Jimenez Mosquea Thelma R, Colasanti Christopher A, Ubillus Hugo A, Walls Raymond J
Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA.
Foot Ankle Orthop. 2025 Apr 11;10(2):24730114251330300. doi: 10.1177/24730114251330300. eCollection 2025 Apr.
Hallux rigidus is a degenerative condition of the first metatarsophalangeal (MTP) joint that can significantly impair function and quality of life. The introduction of polyvinyl alcohol (PVA) hydrogel implants, such as Cartiva, offered an alternative to arthrodesis by preserving joint motion. However, failures of these implants, often resulting in bone loss and joint instability, present a challenge for revision surgery.
We report the case of a 43-year-old woman with persistent pain and functional limitations after a failed PVA hydrogel implant in the first MTP joint. The revision surgery involved a biologic resurfacing using the Osteochondral Autograft Transfer System (OATS) with a graft harvested from the ipsilateral femoral condyle, complemented by interpositional arthroplasty with a dermal graft and a proximal phalanx closing wedge osteotomy to correct residual hallux valgus.
At the 3-year follow-up, the patient-reported complete resolution of pain and returned to full activity with improved range of motion (40 degrees dorsiflexion, 15 degrees plantarflexion). Radiographic evaluation demonstrated graft incorporation and restoration of joint space, confirming the success of the procedure.
This case highlights the potential of OATS combined with interpositional arthroplasty as a viable option for revision surgery in complex cases of failed synthetic cartilage implants in hallux rigidus. By addressing bone loss and preserving joint function, this approach provides a patient-specific alternative to traditional arthrodesis. Further studies are warranted to establish the long-term efficacy of this technique in similar cases.
Level V, case report.
僵硬性拇趾是第一跖趾关节的一种退行性疾病，可显著损害功能和生活质量。聚乙烯醇（PVA）水凝胶植入物（如Cartiva）的引入，通过保留关节活动度为关节融合术提供了一种替代方案。然而，这些植入物的失败，常导致骨质流失和关节不稳定，给翻修手术带来了挑战。
我们报告了一例43岁女性的病例，该患者在第一跖趾关节的PVA水凝胶植入物失败后持续疼痛且功能受限。翻修手术包括使用骨软骨自体移植转移系统（OATS）进行生物表面重建，移植物取自同侧股骨髁，并辅以真皮移植物间置关节成形术和近节趾骨闭合楔形截骨术以纠正残留的拇外翻。
在3年的随访中，患者报告疼痛完全缓解，恢复了全部活动，活动范围得到改善（背屈40度，跖屈15度）。影像学评估显示移植物融合且关节间隙恢复，证实了手术的成功。
本病例突出了OATS联合间置关节成形术作为僵硬性拇趾合成软骨植入物失败复杂病例翻修手术可行选择的潜力。通过解决骨质流失问题并保留关节功能，这种方法为传统关节融合术提供了一种针对患者的替代方案。有必要进一步开展研究以确定该技术在类似病例中的长期疗效。
V级，病例报告。
