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. 2025 Mar 29;10(1):24730114251324184.
doi: 10.1177/24730114251324184. eCollection 2025 Jan.

Treatment of Hallux Rigidus: Comparison of Hemiarthroplasty with Cartiva Implant, Allograft Interpositional Arthroplasty, and Arthrodesis

Ryan Sanii  1 , Kevin Phan  2 , Drew Krumm  3 , Daniel J Patton  2 , Tyler Madden  3 , John G Anderson  2 , John D Maskill  2 , Donald R Bohay  2 , Michelle A Padley  2 , Cameron G Patthanacharoenphon  4
Affiliations

Treatment of Hallux Rigidus: Comparison of Hemiarthroplasty with Cartiva Implant, Allograft Interpositional Arthroplasty, and Arthrodesis

Ryan Sanii et al. Foot Ankle Orthop. .

Abstract

Background: A modern technique for the treatment of hallux rigidus (HR) is first metatarsophalangeal (MTP) hemiarthroplasty with the use of a Cartiva synthetic cartilage implant. Current scientific literature reporting early outcomes of the procedure is sparse and mixed, indicating the need for further analysis. The objective of this study was to compare improvement in visual analog scale (VAS) scores with first MTP hemiarthroplasty with Cartiva implant (HI), allograft interposition arthroplasty (IA), and arthrodesis (A) in patients who failed conservative management or cheilectomy.

Methods: A retrospective cohort study of 99 patients was performed. There were 49 patients in the HI group, 25 patients in the IA group, and 25 patients in the A group. A follow-up survey was administered from which updated VAS and updated American Orthopaedic Foot & Ankle Society scores were obtained.

Results: Mean VAS scores improved by 2.73 (SD ± 2.80) points in the HI group, 4.16 (SD ± 2.01) points in the IA group, and 4.36 (SD ± 3.67) points in the A group (P = .035). Mean AOFAS scores improved by 14.90 (SD ± 17.31) points in the HI group, 27.80 (SD ± 15.22) points in the IA group, and 27.88 (SD ± 25.34) points in the A group (P = .005). There were 3 (6.1%) revision surgeries in the HI group, 2 (8.0%) revision surgeries in the A group, and no revision surgeries in the IA group (P = .59). Within the HI group, all 3 revisions were due to pain associated with the implant and were revised to MTP arthrodesis. The A group had 1 revision due to broken hardware and 1 revision due to infection. In both cases, the patients were treated with hardware removal.

Conclusion: Pain and function may be slightly more improved with interpositional arthroplasty and arthrodesis for the treatment of HR, when compared to hemiarthroplasty with the Cartiva implant.

Level of evidence: Level III, therapeutic studies; case-control study.

Keywords: arthrodesis; arthroplasty; hallux rigidus; implant.

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Conflict of interest statement

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Daniel J. Patton, MD, reports general disclosures from Arthrex—fee paid for direct education hours—not related to a product named in the article nor in competition to a product named in this article. John G. Anderson, MD, John D. Maskill, MD, and Donald R. Bohay, MD, FACS, report disclosures relevant to manuscript from grant to help patients and physicians choose the appropriate surgery for end-stage hallux rigidus (award no. R01AR078487). Disclosure forms for all authors are available online.

Figures

Visual Abstract
Visual Abstract
This is a visual representation of the abstract.
Figure 1.
Figure 1.
Symptom duration for each treatment group. HI, hemiarthroplasty with implant group; IA, interpositional arthroplasty group; A, arthrodesis group.
See this image and copyright information in PMC

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