Comparative study assessing sporting ability after arthrodesis and cartiva hemiarthroplasty for treatment of hallux rigidus

B. Brandao, A. Aljawadi, A. Fox, A. Pillai

Background: Arthrodesis and Cartiva synthetic cartilage implant (SCI) are accepted treatments for hallux rigidus. Arthrodesis is the gold standard treatment of hallux rigidus. Although good functional outcomes have been reported for both procedures, there is little data available on post-operative sporting ability for these patients. As of now, there are no independent comparative series for treatment of hallux rigidus utilising polyvinyl alcohol implants.

Objectives: To compare sporting ability after Arthrodesis and Cartiva SCI hemiarthroplasty of the first metatarsophalangeal joint.

Study design and methods: Patients at a single centre with symptomatic hallux rigidus who underwent Arthrodesis or Cartiva SCI hemiarthroplasty were identified. Sporting ability was assessed at a minimum of 12 months post-operative utilising the patient reported outcome measure, Foot & Ankle Ability Measure (FAAM) sports questionnaire. First metatarsophalangeal joint arthritis was radiographically graded according to the Hattrup and Johnson (HJ) classification.

Results: 42 Arthrodesis and 26 Cartiva patients were included in this study. Mean ages for this cohort were 64 and 58 respectively with a follow-up time of 19 and 18 months respectively. Arthrodesis patients consisted of 6.8% HJ1, 40.9% HJ2 and 52.3% HJ3 and Cartiva SCI patients 31% HJ2 and 69% HJ3 with no HJ1 patients. Mean post-operative FAAM scores were 80.9% for Arthrodesis and 78.9% for Cartiva SCI. Mann-Whitney U testing revealed no statistically significant difference between Arthrodesis and Cartiva SCI (p>0.3). Comparing age (< 55 and >55) and gender matched cohorts revealed no statistically significant results.

Conclusions: Our results suggest that both Arthrodesis and Cartiva SCI result in similar post-operative sporting ability. Cartiva SCI results in a faster return to activities and preserves joint flexibility with adequate pain reduction. More research with larger cohorts and longer follow up is indicated. Initial results of Cartiva SCI are favourable and comparable to arthrodesis.