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Polyvinyl Alcohol Hydrogel Hemiarthroplasty of the Great Toe: Technique and Indications

Younger, Alastair S. E. MB ChB, ChM, MSc, FRCSC*,†; Baumhauer, Judith F. MD, MPH

Techniques in Foot & Ankle Surgery: September 2013 - Volume 12 - Issue 3 - p 164–169
doi: 10.1097/BTF.0b013e3182a2b350

Joint replacements of the first metatarsophalangeal (MTP) joint have traditionally had limited success. Joint replacements designed to date can be subdivided into hemiarthroplasties and total joint replacements. Despite ongoing requests from patients to have a joint replacement to preserve shoe wear options, many have failed to meet expectations because of loosening, implant wear, osteolysis, or loss of motion. Fusion has therefore remained the gold standard for treatment of end-stage MTP joint arthritis. A polyvinyl alcohol hydrogel implant shows promise. The Cartiva implant is a 8 or 10 mm disk of durable hydrogel material shown to resist compression and shear with exceptional wear characteristics. It is implanted with approximately 1 to 1.5 mm protrusion and acts as a spacer for the first MTP joint. This implant is commercially available in Europe and Canada. A prospective, randomized, multicenter clinical trial is underway in the United Kingdom and Canada to assess outcomes with this implant. This article outlines the indications for surgery, surgical technique, and potential complications for hemiarthroplasty of the great toe.

*Department of Orthopaedics, University of British Columbia

BC’s Foot and Ankle Clinic, St Paul’s Hospital, Vancouver, BC, Canada

Department of Orthopaedics, University of Rochester School of Medicine and Dentistry, University of Rochester, Rochester, NY

A.S.E.Y. and J.F.B. have received institutional support from Carticept Medical Inc., to assist in the conduct of a randomized prospective study.

Address correspondence and reprint requests to Judith F. Baumhauer, MD, MPH, University of Rochester School of Medicine and Dentistry, University of Rochester, 601 Elmwood Ave., Box 665, Rochester, NY 14642. E-mail:

© 2013 by Lippincott Williams & Wilkins