Cartiva Implant Surgery

What is arthritis of the big toe joint?

Arthritis of the big toe joint is a condition which affects your big toe. As a result your big toe becomes stiff and painful. This can lead to a bony lump on the top of your joint which can cause difficulties with shoe fitting.

What are the benefits of surgery?

These include:

• reducing painful movement in your big toe joint

• removing the bony lump from your big toe

• improving the movement in your big toe joint.

What does it involve?

Your operation will be performed as day case surgery. This means you will be able to go home the same day. However, you must have a responsible adult to take you home and stay with you for the first 48 hours.

Your operation will be carried out under local anaesthetic. Injections are given around your ankle or behind your knee to numb the skin and deeper nerves. You will be awake during the operation but will not be able to see your operation or feel any pain.

The operation takes about 1 hour, although you should expect to be in the clinic for around 3 hours. This is to allow time before your operation to give you your local anaesthetic and time after your operation, to allow you to rest and recover before going home.

During your operation an incision (cut) is made to the side of your big toe joint down to the bone. Cuts are then made in the bone to prepare the joint for the implant. The Cartiva implant is designed to replace the damaged cartilage of your arthritic joint.

The incision is closed using sutures (stitches) and covered with a large dressing for 2 weeks.

What happens after my operation?

You will be taken to the recovery area. You will be given a special shoe to wear and shown how to use your crutches. The painkillers you have been given should help if taken regularly. You should always follow the instructions provided in the leaflet supplied with your tablets. You will be given a leaflet, ‘Foot Surgery – Discharge Advice’, giving advice on how to look after yourself and your foot. You will then be able to go home.

What are the risks and possible complications?

There are risks you need to consider before you agree to the procedure.

You should be aware that all of these complications are rare. Complications can usually be treated and need not result in you having permanent disability or pain.

These can include:

• continued stiffness in the big toe joint. You will be given exercises to do when your sutures (stitches) are removed to help keep the movement in your big toe joint. It is important you do these to stop the joint becoming stiff.

• continued pain in the big toe joint

• slightly elevated (raised) big toe

• failure, movement or fracture of the implant requiring its removal. This can happen to 1 patient in every 10³.  You may also need further surgery to fuse the joint

• Deep Vein Thrombosis –DVT (blood clots in the leg veins) or Pulmonary Embolism – PE (blood clots in the lungs).

All adult patients will have their risk of developing a blood clot assessed at their pre-assessment visit. The healthcare professional who carried out the risk assessment will discuss your risk factors with you and advise on treatment to reduce your risk.

You will be given information, ‘Your personal advice for the prevention of venous thromboembolism (blood clots)’ advising you on how to reduce your risk of developing a blood clot.

• infection of your skin. This can happen to 1 patient in every 83¹.  Infection of your skin can be easily treated with antibiotics

• infection of your bone. This is rare and can happen to about 1 patient in every 2,000¹. This is a more serious complication; you may need another operation to remove the infected bone, a stay in hospital and long courses of antibiotics

• delayed healing of the skin or bone in your foot. Although you will be told how long your foot should take to heal, delays in healing of the skin and bone can occur. The information on healing times is given to you as a guide only and you should allow for this when planning your recovery

• prolonged swelling in your foot. Swelling is always present after surgery as it is part of the normal healing process. Swelling lasting longer than expected has been found to occur in about 1 patient in every 500 operations²

• haematoma. This is a painful collection of blood within your foot at the operation site. This occurs very rarely and generally settles without any problems

• thick or sensitive scarring of the incision

• problems with local anaesthetic. A reaction to the local anaesthetic used to numb your foot is rare and can happen to less than 1 patient in every 10,000¹

• nerve damage. This is usually temporary but can be permanent. Great care is taken to avoid damage to the nerves in your foot during the local anaesthetic and your operation

• more pain after surgery. The majority of patients who have foot surgery have less pain after their operation. However, you may have no improvement in your symptoms or more pain after surgery

• avascular necrosis. This is a very rare complication. It is where part of the bone in your foot loses its blood supply. Your bone may then become weaker, change shape and become damaged resulting in problems such as arthritis in the joint

• Chronic Regional Pain Syndrome. This is a very rare condition where pain develops in foot after your operation and does not settle down. If this happens you would need to see a pain specialist.

How long will it take to get my foot back to normal after my operation?

Between 4 to 6 weeks after your operation, your foot will begin to return to normal and you may be able to wear your shoes again. Trainers or flat, loose fitting lace up shoes are the type you should wear. Your foot will still be quite swollen, especially at the end of the day.

At 6 weeks you may return to driving if you can perform an emergency stop. You must check with your insurance company before driving again. Your healthcare professional will also advise you when you can drive again.

After 6 weeks you may return to work. This will depend on the type of operation you have had. If you have an active job you may need a longer time off to recover. Your healthcare professional will advise you when you can return to work.

You should avoid taking part in sport until you are advised by your healthcare professional.

6 months after your operation you will be given an appointment for a final review of your foot. You should now only have slight swelling in your foot and you should be getting the full benefit of your operation.

12 months after your operation your foot should be completely healed.

What other treatments are available?

Other treatments can include:

• changing your style of shoe
• wearing insoles inside your shoe to correct the position of your foot
• steroid injections into your big toe joint. These can help to reduce swelling and inflammation. You can have up to 3 steroid injections in a 12 month period
• no treatment. With time your big toe joint may fuse naturally, reducing the pain when you walk.

Contact numbers

If you need advice or have any problems. Please contact the Podiatric Surgery Team:

North Tees and Hartlepool NHS Foundation Trust

Podiatric Surgery Team

One Life Hartlepool

Park Road

Hartlepool

TS24 7PW

Central booking office :01429 522471

Opening hours: 8.30am to 4.30pm (Monday to Friday)

References

1. Kilmartin TE (2006). Critical Review: The Surgical Management of Hallux Valgus. British Journal of Podiatry, Vol 9, no.1, pages 4-24.
2. Daniels TR., Younger ASE., Penner MJ., Wing KJ., Miniaci-Coxhead SL., Pinsker E. and Glazebrook M. (2016) Midterm Outcomes of Polyvinyl Alcohol Hydrogel Hemiarthroplasty of the First Metatarsophalangeal Joint in Advanced Hallux Rigidus. Foot & Ankle International.
3. Baumhauer JF., Singh, D., Glazebrook M., Blundell C., De Vries G., Le ILD., Nielson D., Pederson E., Sakellariou A., Solan M., Wansbrough G., Younger ASE. and Daniels T. (2016) Prospective, Randomised, Multi-centered Clinical Trial Assessing Safety and Efficacy of a Synthetic Cartilage Implant Versus First Metatarsophalangeal Arthrodesis in Advanced Hallux Rigidus. Foot & Ankle International, Vol 37, no. 5, pages 457 – 469.

Comments, concerns, compliments or complaints

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