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Wednesday, January 10, 2018

Cartiva Joint Implant vs Arthrosurface: Present Thoughts


     As you all know there are 2 givens in this post: I am not a surgeon, and it is hard to recommend anything you have no experience dealing with. So, that is the basis of our office recommending Arthrosurface for joint implantation if surgery is decided on to help the pain created by Hallux Rigidus. As of January 2018, I have not seen one patient present with the Cartiva implant, so please be free to comment below. Cartiva seems to be doing a great PR campaign, but the only comparison I could find between Cartiva and Arthrosurface was very heavily supportive of Arthrosurface. I am sure that the jury is out. I think all of these procedures do work when done on the right person. It is finding the right person. Doctors must rely on what they are trained in doing unless the doctor is dissatisfied with the results. Or, unless they are seeing patients from other doctors (our patients are so mobile so I follow patients from literally all around the world) that are getting fabulous results from another procedure. This is presently not happening with Cartiva. I would not believe a representative of the company, but patients who have used the Cartiva or the Arthrosurface are free to weigh in. I am hopeful this blog can inform people intelligently, but in some way, you have to trust what your doctor wants to do. At least now, you can pre-operatively ask if Arthosurface or Cartiva is right for you. Maybe your doctor has experience in both and prefers one over the other. That is what I am actually looking for. A doctor who has experience in both, and knows when to use either one (what are the implications to use one versus another). Wouldn't that even be a better post on my blog?


Arthrosurface Implant Left Big Toe Joint in one of my patients

Side View Arthrosurface Implant



4 comments:

  1. Dr. Blake,

    As per your comments, I agree that the Arthrosurface is a good implant. I have been performing the Arthrosurface for over 10 years now and have had overall very positive outcomes, with very satisfied patients.

    I have started using the "total" 1st MPJ replacement system by Arthrosurface more often and feel that it has displayed distinct advantages over the HEMI joint, although the HEMI has performed well. The "total" patients seem to achieve maximum pain relief faster.

    I do not necessarily have a negative opinion of Cartiva at this time, however with the old saying, "if it ain't broke, don't fix it", it has been difficult for me to jump on the band wagon.

    An article published this past December of 2017 in orthopedic proceedings showed positive results with Captive, but it bares mentioning that:

    "Composite primary endpoint criteria for clinical success included pain reduction ≥30%, maintenance/improvement in function, and no radiographic complications or secondary surgical intervention at 24 months."

    I have reservation about a surgery being listed as successful if the patient only achieves a 35% reduction in pain, as would be considered a success in this study. Also procedures that did not need additional surgery for 2 years were considered successful. We typically do not pass solid judgement on a procedure, especially joint replacement, prior to the 5 year outcome studies mark.

    There may be a 5 year study available, but I am unaware at the time of writing this.

    I do the most Arthrosurface joint replacements in my greater Chicagoland region, unless my rep is not telling me the truth, and can honestly say that yes, there are sometimes complications and some small design improvements that could be made to increase the indications, but the vast majority of my patients selected as good candidates achieve very good results.

    I will be seeing a failed Cartiva next week as the patient was referred to me specifically for revision with an Arthrosurface joint. I will gladly report back to you on my findings.

    Please note, that one failure does not imply a bad implant and it is not my intention to suggest as such.

    I have always said that if a surgeon is getting good reproducible results with a certain procedure then it is hard to get him/her to change simply because there is a new technology out.

    There are pros and cons to everything we do and patients should talk with a surgeon who they like and trust about their big toe pain and remember that not every patient is a good candidate for any one type of surgery.

    Unfortunately, for new technologies, time is on the side of older technologies that work well and the Arthrosurface Big Toe Joint is a technology with a track record. I am not prepared to switch at this time due to my 10+ year outcomes with Arthrosurface and lack of added Value for Captiva, but it very well could be an equivalently effective and successful procedure down the road.

    Dr. Douglas Pacaccio, DPM, DABFAS
    Sycamore and Yorkville, IL

    Feel free to email me at:

    doug.afas@Yahoo.com


    Thanks for the blog. Well Done.

    ReplyDelete
    Replies
    1. Dear Dr. Pacaccio, Thank you wholeheartedly for your incredible comment. This is the same opinion as our surgeon. This topic is only helpful if someone doing the Arthrosurface or Cartiva weighs in, so I am very grateful. Keep up the great work in the Chicago area. Rich

      Delete
  2. Hi Dr. Pacaccio - in your post you mention meeting with a failed Cartiva patient earlier this year. Did you indeed meeting with matient, and were you able to help them? Being a failing Cartiva patient myself (the implant has receded in the metatarsal bone) I'm curious about non-fusion alternatives.

    ReplyDelete
  3. I am 8 months out of having the cartiva and I have e pain every day. Doctor wants me to hold out for a year. I am very upset since I don't want a fusion because it brings in other problems.

    ReplyDelete

Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.