Implant provides hope for the limping

Elizabeth Newman
Elizabeth Newman

In one of the sadder coincidences of my life, news of an FDA-approved cartilage implant made me more excited than it would have a year ago. That's because this particular synthetic cartilage implant is for those with osteoarthritis in their big toe, and I happened to be diagnosed this summer with arthritis in my toes.

Unbeknownst to me, osteoarthritis in one's big toe is the most common arthritis in the foot. That's according to Judy Baumhauer, M.D., MPH, professor at the University of Rochester and principal investigator on a new study evaluating those who had the Cartiva Synthetic Cartilage Implant (SCI). Their results found only 1 in 10 implants would fail for patients, and that was related to pain relief. Those patients could then receive fusion, which was traditionally the treatment at the get-go, she explained.

But “fusion locks up your toe so you can't move it,” she noted. “The implant preserves motion and movement in your toe.”

It turns out it's not unusual for people my age to have osteoarthritis, especially if they played soccer or performed ballet. I did both of those sports, not particularly well, but enough that it wouldn't surprise me if it wore down some cartilage.

For middle-aged providers in a similar boat, Baumhauer recommended an option of stiffer shoes. Indeed, I've noticed a difference in pain after buying shoes with a wider toe box and more stiffness. I look shorter, but I can walk farther, so it's a win. As for my 20-something friends, this woman in love with her Jimmy Choo wedding shoes is not going to tell you not to wear high heels, but you should stop wearing high heels. (Fun fact about those shoes, which I bought eight years ago: I literally cannot get them on my feet, which my orthopedist said is because women's feet change about every six months. Go ahead and add that to the list of things no one tells you about growing older.)

Moving back to long-term care residents, the implant may be right for active seniors. If a resident is in a wheelchair, or diabetic, it is not the right choice. But if pain is limiting a senior from staying active, and there aren't other aggravating factors such as blood flow problems, it could be a great suggestion. Toe fusion often means a cast or walking boot, which can cause greater balance issues for seniors.

“In this day and age, 60 is the new 80,” Baumhauer said. “People are up and moving and if their toe is the thing that is limiting them, this simple implant is a great solution.” Another plus is that it can be done under a block rather than general anesthesia.

For those who need the details, the implant is made of 40% polyvinyl alcohol (PVA) and saline (0.9%). The physical properties of high water content are similar to healthy cartilage, and makes it a good replacement for damaged cartilage. It doesn't degrade and is flexible. What's also interesting about the implant is that it's been used with around 4,000 patients in Europe, but there wasn't FDA approved in the United States until July 1.

I'm aware all of this makes me slightly sound as if I'm a crazed cheerleader for the Cartiva implant. (Cheerleaders also probably have damaged cartilage, come to think of it.) But I'm truly really excited about development of an option for seniors and those of us who are headed there. By the time my arthritis is bad enough for the implant, we may be ruled by robot overlords. But I'm confident they'll embrace our cool new technology for toes.

If you see Elizabeth Newman wearing high heels at a conference, give her a hard time about it. Follow her @TigerELN.



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Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Emily Mongan.

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