Revision Surgery for Failed Polyvinyl Alcohol Hydrogel Implant in the First MTP Joint: A Case Report and Comprehensive Review
Background: Hallux rigidus is a degenerative condition of the first metatarsophalangeal (MTP) joint that can significantly impair function and quality of life. The introduction of polyvinyl alcohol (PVA) hydrogel implants, such as Cartiva, offered an alternative to arthrodesis by preserving joint mo...
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2025-04-01
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| Series: | Foot & Ankle Orthopaedics |
| Online Access: | https://doi.org/10.1177/24730114251330300 |
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| author | Thelma R. Jimenez Mosquea MD Christopher A. Colasanti MD Hugo A. Ubillus MD Raymond J. Walls MD, FRCS(Tr&Orth), MFSEM, FAAOS |
| author_facet | Thelma R. Jimenez Mosquea MD Christopher A. Colasanti MD Hugo A. Ubillus MD Raymond J. Walls MD, FRCS(Tr&Orth), MFSEM, FAAOS |
| author_sort | Thelma R. Jimenez Mosquea MD |
| collection | DOAJ |
| description | Background: Hallux rigidus is a degenerative condition of the first metatarsophalangeal (MTP) joint that can significantly impair function and quality of life. The introduction of polyvinyl alcohol (PVA) hydrogel implants, such as Cartiva, offered an alternative to arthrodesis by preserving joint motion. However, failures of these implants, often resulting in bone loss and joint instability, present a challenge for revision surgery. Methods: We report the case of a 43-year-old woman with persistent pain and functional limitations after a failed PVA hydrogel implant in the first MTP joint. The revision surgery involved a biologic resurfacing using the Osteochondral Autograft Transfer System (OATS) with a graft harvested from the ipsilateral femoral condyle, complemented by interpositional arthroplasty with a dermal graft and a proximal phalanx closing wedge osteotomy to correct residual hallux valgus. Results: At the 3-year follow-up, the patient-reported complete resolution of pain and returned to full activity with improved range of motion (40 degrees dorsiflexion, 15 degrees plantarflexion). Radiographic evaluation demonstrated graft incorporation and restoration of joint space, confirming the success of the procedure. Conclusion: This case highlights the potential of OATS combined with interpositional arthroplasty as a viable option for revision surgery in complex cases of failed synthetic cartilage implants in hallux rigidus. By addressing bone loss and preserving joint function, this approach provides a patient-specific alternative to traditional arthrodesis. Further studies are warranted to establish the long-term efficacy of this technique in similar cases. Level of Evidence: Level V, case report. |
| format | Article |
| id | doaj-art-c7f14ad836ec4bfe89b313ec4ac41d91 |
| institution | OA Journals |
| issn | 2473-0114 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Foot & Ankle Orthopaedics |
| spelling | doaj-art-c7f14ad836ec4bfe89b313ec4ac41d912025-08-20T02:31:34ZengSAGE PublishingFoot & Ankle Orthopaedics2473-01142025-04-011010.1177/24730114251330300Revision Surgery for Failed Polyvinyl Alcohol Hydrogel Implant in the First MTP Joint: A Case Report and Comprehensive ReviewThelma R. Jimenez Mosquea MD0Christopher A. Colasanti MD1Hugo A. Ubillus MD2Raymond J. Walls MD, FRCS(Tr&Orth), MFSEM, FAAOS3Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USADepartment of Orthopedic Surgery, NYU Langone Health, New York, NY, USADepartment of Orthopedic Surgery, NYU Langone Health, New York, NY, USADepartment of Orthopedic Surgery, NYU Langone Health, New York, NY, USABackground: Hallux rigidus is a degenerative condition of the first metatarsophalangeal (MTP) joint that can significantly impair function and quality of life. The introduction of polyvinyl alcohol (PVA) hydrogel implants, such as Cartiva, offered an alternative to arthrodesis by preserving joint motion. However, failures of these implants, often resulting in bone loss and joint instability, present a challenge for revision surgery. Methods: We report the case of a 43-year-old woman with persistent pain and functional limitations after a failed PVA hydrogel implant in the first MTP joint. The revision surgery involved a biologic resurfacing using the Osteochondral Autograft Transfer System (OATS) with a graft harvested from the ipsilateral femoral condyle, complemented by interpositional arthroplasty with a dermal graft and a proximal phalanx closing wedge osteotomy to correct residual hallux valgus. Results: At the 3-year follow-up, the patient-reported complete resolution of pain and returned to full activity with improved range of motion (40 degrees dorsiflexion, 15 degrees plantarflexion). Radiographic evaluation demonstrated graft incorporation and restoration of joint space, confirming the success of the procedure. Conclusion: This case highlights the potential of OATS combined with interpositional arthroplasty as a viable option for revision surgery in complex cases of failed synthetic cartilage implants in hallux rigidus. By addressing bone loss and preserving joint function, this approach provides a patient-specific alternative to traditional arthrodesis. Further studies are warranted to establish the long-term efficacy of this technique in similar cases. Level of Evidence: Level V, case report.https://doi.org/10.1177/24730114251330300 |
| spellingShingle | Thelma R. Jimenez Mosquea MD Christopher A. Colasanti MD Hugo A. Ubillus MD Raymond J. Walls MD, FRCS(Tr&Orth), MFSEM, FAAOS Revision Surgery for Failed Polyvinyl Alcohol Hydrogel Implant in the First MTP Joint: A Case Report and Comprehensive Review Foot & Ankle Orthopaedics |
| title | Revision Surgery for Failed Polyvinyl Alcohol Hydrogel Implant in the First MTP Joint: A Case Report and Comprehensive Review |
| title_full | Revision Surgery for Failed Polyvinyl Alcohol Hydrogel Implant in the First MTP Joint: A Case Report and Comprehensive Review |
| title_fullStr | Revision Surgery for Failed Polyvinyl Alcohol Hydrogel Implant in the First MTP Joint: A Case Report and Comprehensive Review |
| title_full_unstemmed | Revision Surgery for Failed Polyvinyl Alcohol Hydrogel Implant in the First MTP Joint: A Case Report and Comprehensive Review |
| title_short | Revision Surgery for Failed Polyvinyl Alcohol Hydrogel Implant in the First MTP Joint: A Case Report and Comprehensive Review |
| title_sort | revision surgery for failed polyvinyl alcohol hydrogel implant in the first mtp joint a case report and comprehensive review |
| url | https://doi.org/10.1177/24730114251330300 |
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