Synthetic Cartilage for Painful Toe Arthritis Gives Patients a Leg Up
A husband and wife who enjoy tennis, hiking and traveling together also both suffered from a painful condition that put a crimp in their active lifestyle: arthritis in their big toe. But thanks to surgical procedure using a synthetic cartilage implant at Hospital for Special Surgery (HSS), they are now pain-free.
Made of the same material used in contact lenses, the implant, known as Cartiva, is designed to mimic the natural cartilage found in the joint.
Joy and Arthur Leinoff, both in their 60s, say the procedure has enabled them to enjoy playing tennis several days a week and resume other active pursuits pain-free. Before the surgery, they say the pain had become more frequent and more intense.
Their physician, Dr. Andrew Elliott, an orthopedic surgeon at Hospital for Special Surgery, says toe arthritis can be severely debilitating. "Technically known as hallux rigidus, it’s one of the most frequent arthritic problems we see as foot and ankle surgeons. It occurs when the cartilage in the joint starts to wear out, and it usually gets worse over time," explains Dr. Elliott, who specializes in foot and ankle conditions at HSS.
"I had really bad pain and swelling in my big toe, particularly when I played tennis or when I would walk for long periods of time," Joy recalls. "I was not able to wear high heels. Over the last few years, it got progressively worse. It was really awful."
For her husband, Arthur, it was even worse, Joy says. He had severe arthritis in his big toe on both feet. "He tried everything, from ibuprofen to all kinds of liniments, you name it. He was desperate, but he didn’t want to have the joint in his big toe fused because that would end his tennis career and a lot of other things we like to do," she explained.
Indeed, Arthur says he lived with the pain for years because prior to Cartiva, his best option was a fusion of the bones in his big toe. Although the surgery generally works well to relieve pain, it limits motion in the toe. People may have difficulty walking until they get used to the fusion, which can take up to a year.
"I suffered with arthritis for six or seven years," Arthur says. "It hurt to take a single step; it hurt to have a bed sheet lay on my toes. I changed the way I walked to compensate. I had just about reached my breaking point when I found out about Cartiva."
Last year, Joy had the synthetic cartilage implanted in the big toe on her left foot. Several months later, Arthur had the procedure on one toe, and this year had a second surgery on his other foot. Both Arthur and Joy say it has been life-changing.
Fortunately, they were good candidates for Cartiva. Dr. Elliott notes that patient selection is very important. Those who qualify are individuals with advanced arthritis who do not experience pain relief from conservative treatments such as anti-inflammatory medication. Patients must still have motion in their big toe, and the bones in their joint must be in adequate condition to support the implant.
"In carefully selected patients, I’ve seen the synthetic cartilage work well. Many have gotten back to activities they enjoy," he says. "Still, we caution patients not to engage in intense athletics or exercises that put extreme stress on their toe to ensure that the implant will last."
Joy and Arthur are hoping it lasts a long time. They are back to playing doubles tennis three to five times a week and are planning to a number of trips with walking tours. "This time I’ll be able to concentrate on what the tour guide is saying," Arthur says, "and not on every step I take that causes pain."