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What is Cartiva Joint Replacement?

Cartiva joint replacement is a surgical procedure used to treat osteoarthritis of the big toe joint using the Cartiva implant.

A joint is an articulation (junction) between two or more bones in the body. The articular surfaces of the body’s joints are lined by hyaline cartilage, a smooth tissue that serves as a shock absorber and allows easy movement of the bones within the joint. Osteoarthritis is a degenerative joint disease that causes breakdown and eventual loss of cartilage in the joint, causing a painful rubbing of bone surfaces with movement.

During Cartiva joint replacement, the damaged articular cartilage surface of the big toe joint is removed and replaced with the Cartiva Synthetic Cartilage Implant (SCI). The Cartiva is a man-made (synthetic) implant made of a durable, biocompatible, and slippery organic polymer called polyvinyl alcohol (PVA). PVA has been safely used as a medical device by foot specialists for many years. It has properties similar to that of cartilage and helps to relieve pain and restore normal range of motion and function to the big toe joint when inserted between the arthritic joint.

Indications for Cartiva Joint Replacement

Cartiva joint replacement is typically indicated as a treatment option for a foot condition called hallux rigidus or stiff big toe caused by osteoarthritis of the first metatarsophalangeal (MTP) joint. 

A stiff big toe, also called hallux rigidus, is a form of degenerative arthritis affecting the joint where the big toe (hallux) attaches to the foot. The toe typically becomes stiff at the base and is sometimes called a “frozen joint”. The big toe joint is called the hallux metatarsophalangeal (MTP) joint. It connects the top of the first foot bone (metatarsal) with the base of the first toe bone (proximal phalanx).

Your physician will recommend Cartiva joint replacement when conservative treatment measures such as medications and physical therapy have failed to relieve symptoms of osteoarthritis of the big toe/MTP joint, such as:

  • Pain and stiffness of the big toe
  • Swollen and inflamed toe
  • Damaged or worn-out cartilage
  • Formation of bone spurs on the big toe joint
  • Non-flexion of the big toe
  • Narrowing of joint space
  • Rubbing of the raw bone ends
  • Foot pain that interferes with daily activities 

Preparation for Cartiva Joint Replacement

In general, preparation for Cartiva joint replacement may involve the following:

  • A review of your medical history and a physical examination
  • Routine blood work and imaging
  • Informing your doctor about medications or supplements you are taking
  • Informing your doctor about any allergies to medications, anesthesia, or latex
  • Disclosing any recent illnesses or other medical conditions you have
  • Refraining from medications such as blood thinners and nonsteroidal anti-inflammatories, or other supplements, if contraindicated for the procedure
  • Arranging for someone to drive you home after the procedure
  • Signing an informed consent form

Procedure for Cartiva Joint Replacement

Cartiva joint replacement surgery is usually performed under general anesthesia, and normally involves the following steps:

  • You will be placed in a supine (face-up) position on the procedure table with your foot held in an optimal position to facilitate the surgery.
  • An incision is made over the big toe, and soft tissues are moved away to expose the joint.
  • Using special instruments, your surgeon will carefully remove the damaged portions of the joint, and a small hole – about 1 centimeter - is drilled into the head of the first metatarsal - the long bone connecting the mid-foot to the big toe joint.
  • Next, the Cartiva implant is placed into the hole. The synthetic implant is a tiny cylindrical plug with physical properties similar to those of articular cartilage.
  • The Cartiva implant is designed to replace the damaged cartilage of your arthritic joint. The implant provides a smooth, slippery, load-bearing surface to the joint, allowing it to move freely, relieving pain and stiffness, and improving joint function.
  • Upon completion, the incision is closed with sutures and covered with a sterile bandage.

Postoperative Care and Recovery

In general, postoperative care instructions and recovery after Cartiva joint replacement will involve the following:

  • Your big toe will be secured with a surgical shoe/sandal to facilitate wound healing, with instructions on restricted weight-bearing.
  • You may experience pain, swelling, and discomfort in the foot area. Pain and anti-inflammatory medications are provided as needed to address these.
  • Antibiotics may also be prescribed to address the risk of surgery-related infections.
  • You are advised to keep your foot elevated as much as possible while resting to reduce swelling and pain.
  • Applying ice packs to the foot several times a day is encouraged to reduce swelling and pain once medications are stopped.
  • You are advised to bend your knee, ankle, and toes periodically to stimulate circulation.
  • Instructions on surgical site care and bathing will be provided to keep the surgical site clean and dry.
  • You are advised to refrain from strenuous activities such as running and lifting heavy weights for a defined period.
  • Most patients are able to resume their normal activities in a month or two after surgery, but with certain activity restrictions.
  • Refrain from driving until you are fully fit and receive your doctor’s consent.
  • Periodic follow-up appointments will be scheduled during which you will have your stitches removed, and you will be advised to gradually increase your activity level and gently exercise your big toe.

Risks and Complications

Cartiva joint replacement is a relatively safe surgery; however, as with any surgery, some risks and complications may occur, such as the following:  

  • Damage to surrounding tissue
  • Postoperative pain and discomfort
  • Joint stiffness
  • Infection
  • Numbness
  • Swelling and inflammation
  • Thromboembolism or blood clots
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