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Cartiva Great Toe Arthroplasty

Introduction

Cartiva is a relatively new type of synthetic cartilage material made from a biocompatible organic polymer to very closely mimic the properties of cartilage tissue. It is used to replace damaged cartilage in the big toe which causes Hallux rigidus. In the future it may replace deteriorated cartilage in other joints in the body affected by arthritis. The procedure is known as ’Synthetic Interposition Arthroplasty’.

Treatment with Cartiva is an option for people with Hallux rigidus where alternative treatments such as anti-inflammatory medication or orthotics have failed.

The Procedure

A Synthetic Interposition Arthroplasty is performed under general anaesthesia and sometimes a regional anaesthetic to the ankle. The surgery takes around 30 minutes.

During the procedure a 5cm incision is made on the top of the big toe to expose the metatarso-phalangeal joint. Any bone spurs are removed and a small hole is drilled in the end of the bone where the natural cartilage would sit and the Cartiva implant, which looks like a small transparent ‘plug’, is inserted into the hole in the bone. No cement or glue is needed. Once this is complete, the joint layers are put back in place and the incision is closed and a dressing applied.

Postoperative Guidelines

Once the anaesthetic wears off, you should be able to walk immediately in the surgical sandal provided. You should not need to use crutches. To minimise any swelling and/or pain after the procedure we recommend you keep your foot elevated (ideally above the level of the heart) as much as possible during the first 14 days after surgery. You may also need some medication for any pain.

You will be seen for a post-op check at 10-14 days after the surgery. Dressings are removed and the wound checked. It is usually possible to start wearing regular shoes, returning to day to day activities and driving from hear on. If your work involves prolonged standing or walking, it may take a week or two longer to return.

It is important at this stage to work on exercises to maintain the range of movement and strengthen the toe. A physiotherapist can be very helpful in this regard.

After 6-8 weeks, most patients feel pretty good. Much of the pain should have resolved, and it would be appropriate to start gently returning to recreational walking and light exercise. Impact exercises, running and hard gym training should be avoided for another month or so. Full recovery from the procedure can take up to 6 months.

Mr Callahan will be able to advise you on the most suitable recovery schedule for your circumstances.

Risks

All surgery carries with it some form of risk. Common risks that apply to all surgery, including this procedure, are...

  • Bleeding.
  • Formation of a blood clot (“DVT” or deep vein thrombosis) Pieces of clot in the leg can break off and lodge in the lungs causing a pulmonary embolism. This can be very serious, and in rare cases even cause death.
  • Infection.
  • Nerve damage
  • Difficulty getting the wound to heal
  • Abnormal pain reactions or nerve hypersensitisation known as complex regional pain syndrome (CRPS)

Risks that are related to a Synthetic Interposition Arthroplasty procedure include...

  • Loosening or wearing of the implant.
  • Incomplete resolution of pain, or transfer of pain to another part of the foot.
  • Persistent stiffness in the joint or even further reduction in the range of movement.

Related Information

Cartiva

Downloads


Download Cartiva Surgical Implantation Technique (PDF – 4900 Kb)
Download Cartiva Patient Information (PDF – 5900 Kb)