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Total Ankle Replacement

Cartiva: an Evidence Based Synthetic Cartilage Implant for Great Toe Arthritis

Summary: Cartiva is a new synthetic cartilage implant for Great Toe arthritis. It is supported by Level 1 evidence, randomized control trial. A patient of mine who was one of the first to undergo the procedure in Australia was recently featured an channel 7 news. This can be viewed on

Introduction: Arthritis of the big toe is very common in our community, across all ages and activity levels.  Patients have pain and decreasing activity levels. The pathology in arthritis is a loss of normal cartilage. Cartiva is a new surgical implant that has very similar physical properties to normal cartilage

Treatment Options: The most reliable procedure for arthritis has always been a fusion. Fusion of the joint is considered the ‘Gold Standard’ operation. While a Fusion is a good operation it is not perfect.  Fusion provides reliable pain relief but stops all movement of the joint. This effects a number of activities including wearing heeled shoes and sports. It also has a significant recovery time.

Replacement of the joint in the past has been problematic. The implants have failed early and also compromised the bone

New Evidence Based Treatment: Cartiva is a Synthetic Cartilage Implant.  It has physical properties that are very similar to normal cartilage. The evidence for the use of Cartiva is level 1. There was a prospective randomized control  trial carried out in 2 countries, across 12 different hospitals involving 200  patients (Baumhauer et al 2015). Cartiva showed equivalent pain relief to a fusion with a similar complication rate.  Patients had a significantly increased range of motion of the joint. Cartiva allowed immediate full weight bearing and a much faster recovery. So far survivorship of the implant is excellent out to 5 years. When the implant does fail, it is reliably converted to a fusion at that time.

Ankle replacement

Ankle degenerative joint disease, traditionally called arthritis, is a debilitating condition. The current gold standard is an ankle fusion. However this is not a perfect solution. Interest in ankle replacement has been increasing in Europe and North America to try and improve outcomes for these patients. The results have continually improved so that now total ankle replacement is a accepted alternative to ankle fusion.


In 2014 The American Orthopedic Foot & Ankle Society published a position statement on total ankle replacement.

“in an appropriately indicated patient, high level evidence indicates that total ankle replacement safely relieves pain and may provide superior functional results when compared to ankle fusion”


Ankle degenerative joint


2 examples of ankle fusion


Ankle replacement