Clinical Outcomes of Synthetic Cartilage Implant for Second Metatarsophalangeal Joint Arthritis

CATEGORY: Midfoot/Forefoot INTRODUCTION/PURPOSE: Second metatarsophalangeal joint (MTPJ) arthritis can be caused by both traumatic and non-traumatic conditions such as inflammation, osteoarthritis, and Freiberg's disease. Although many treatment options for second MTPJ arthritis are available, resurfacing with a synthetic cartilage implant (SCI) has recently gained popularity since it demonstrates similar biomechanical properties as native cartilage, eliminates pain, and preserves second MTPJ motion. With limited data available on the efficacy of SCI resurfacing for the lesser toes, the purpose of this study was to report on the clinical outcomes of SCI resurfacing in patients with second MTPJ arthritis. METHODS: Electronic health records were queried from July 2017 to December 2020 for patients who were experiencing symptomatic second MTPJ pain and were treated with SCI (Cartiva Synthetic Cartilage Implant; Cartiva Inc., Alpharetta, GA) by a single surgeon. Patient demographics such as body mass index (BMI), age, sex, medical comorbidities, American Society for Anesthesiologists (ASA) physical status, past surgical history, and followup periods were recorded. Preoperative and postoperative range of motion, visual analog scale (VAS) pain scores, and x-ray imaging were compared. Descriptive and univariate statistics were used to analyze data. RESULTS: A total of six patients received SCI resurfacing for second MTPJ pathologies including Freiberg's disease (50%), osteoarthritis (67%), and subluxation (50%). All six patients were female and the mean BMI and age were 28.3+-6 Kg/m2 and 56.3+-14 years, respectively. Three patients (50%) received index SCI resurfacing, while three patients (50%) received SCI resurfacing as a revision procedure. No significant differences were observed between preoperative and postoperative pain VAS, dorsiflexion, and plantarflexion measurements. The mean followup period was 16.4+-14 (range, 5-38) months and no postoperative complications were reported. When reviewing imaging, all patients demonstrated second MTPJ alignment within 10 degrees of valgus and maintenance of articular space (Table 1). CONCLUSION: SCI resurfacing can be utilized as a treatment option for second MTPJ arthritis. Future prospective studies should be performed to expand upon the limited clinical outcomes data presently available.