HALLUX RIGIDUS – Synthetic interposition arthroplasty (CARTIVA)

Pain, swelling and stiffness at the base of the big toe is frequently caused by osteoarthritis of the 1st (big toe) metatarso-phalangeal joint. It results in pain, spurs and progressive restriction of movement. The cause is unfortunately unknown in most cases. The treatment is aimed at relieving pain. If non-operative means such as anti-inflammatories, accommodative footwear or orthoses fail to control symptoms surgery may be indicated. Synthetic interposition arthroplasty is a joint movement preserving option for managing big toe osteoarthritis. It is a relatively new procedure however it has promising medium-term results in clinical studies.

The Surgery

The procedure is performed under general anaesthetic. An incision is made on top of the big toe and the joint is exposed. The spurs are removed with a small saw. A hole is reamed in the metatarsal head to allow placement of the synthetic ‘cartilage-like’ implant. The layers of the joint and skin are closed. A dressing is applied.

Post-Operatively

You can walk on the foot with a surgical shoe/sandal (provided) as soon as you are awake. Crutches are optional. You will need to keep the foot elevated as often as possible for the first 2 weeks. This is to control swelling and pain. You may need to take medication to control pain. You should keep the bandages dry and clean until your first post-operative clinic visit.

  • Activity
  • Timeframe (approximate)
  • Walk with surgical shoe/sandal
  • 6 wks
  • Walking in wide shoes
  • 6 wks– 3 mts
  • Most activities and shoes
  • 3 – 6 mts
  • Full Recovery
  • Up to 12 mts
  • Type of Work
  • Time off
  • Sitting
  • 2 weeks
  • Standing
  • 4 weeks
  • Driving
  • 4 weeks
  • Lifting
  • 6 weeks

Risks of surgery

All surgical procedures carry some risk. The risk of complications with interpositional arthroplasty is low. Most patients benefit from this surgery. A small number of patients can be made worse. You should weigh up the benefits with the risks prior to electing to have surgery.

This is a list of the most common problems which can occur:

  • Swelling – is normal and improves with time, but can occasionally persist past 6 months
  • Wound healing problems – increased if smoking, diabetes, poor circulation
  • Nerve injury – resulting in numbness or pins and needles, occasionally pain
  • Bleeding – usually just visible through the dressing
  • Infection – minimised with antibiotics, elevation, keeping the dressing clean and dry
  • Pain – which may require strong medication (usually Paracetamol is adequate)
  • Progression or recurrence of disease – may require further surgery, usually a fusion

These are rarer complications, but they can and do happen:

  • Failure to relieve pain or transfer of pain to other part of foot
  • Early mechanical failure of the implant – wear or loosening/dislodgement
  • Complex regional pain syndrome (CRPS) – nerve pain syndrome, risk reduced with Vitamin C 500mg daily for 40 days
  • DVT – clot in the deep veins of the leg (increased if smoking, contraceptive pill, hormone replacement or previous history)
  • Anaesthetic complications – more likely if there are pre-existing medical disorders

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  • Fellow of the Royal Australasian College of Surgeons
  • Fellow of the Australian Orthopaedic Association
  • Australian Medical Association
  • Royal North Shore Hospital
  • British Orthopaedic Foot & Ankle Society
  • American Orthopaedic Foot & Ankle Society
  • Australian Orthopaedic Foot & Ankle Society