title: Midterm Outcomes of Polyvinyl Alcohol Hydrogel Hemiarthroplasty of the First Metatarsophalangeal Joint in Advanced Hallux Rigidus.
abstract: BACKGROUND
  Hallux rigidus is the most common arthritic condition of the foot. A randomized clinical trial of first metatarsophalangeal (MTP) joint hemiarthroplasty with a polyvinyl alcohol (PVA) hydrogel implant (Cartiva) demonstrated pain relief and functional outcomes equivalent to first MTP arthrodesis at 2 years postoperation, with no cases of implant fragmentation, wear, or bone loss. We prospectively determined 5-year outcomes of first MTP hemiarthroplasty with the PVA hydrogel implant.
  
  
  METHODS
  Patients who underwent first PVA hydrogel MTP hemiarthroplasty in the previously reported trial were evaluated at 5 years postoperatively. Patients underwent physical examination and radiographic evaluation and completed a pain VAS, the Short-Form-36 (SF-36), and the Foot and Ankle Ability Measure (FAAM) sports subscale and activities of daily living (ADL) subscale. At the time of this study, 29 patients had reached 5 years' follow-up. Two were lost to follow-up, leaving 27 patients with mean age 56.1 (range, 40.1-71.9) years. Mean follow-up was 5.4 (range, 4.9-6.4) years.
  
  
  RESULTS
  Postoperative active MTP natural joint dorsiflexion and peak MTP dorsiflexion were mean 18.2 (range, 10.0-30.0) and 29.7 (range, 10.0-45.0) degrees, respectively. Pain VAS, SF-36 PCS, FAAM ADL, and FAAM Sports scores demonstrated clinically and statistically significant improvements. Radiographically, no patient demonstrated changes in implant position, implant loosening or subsidence, or implant wear. One implant was removed because of persistent pain and converted to fusion 2 years postoperation.
  
  
  CONCLUSIONS
  Five years following first MTP hemiarthroplasty with a PVA hydrogel implant, functional outcomes improved significantly, pain was reduced significantly, and the implant demonstrated excellent survivorship.
  
  
  METHODS
  Level IV, prospective case series.
authors.affiliation: 1 Division of Orthopaedic Surgery, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada.
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Daniels
authors.affiliation: 2 Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada.|3 British Columbia Foot and Ankle Clinic, St. Paul's Hospital, Vancouver, British Columbia, Canada.
authors.forename: Alastair S E
authors.initials: AS
authors.lastname: Younger
authors.affiliation: 2 Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Murray J
authors.initials: MJ
authors.lastname: Penner
authors.affiliation: 2 Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Wing
authors.affiliation: 4 Cleveland Clinic Foundation, Orthopaedic and Rheumatologic Institute, Cleveland, Ohio, USA.
authors.forename: Sara Lyn
authors.initials: SL
authors.lastname: Miniaci-Coxhead
authors.affiliation: 1 Division of Orthopaedic Surgery, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada.
authors.forename: Ellie
authors.initials: E
authors.lastname: Pinsker
authors.affiliation: 5 Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada.|6 Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Glazebrook
mesh_terms: D019643:Arthroplasty, Replacement / Q000379:methods*; D020859:Hallux Rigidus / Q000601:surgery*; D062785:Hemiarthroplasty / Q000379:methods*; D006801:Humans; D008683:Metatarsophalangeal Joint / Q000601:surgery*; D017063:Outcome Assessment, Health Care; D010147:Pain Measurement; D017060:Patient Satisfaction; D011142:Polyvinyl Alcohol / Q000737:chemistry*; D011446:Prospective Studies; D016059:Range of Motion, Articular
chemical_list: C062364:polyvinyl alcohol hydrogel; D011142:Polyvinyl Alcohol
keywords: first metatarsophalangeal; hemiarthroplasty; implant; midterm outcomes; polyvinyl hydrogel; survivorship