Surgery to put Cartiva Synthetic Cartilage Implants in the large joints of my big toes has reduced pain and restored motion and function.
By last October, I was down to exactly three pairs of shoes I could wear – a pair of cork bed sandals, my combat boots, and my hiking shoes. I had cut way back on physical activity — I dropped karate classes, stopped running, and tried my best to keep going to spin class and walking lots — but my feet were still sore and swollen. The bone bumps kept getting larger. Over a few years, I had developed arthritis in my big toes.
About big toe arthritis
In a healthy joint, cartilage provides a smooth surface for bones to move across as you articulate the joint. When cartilage is destroyed by osteoarthritis, bone rubs on bone, causing inflammation. But cartilage is a tissue that does not regenerate, so the body tries to compensate by growing more bone. That excess bone growth causes pain when it presses on shoes and limits the range of motion of the joint.
X-rays confirmed that I had lost a lot of cartilage in the large big toe joints in both feet. My right foot had grown more excess bone, so I suspect that the degeneration started with an injury in karate class a few years earlier, but I may also have a genetic predisposition for developing osteoarthritis.
Hallux rigidus, the technical name for “big toe arthritis,” is the most common foot arthritis condition that affects 1 in 40 people over the age of 50.
Fun fact: the first metatarsophalangeal (MTP) joint, the large big toe joint, carries about 119% of your body weight with each step.
Cartiva Synthetic Cartilage Implant
The Cartiva Synthetic Cartilage Implant (SCI) is a medical device, the size of a jelly bean, made from hydrogel material that is compatible with the human body. It was designed to have similar properties to human cartilage: it’s compressible and has a low-friction and durable bearing surface. It comes in two sizes, the 8 mm and the 10 mm. I am the proud owner of two 10mm implants. Here is an animated video showing the procedure:
Cartiva MTP Surgical Technique
What was my other option?
The current standard of care treatment for hallux rigidus is total joint fusion with screws and plates. Fusion is effective for eliminating pain, but it permanently prevents movement of the joint. For me, maintaining mobility was a top priority for physical fitness and long-term health.
What were the clinical study results?
At my consultation appointment, my surgeon advised that they have data showing the device lasts up to 8 years. He expected it would last much longer, but as a new product, they didn’t have data further out. He had performed about 70 procedures at that point and said there were only two cases that he was watching closely that might require revision surgery.
The MOTION clinical study was a 236-patient, multi-centre, prospective, randomized trial that compared Cartiva SCI to total fusion, the standard of care treatment. My surgeon, Timothy Daniels MD, FRCSC was the primary investigator at St. Michael’s Hospital in Toronto, one of 12 sites across Canada and the United Kingdom, and co-author on the published paper.
In the study, patients received either the Cartiva SCI implant or total fusion. The key findings were:
- Patients in the Cartiva group achieved clinical success of 80% for the composite primary endpoint score for pain, function and safety at 24 months, compared to 79% success for the fusion group. (For my health journalism friends, this was a non-inferiority trial).
- Patients in the Cartiva group:
- Achieved a 93% reduction in pain
- Saw a 168% improvement in ability to perform sporting activities and a 65% improvement in activities of daily living
- Experienced a 26% improvement in range of motion compared to baseline
If the Cartiva implants didn’t work, I could still have total joint fusion in the future. In the clinical study, less than 10% of the Cartiva implant group needed revision fusion surgery at the two-year mark. Those odds sounded good!
I asked so many questions at the consultation appointment that my surgeon asked me what I did for a living. After I told him, he suggested that I write about excessive wait times. Here is my timeline:
- April 2014: Consultation with my family doctor and initial X-rays
- February 2015: Consultation with orthopedic surgeon
- October 2o16: Surgery
So all in, from start to finish, it took two and a half years to go from the initial consultation with my family doctor to the surgery date. But wait, there’s more! It would have been even longer if I had not been on the cancellation list. I spoke to my surgeon’s assistant in February 2016 to make sure, and at that point, she was doing call-backs from 2011. I said I would be able to commit to a date on short notice. By October, I got my chance.
Given that I had already waited so long, I agreed right away when the surgeon said I could have both feet repaired in the same operation. It was brave, and a bit tricky getting around the first few days after, but I’m glad I did both feet in one procedure.
It’s been about three months now and my feet are healing nicely. I have regained a lot of motion and the pain and swelling have subsided a lot. My right foot is taking longer than the left, but much more excess bone was removed from that foot. I expect my feet will continue to improve over the next three months. I’m able to return to more activities as the weeks go by — I’m back to my spin class, wearing my spin shoes, and I can tolerate standing while biking for part of the class. I’m looking forward to running again in a few months and doing some stair training with a friend when the summer rolls around.
Here is a video, featuring another patient and Dr. Daniels talking about the procedure.
The Cartiva Synthetic Cartilage Implant is available in Canada. In spite of the long wait time, I’m glad my family physician referred me to Dr. Daniels. In addition to serving as a lead investigator in the MOTION trial, he is head of the Division of Orthopedic Surgery at St. Michael’s Hospital in Toronto.
Disclaimer: Several people have asked me about my recent foot surgery, so I wrote this blog post to share information. If you have pain due to osteoarthritis in your big toes, this procedure might be an option to discuss with your physician. This information is NOT medical advice. Your mileage may vary.