Revision of Synthetic Cartilage Implant Hemiarthroplasty of the Great Toe to Metatarsophalangeal Joint Arthrodesis: Technique and Indications

摘要

The use of a polyvinyl alcohol hydrogel synthetic cartilage implant hemiarthroplasty for osteoarthritis of the first metatarsophalangeal joint has increased since publication of the results of a pivotal, prospective, randomized, multicenter, noninferiority, clinical trial performed in the United Kingdom and Canada. The synthetic cartilage implant was awarded FDA approval in July 2016, permitting its commercial distribution in the United States, which has led to a notable escalation in its use. Concomitant failures in a small proportion of these patients will require conversion to arthrodesis. This study describes the surgical technique used to convert synthetic cartilage implant hemiarthroplasty of the first metatarsophalangeal joint to arthrodesis and the 3 cases that underwent revision at a single center in the United Kingdom. Level of Evidence: Diagnostic Level IV, case series. See Instructions for Authors for a complete description of levels of evidence. First metatarsophalangeal joint (MTPJ) arthroplasty and hemiarthroplasty are surgical options for the treatment of moderate to severe hallux rigidus that help preserve motion through the joint. Several generations of implants have been developed, including silicone, ceramic, and metal alloy joint replacements, as well as metal hemiarthroplasties. However, many of these implants have demonstrated high rates of failure due to loosening, malalignment, dislocation, subsidence, implant fragmentation, and bone loss.