measure sports scores were higher for the fusion group at 6, 12, and 24 months, although these did not achieve statistical significance. Our patient cohort did not achieve this level of improvement within the 12-month time frame; however, we are unable to make direct comparisons to initial studies because similar parameters were not measured.…”

Section: Discussionmentioning

confidence: 79%

“…This study represents the first to add to the body of literature for SCI that previously only included patients from the United Kingdom and Canada. 2,3,6,[8][9][10][11] Our study population demonstrated an overall "neutral" level of satisfaction with the procedure, average PROMIS scores with mild pain interference and physical dysfunction when compared to the US normative population, approximately half of patients opting for further treatment with corticosteroid to address continued pain postoperatively, one-third undergoing advanced imaging workup, and 14% requiring additional DME (Dynasplint) for functional range of motion limitation. Although this study differs with concurrent surgeries, postoperative treatment, statistical methodology, and assessment than the initial study with this device, our patients did not fare as well as the original prospective randomized trial.…”

Section: Discussionmentioning

confidence: 99%

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Early Outcomes and Complications of Synthetic Cartilage Implant for Treatment of Hallux Rigidus in the United States

et al. 2019

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Background: The aim of this study was to determine the early outcomes and complications following the implantation of a hydrogel synthetic cartilage implant (SCI, Cartiva) for the treatment of hallux rigidus by a single surgeon. Methods: A retrospective chart review was performed of consecutive patients who underwent treatment for hallux rigidus with an SCI between August 2016 and April 2018 by a single surgeon. Demographic information, radiographic assessment, and concomitant operative procedures performed were evaluated for all patients. Postoperatively, PROMIS physical function (PF) and pain interference (PI) scores, patient satisfaction, reoperation, conversion to arthrodesis, and need for further clinical treatment were collected. Sixty-four SCIs were implanted in 60 patients. Follow-up averaged 18.5 months (range 12-30 months). Results: 14% (9/64) of patients were very satisfied, 28% (18/64) satisfied, 20% (13/64) neutral, 11% (7/64) unsatisfied, and 27% (17/64) very unsatisfied with their outcome. In addition, 45% of patients underwent additional procedures at the time of SCI, and 23% had a history of surgery on the hallux before implantation. PROMIS PF scores averaged 42 and PROMIS PI scores averaged 60. Overall, 63% completed PROMIS PI, 66% completed PROMIS PF, and 100% completed a satisfaction survey. In addition, 30% (19/64) underwent magnetic resonance imaging (MRI) postoperatively due to pain. There was a 20% reoperation rate, which included an 8% rate of conversion to arthrodesis. Conclusion: Synthetic cartilage implantation yielded neutral patient satisfaction, mild pain, and physical dysfunction at early follow-up. We believe patient selection and counseling regarding early postoperative limitations are important before proceeding with SCI. Level of Evidence: Level IV, case series.

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Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Early Outcomes and Complications of Synthetic Cartilage Implant for Treatment of Hallux Rigidus in the United States

et al. 2019

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“…Therefore, a total of 7 publications met the inclusion criteria and were included in this study. 9-15…”

Section: Resultsmentioning

confidence: 99%

The Use of a Synthetic Cartilage Implant for Hallux Rigidus: A Systematic Review

Smyth

Hannon

Kaplan

et al. 2020

Foot & Ankle Specialist

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Background. Hallux rigidus is a common pathology afflicting the foot, for which various joint salvage techniques have been described with a multitude of different implants. Recently, a synthetic cartilage implant composed of polyvinyl alcohol (PVA) received FDA premarket approval for the treatment of arthritis of the great toe. The purpose of this study was to (1) systematically review the clinical evidence supporting the use of a PVA implant in hallux rigidus and (2) determine the strength of the recommendation that can be made supporting the use of a PVA implant by evaluating the quality of evidence available. Methods. A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Using the terms “cartiva OR polyvinyl alcohol OR synthetic cartilage OR hemiarthroplasty AND hallux rigidus OR great toe arthritis OR first toe arthritis” we searched the PubMed/Medline database. The quality of the included studies was evaluated using the American Academy of Orthopaedic Surgeons Clinical Practice Guideline and Systematic Review Methodology. Results. Seven studies met the inclusion criteria, 6 of these were derived from a single randomized controlled trial. A moderate recommendation can be given for the use of a PVA implant for hallux rigidus based on short-term outcomes. A limited recommendation can be given for the use of a PVA implant for hallux rigidus based on mid-term outcomes. Conclusion. There are limited studies available detailing the outcomes of a PVA implant for hallux rigidus; however, the results that are available demonstrate a high level of evidence. Levels of Evidence: Level I: Systematic review

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“…The pattern of recovery following PVA hydrogel implant hemiarthroplasty has documented improvement beginning at 6 weeks and progressing throughout the first year. 6,10 Patients should be informed that healing does take time. The surgeon must understand that many patients in the RCT continued to experience improvements in pain relief for up to 6 to 9 months following surgery.…”

Section: Patient Educationmentioning

confidence: 99%

“…As such, any running or jumping activities that cause pain and swelling at the MTP joint should be curtailed or avoided for a minimum of 3 months after surgery. The pattern of recovery following PVA hydrogel implant hemiarthroplasty has documented improvement beginning at 6 weeks and progressing throughout the first year 6,10…”

Section: Indications and Contraindicationsmentioning

confidence: 99%

First Metatarsophalangeal Joint Polyvinyl Alcohol Hydrogel Implant Hemiarthroplasty: Current Operative Technique

Younger

Glazebrook

Daniels

et al. 2021

Techniques in Foot &Amp; Ankle Surgery

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Polyvinyl alcohol hydrogel implant hemiarthroplasty for the first metatarsophalangeal joint has been shown to be an effective, safe, motion-preserving, surgical treatment alternative to fusion for hallux rigidus in a level I, randomized controlled trial. To obtain optimal results, however, surgeons must be sure to perform the appropriate surgical technique as well as educate patients regarding pertinent risks, benefits, and the associated recovery process. Achievement of results commensurate with those published in the randomized controlled trial is predicated on an understanding of the various technical aspects of the surgical procedure, such as avoiding excessive heat during reaming, ensuring appropriate implant positioning, and appreciating the need for performing associated procedures when anatomically appropriate, as well as their potential effect on clinical outcome. This paper will review the initial technique described in 2013 and provide key clinical care suggestions resulting from the 10 years of experience with polyvinyl alcohol hydrogel implant hemiarthroplasty for the surgical treatment of hallux rigidus. Levels of Evidence: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence.

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Treatment of first metatarsophalangeal joint arthritis using hemiarthroplasty with a synthetic cartilage implant or arthrodesis: A comparison of operative and recovery time

Cited by 14 publications

References 18 publications

Early Outcomes and Complications of Synthetic Cartilage Implant for Treatment of Hallux Rigidus in the United States

Early Outcomes and Complications of Synthetic Cartilage Implant for Treatment of Hallux Rigidus in the United States

The Use of a Synthetic Cartilage Implant for Hallux Rigidus: A Systematic Review

First Metatarsophalangeal Joint Polyvinyl Alcohol Hydrogel Implant Hemiarthroplasty: Current Operative Technique

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