The most reliable procedure for arthritis has always been a fusion. Fusion of the joint is considered the ‘Gold Standard’ operation. While aFusion is a good operation it is not perfect. Fusion provides reliable pain relief but stops all movement of the joint. This affects a number of activities including wearing heeled shoes and sports. It also has a significant recovery time.
Replacement of the joint in the past has been problematic. The implants have failed early and also compromised the bone.
Cartiva is made from a hydrogel that works like natural cartilage. The saline and organic polymer implant can withstand repetitive loading typical of the first MTPJ. Patients can bear weight immediately as tolerated, are able to drive and can undertake a range of motion exercises following their operation.
New evidence-based treatment
The evidence for the use of Cartiva is level 1. In a prospective randomised control trial carried out in two countries, across 12 different hospitals involving 200 patients (Baumhauer et al 2015). Cartiva showed equivalent pain relief to a fusion with a similar complication rate in 91% of patients. Patients had a significantly increased range of motion of the joint. Cartiva allowed immediate full weight bearing and a much faster recovery. So far survivorship of the implant is excellent out to 5 years. When the implant does fail, it is reliably converted to a fusion at that time.
In a cohort of 106 patients from Cartiva's pivotal clinical trial followed out to 5.8 years, pain was reduced significantly and functional outcomes improved significantly.
97% reduction in pain
176% functional improvement
Cartiva patients return to pre-operative activities faster than fusion patients
Cartiva demonstrated excellent durability and survivorship. Furthermore, patients maintained their great toe motion and were satisfied, with 93% of patients indicating they would undergo the procedure again.
A patient of mine who was one of the first to undergo the procedure in Australia was recently featured in 7 News. This patient is now able to wear normal and healed shoes and is walking briskly without pain https://drjacobkaplan.com.au/.
Dr Jacob Kaplan, BSC (Hons), MBBS, FRACS (Orth)
Dr Jacob Kaplan is a specialist orthopaedic surgeon. He focuses on the diagnosis and surgical treatment of disorders of the foot, kneeankle. Dr Kaplan completed his orthopaedic training in NSW and then underwent subspecialty foot, knee and ankle surgery training in Toronto, Canada.
Dr Kaplan performs all types of foot, knee and ankle surgery including minimally invasive forefoot surgery, sporting injuries, ankle replacement, robotic knee replacement, treatment of degenerative and arthritic conditions, deformity correction and fracture treatment.
Dr Kaplan is an active member of the Australian Orthopaedic Association and the Australian Orthopaedic Foot and Ankle Society. In addition he is active in the Canadian and American foot and ankle surgery societies.
He is involved in international research in regard to the developing area of ankle replacement and is an active member of orthopaedic outreach, providing orthopaedic care in the South Pacific.