Cartiva or fusion for Hallux Rigidus? A systematic review and meta-analysis

Area of Science:

• Orthopedic surgery
• Biomaterials science
• Clinical trial methodology

Background:

• First metatarsophalangeal (MTP) joint arthrodesis is the gold standard treatment for advanced hallux rigidus.
• Cartiva synthetic cartilage implantation (polyvinyl alcohol hydrogel hemiarthroplasty) offers motion preservation but its comparative effectiveness is uncertain.

Purpose of the Study:

• To compare Cartiva synthetic cartilage implantation with MTP joint arthrodesis for hallux rigidus.
• To evaluate outcomes including pain, function, range of motion, and reoperations.

Main Methods:

• Systematic literature search of multiple databases (MEDLINE, Embase, etc.) up to June 2025.
• Included adult studies comparing Cartiva hemiarthroplasty versus arthrodesis with ≥12-month follow-up.
• Random-effects meta-analysis of pooled data for standardized mean differences and risk ratios.

Main Results:

• Both procedures improved pain and function at 12-24 months, with low-certainty evidence for functional differences.
• Cartiva preserved approximately 6° dorsiflexion, while arthrodesis provided greater pain relief (SMD 0.44).
• No significant difference in overall reoperations (RR 0.90); a nonsignificant increase in true revisions for Cartiva (RR 1.79).

Conclusions:

• Cartiva may preserve motion and offer similar short-term function, but arthrodesis likely provides superior pain relief.
• Evidence regarding reoperations and complications is highly uncertain, with a potential increase in true revisions for Cartiva.
• Findings are based on limited, heterogeneous, short-term data and require cautious interpretation and confirmation in longer-term studies.