Mahmood Abid, Atcha Hussain, Khan Shahnawaz, Atkinson Henry
Trauma and Orthopaedics, Maidstone and Tunbridge Wells NHS Trust, London, GBR.
Diabetes and Endocrinology, Essex Partnership University NHS Foundation Trust, Colchester, GBR.
Cureus. 2024 Dec 13;16(12):e75683. doi: 10.7759/cureus.75683. eCollection 2024 Dec.
Background Severe osteoarthritis (OA) of the first metatarsophalangeal joint (MTPJ) is usually treated by arthrodesis, which results in a loss of mobility in the joint. Cartiva (Stryker Corporation, Kalamazoo, USA) is a synthetic cartilage implant (SCI) designed to repair osteochondral defects in the treatment of the first MTP OA. Treatment using the Cartiva SCI should relieve symptoms of OA whilst sparing motion in the first MTPJ and may provide a superior alternative to arthrodesis. Objectives The objective of this article is to assess the clinical outcomes of a novel SCI, Cartiva, for arthroplasty in the management of the first MTPJ arthritis. Study design and methods We retrospectively reviewed 64 patients who had received a total of 67 Cartiva implants between May 2016 and June 2020. The average age of these patients at the time of surgery was 54.3 years with a range from 19 to 77 years. Forty-five of the 67 implants were used in females and 22 were used in males. Radiological Grade 2 OA was present in 46 cases with Grade 3 in 21 (Hattrup and Johnson classification). Validated patient-reported outcomes measures (PROMs) were used to assess the functional efficacy of the implants. All cases were performed by a single surgeon. The PROMs data was collected via follow-up phone calls with the patients who were asked questions from the American Academy of Orthopaedic Surgeons' Foot and Ankle Measure (AAOS-FAM), the EQ-5D-3L survey and the Manchester-Oxford Foot and Ankle Questionnaire (MOXFQ). All data collected was anonymised to preserve confidentiality and local hospital ethics committee approval was sought. All statistical analysis was done using Microsoft Excel (Microsoft® Corp., Redmond, WA) and Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Version 23.0, Armonk, NY). Results There was a significant improvement in all PROMs at three years, and one patient developed an implant-related infection. The average scores for the EQ-5D-3L survey significantly improved from 0.69 to 0.85 post-operative (post-op) (p<0.05). The mean MOXFQ scores improved from 42.5 to 15.4 post-op (p<0.05). The radiologic evaluation demonstrated satisfactory implant positioning in all cases at the last follow-up. Conclusions The data shows significant improvements between pre-op and post-op scores. The implication of this is that synthetic cartilage arthroplasty provides a viable alternative to arthrodesis in the treatment of OA affecting the first MTPJ. However, more studies may need to be done focusing on larger sample sizes and patients should be observed over a longer term, including a formal multi-centred clinical trial.
背景 第一跖趾关节（MTPJ）的重度骨关节炎（OA）通常采用关节融合术治疗，这会导致关节活动丧失。Cartiva（美国史赛克公司，卡拉马祖）是一种合成软骨植入物（SCI），设计用于修复第一跖趾关节OA治疗中的骨软骨缺损。使用Cartiva SCI进行治疗应能缓解OA症状，同时保留第一跖趾关节的活动度，并可能为关节融合术提供更好的替代方案。目的 本文的目的是评估一种新型SCI，即Cartiva，用于第一跖趾关节置换治疗关节炎的临床效果。研究设计与方法 我们回顾性分析了2016年5月至2020年6月期间接受共计67枚Cartiva植入物的64例患者。这些患者手术时的平均年龄为54.3岁，范围为19至77岁。67枚植入物中有45枚用于女性，22枚用于男性。根据Hattrup和Johnson分类，46例为放射学2级OA，21例为3级。采用经过验证的患者报告结局指标（PROMs）来评估植入物的功能疗效。所有病例均由一名外科医生进行。通过与患者进行随访电话收集PROMs数据，向患者询问美国矫形外科医师学会足踝测量（AAOS - FAM）、EQ - 5D - 3L调查问卷和曼彻斯特 - 牛津足踝问卷（MOXFQ）中的问题。收集的所有数据均进行了匿名处理以保护隐私，并寻求当地医院伦理委员会的批准。所有统计分析均使用Microsoft Excel（微软公司，华盛顿州雷德蒙德）和社会科学统计软件包（IBM SPSS Statistics for Windows，IBM公司，版本23.0，纽约州阿蒙克）进行。结果 三年时所有PROMs均有显著改善，1例患者发生了与植入物相关的感染。EQ - 5D - 3L调查问卷的平均得分术后从0.69显著提高至0.85（p < 0.05）。MOXFQ平均得分术后从42.5提高至15.4（p < 0.05）。放射学评估显示在最后一次随访时所有病例的植入物位置均令人满意。结论 数据显示术前和术后评分有显著改善。这意味着在治疗影响第一跖趾关节的OA时，合成软骨置换术为关节融合术提供了一种可行的替代方案。然而，可能需要进行更多针对更大样本量的研究，并且应在更长时间内观察患者，包括进行正式的多中心临床试验。
