Cartiva

[ExperiencedDPM]

you will be paid in pow.

and I’m pleased to announce that given all of the white stuff on the ground, in the air, and on your face if it’s deep enough...bradlet bakotic will be sponsoring the meeting

Harsh!

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[NatCh]

Have never put in a cartiva. Considered it once for a grade 1/2 HR with a more significant central lesion, but just opted for the cheilectomy. My most close colleagues have done them with mixed results.

Have done a handful of interpositional arthroplasty +/- plantarflexory (base) osteotomy in younger (30s) people with elevatus. Good results with no pain at discharge. All are probably 18 to 36 months out currently.

As an aside, reading through this and the RFC thread, I would probably be a poor PP pod. In general, I think 1st ray pathology is probably over operated on. If I dont think you need a 1st mpj fusion or lapidus, I'm probably not operating on you. In 4 years (still time to change my mind) I've probably done 5 or 6? Distal bunions and less cheilectomies, while doing 5-10 cases/week.

Maybe I'm reading your post wrong but it sounds like you're conflating hallux rigidus with bunions/HAV? Cartiva is not a good choice for the latter even though they claim you can use it with up to 20 degrees HA angle. I wouldn't use it in anyone with a valgus component.

 

[DYK343]

I've never put in in outside of training, but I agree with this. I think they do have a (small) place. Make a code, make it pay equivalent to a neuroma or something. Boom. No more fraud.

I havent done one since residency either. The only provider in residency who I did them with was our peds ortho guy. My DPM attendings didnt use them. They seemed to provide good correction on the table but long term I have no experience. I think they do have a place but I havent had the right patient for one. I would consider using one after a coalition resection without fusion. I could see that being useful.

 

[msuDPM]

Maybe I'm reading your post wrong but it sounds like you're conflating hallux rigidus with bunions/HAV? Cartiva is not a good choice for the latter even though they claim you can use it with up to 20 degrees HA angle. I wouldn't use it in anyone with a valgus component.

Apologies if it came across that way. I was speaking as an aside to 1st ray pathology in general. I wouldn't consider an implant in valgus cases. Was simply saying 99% of my HR cases are arthrodesis. HAV I predominantly treat with Lapidus or 1st mpj arthrodesis. I find few patients that are suitable for a head procedure to truly need it.

 

[NatCh]

Apologies if it came across that way. I was speaking as an aside to 1st ray pathology in general. I wouldn't consider an implant in valgus cases. Was simply saying 99% of my HR cases are arthrodesis. HAV I predominantly treat with Lapidus or 1st mpj arthrodesis. I find few patients that are suitable for a head procedure to truly need it.

Ahhh, got it. I figured that I was misreading your post. All clear now.

 

[NatCh]

Is there a technical article for using a dermal substitute in the 1st MPJ? I haven't heard of it until now.

It turns out I have print copies of articles that I had totally forgotten about. Here are some illustrations:

 

[Halux]

It turns out I have print copies of articles that I had totally forgotten about. Here are some illustrations:

This is exactly how I do it. One drill hole with the bottom suture wires coming up to the top. I usually run sutures around the top and then hand tie the bottom to the top. when you run the sutures around the entire graft it tightens it on the sides as well so it fits snug around the head.

 

[GreenHousePub]

It turns out I have print copies of articles that I had totally forgotten about. Here are some illustrations:

Thanks for this

 

[Feli]

Cartiva is a joke... it is a bad remake of silicone implants.

Very funny thread...
Personally, I simply do injects, orthotics with Morton, and stiff sole shoes/boots til it doesn't work.

Surgically, you can try cheilectomy with interposition... think Valente with capsule purse-string stuffed in (typically a lot of redundant capsule when you resect a lot of dorsal cartilage on both met head and phalanx, as you should if you expect it to actually do anything). This is for the people dead set on saving motion or who I think might get 5-10yrs+ out of that before a fusion is the answer. I save all the plantar attachments and length, so all you need to fuse them later is some DBM +/- chips and a lock plate (not a large structure graft like with failed implants). I tell them they might get a few years from the Valente and might retain a bit of motion or decrease pain a bit. They typically can achieve all of those things... but just for awhile. The joint will lock up again, start to hurt, or occasionally the hallux drifts. So, it is a bit like implants but without the cost or losing all that bone...

...or I just skip right to fusions. Implants or even the cheilectomy is extra-stupid in diabetics or obese or end stage. I put in a lot of MPJ1 implants - many designs - in residency, but I was not excited to go scrub those. They don't move or survive well, the literature is pathetic on all of them, and it is not an essential joint. I have seen nothing to ever change my mind since, and I would never do that to any patient.

I don't get it... only in podiatry. The hemis or JuJubes are bad enough. The folks doing total first MPJs truuuly crack me up... yet those re-surface every few years with 'this time will be different.' That should probably be the official motto of all forefoot surgery implants? One of my favorite attendings always liked to say "stop putting sh1t in the foot!" There is seldom a need for implanting anything (besides stainless fixation and a bit of suture).

What could work is an implant made of Cartiva material but instead of a plug it would be a cap that goes over the entire met head. You could roll it on like a condom. You could name it Toejan.

You don't need an implant at all... capsule is fine if it is thick and hypertrophic enough... otherwise, allograft tendon ball (Myerson). Some people are doing Dermagraft for what you describe, but it's over-dissection and tits on a bull to me

 

[NatCh]

You don't need an implant at all... capsule is fine if it is thick and hypertrophic enough... otherwise, allograft tendon ball (Myerson). Some people are doing Dermagraft for what you describe, but it's over-dissection and tits on a bull to me

Hmmm. I can’t make a Toejan condom joke out of that though.