Orthopedic Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
Rueckenprofis Hannover, Luisenstraße 10-11, 30159, Hannover, Germany.
Arch Orthop Trauma Surg. 2024 Sep;144(9):4343-4354. doi: 10.1007/s00402-024-05534-9. Epub 2024 Sep 17.
This study evaluated the outcome of the Cartiva synthetic cartilage implant (SCI) in the treatment of hallux rigidus.
In the present retrospective matched case-control study, we compared 18 patients with Cartiva SCI (mean follow-up: 17.7 months) to 18 patients with metatarsophalangeal joint arthrodesis (mean follow-up: 20 months) using multiple function measures, along with four specified visual analog subscales for pain. Pre- and postoperative radiographs were compared, and radiographic abnormalities were documented.
We observed no significant differences in function measures between groups. While both groups experienced significant pain reduction, the arthrodesis group reported significantly lower exertion pain than the Cartiva SCI group (p = 0.004). Radiographic abnormalities, including implant site enlargement (6/18, 33.3%), erosive changes of the metatarsal bone (11/18, 61.1%) or articular surfaces (10/18, 55.6%), and bright sclerotic margins (12/18, 66.7%), occurred in the Cartiva SCI group.
The present study showed good functional results and a high satisfaction rate after MTP joint arthrodesis, which is considered the gold standard surgical treatment for higher grade hallux rigidus. While the Cartiva SCI group did not show significant differences from the arthrodesis in most aspects of function and clinical scores, the arthrodesis group tended to have better results in terms of satisfaction, residual pain, and revision rate. Even after the short follow-up period, there were some remarkable radiographic findings in the Cartiva SCI group, the long-term effects of which are not yet evident, but which may lead to implant loss. Cartiva SCI has advantages for patients who prioritize postoperative mobility, but the potential risks should be considered in the patient's informed consent. Therefore, the present study highlights the importance of MTP joint arthrodesis for the treatment of hallux rigidus.
Level IV - Retrospective matched case-control study.
本研究评估了 Cartiva 合成软骨植入物（SCI）治疗僵硬拇趾的疗效。
在本回顾性匹配病例对照研究中，我们比较了 18 例 Cartiva SCI 患者（平均随访 17.7 个月）和 18 例跖趾关节融合术患者（平均随访 20 个月），使用了多种功能测量指标，以及 4 项特定的疼痛模拟量表。比较了术前和术后的 X 线片，并记录了放射学异常。
我们没有观察到两组之间在功能测量指标上有显著差异。虽然两组都经历了显著的疼痛减轻，但融合组报告的用力疼痛明显低于 Cartiva SCI 组（p=0.004）。放射学异常包括植入物部位扩大（6/18，33.3%）、跖骨侵蚀性改变（11/18，61.1%）或关节面（10/18，55.6%）和明亮的硬化边缘（12/18，66.7%），发生在 Cartiva SCI 组。
本研究显示，跖趾关节融合术具有良好的功能结果和高满意度，被认为是僵硬拇趾较高等级的金标准手术治疗方法。虽然 Cartiva SCI 组在大多数功能和临床评分方面与融合术无显著差异，但融合术组在满意度、残留疼痛和翻修率方面的结果更好。即使在短期随访后，Cartiva SCI 组也有一些显著的放射学发现，其长期影响尚不清楚，但可能导致植入物丢失。Cartiva SCI 对术后活动能力有较高要求的患者有优势，但在患者知情同意时应考虑潜在风险。因此，本研究强调了跖趾关节融合术治疗僵硬拇趾的重要性。
IV 级-回顾性匹配病例对照研究。
