Cartiva Implant: The Most Advanced Treatment for Toe Arthritis
When the cartilage around the big toe joint erodes over time, it limits the function and mobility of the foot and affects our capacity to walk, run and engage in sporting, social, and even everyday activities. This pain and stiffness associated with advanced-stage arthritis of the big toe can limit what is supposed to be the best years of one’s life, but there is a revolutionary new procedure for those suffering chronic big toe pain.
“Big toe arthritis is extremely common,” says Dr. Breslauer. “I see it at least once a day and sometimes several times a day at different stages of severity among patients middle aged and older.”
What Is Cartiva?
What Are the Symptoms of Big Toe Arthritis?
The onset of symptoms of arthritis in the first metatarsophalangeal (MTP) joint can be subtle and can also come about as a result of an acute or traumatic injury. Typical symptoms include:
- Joint pain when walking or running
- Joint inflammation/swelling
- Enlargement of the bone or spurs that rub against shoes
- Inflexibility and restricted mobility of the big toe
What Is the Conventional Treatment for Big Toe Joint Arthritis?
For years, the go-to procedure for severe arthritis of the big toe was fusion surgery, known as arthrodesis. The process involves removing damaged cartilage and then stabilizing the joint by inserting pins, screws or a plate, thus allowing the bones to grow and fuse slowly together.
Although the procedure effectively eliminated the pain, it also significantly restricted the mobility of the big toe to such a degree that patients were limited from engaging in many sporting and recreational activities such as jogging, dancing or skiing.
“Fusion has been the standard for a long time, and it does indeed work, but it has its limitations,” says Dr. Breslauer. “A lot of people aren’t crazy about having their big toe joint fused for many reasons. There have been a plethora of alternatives to fusion, procedures that put in different types of spacers, artificial joints, and different metallic materials, but those have had very hit-and-miss success over the years.”
According to Dr. Breslauer, one of the main problems with a fusion surgery is that it is impossible to predict how a patient will respond to the surgery. “You don’t really know until the procedure is done,” he says. “And for women, it can create significant restrictions on shoe options if your toe doesn’t bend.”
Without the joint being able to move, many kinds of high-heeled shoes become an impossibility for women – but not with the Cartiva treatment.
What Makes Cartiva Different?
Although previous implants have had mediocre results, the new state-of-the-art Cartiva implant is inserted as part of a concise process that favors quicker recovery while preserving function of the big toe joint. It also allows for additional surgical treatment in the future to address any difficulties.
According to the FDA, the Cartiva synthetic cartilage implant is designed, approved and supported for surgical placement in individuals having degenerative arthritis in the MTP joint. The innovative implant is made of the same biocompatible material as contact lenses and was conceived to replace damaged cartilage and imitate its natural characteristics.
“The procedure does not require any removal of the joint itself, whereas prior implants called for a more significant part of the joint to be extracted,” says Dr. Breslauer. “Should you later need a fusion for whatever reason, it’s quite easy to remove the Cartiva implant and still have all your bone length there to convert it to a fusion.”
Dr. Breslauer explains that with other pre-Cartiva procedures, removing the implants to prepare for fusion surgery left patients with limited and complex bone integrity. “You’re left with a very short set of bones to work with, damaged bone, which typically involves putting bone graft in there for the fusion, and that takes longer to heal so it’s much more complicated,” he says.
How is Cartiva Surgery Performed?
The Cartiva implant operation is an outpatient procedure that takes about 30 minutes to complete. To insert the implant, Dr. Breslauer first makes a 4-5 cm incision over the big toe joint. Following the removal of any bone growths or spurs, the injured cartilage is taken out and replaced with a specially-fitted Cartiva synthetic implant, providing a smooth, weight-bearing joint surface.
“We drill a hole into the metatarsal side of the big toe joint,” says Dr. Breslauer. “Then we press-fit the Cartiva into the hole so that a few millimeters of it projects into the joint space, and that’s what allows the big toe to bite on and create some space there.”
“I like to use an analogy with my patients. I describe Cartiva somewhat like a pencil eraser, firm but also kind of soft. Most of it sits down into the bone, just like an eraser sits down into the metal on the top of a pencil; but some of it sticks out of the metal just like some of this sticks out of the bone and projects into the joint.”
What Can You Expect After Cartiva Implant Surgery?
As opposed to fusion surgery, patients can walk out the door right after surgery and begin the rehabilitation process immediately.
“There’s no bone healing that needs to occur after the surgery, so patients are 100% weight-bearing the same day of surgery,” says Dr. Breslauer. “We start them on range of motion exercises right away, so the recovery is much less onerous for patients.”
Stitches are usually removed after around twelve days at which time patients can transition into comfortable shoes such as sandals or sneakers. Some swelling may persist for a few weeks after the procedure, but it will normally resolve after four to six weeks.
According to Dr. Breslauer, patients can do any activities they’re comfortable doing but should avoid any excessive running or anything that creates excessive wear and tear on the joint. And of course, patients are also free to wear most any type of shoe they wish.
“By doing this procedure, we’re not only alleviating the source of the pain we’re also maintaining some motion at the joint, so there’s more freedom for the position of the toe inside of the shoe,” he says.
What Are the Results of Cartiva Implant Surgery?
Cartiva implants have passed the five-year milestone with flying colors, and there is every reason to believe in their continued benefit and durability. In fact, there was a follow-up paper published at the beginning of 2017 to the initial FDA pilot study and there wasn’t one material failure in the original patients implanted with Cartiva over that five-year period.
Is Cartiva Right for You?
As with most surgical procedures, the only way to know for sure if Cartiva is right for you is to talk it over with your podiatrist. By undergoing a thorough exam, reviewing image studies and discussing lifestyle expectations, Dr. Breslauer will be able to recommend the best course of action for your own unique circumstances.