DETROIT – Orthopedic surgeon Dr. Matthew Brewster had long sought a better treatment option for his younger, still-active patients suffering from arthritic joint pain in their big toe.
The gold standard for moderate to severe big-toe arthritis — a fusion of the bones — could relieve their pain but permanently rob them of mobility in the toe, limiting their ability to partake in athletic activities such as jogging and wearing heels.
“I didn’t like fusing 55-year-old women’s toes that want to run and wear heels,” said Brewster, who practices at Associated Orthopedists of Detroit.
So when the U.S. Food and Drug Administration last July approved the first synthetic cartilage-like implant as a treatment for big-toe arthritis, he signed up. Brewster performed his first procedure with the Cartiva implant that month, helping a 62-year-old Clinton Township, Mich., woman regain the ability to wear shoes without pain and even go running. She became only the second U.S. patient to receive the implant, which has been available in Europe for more than a decade.
Brewster has since successfully treated 13 patients with the implant. All of them were relieved of their pain and kept about half of their pre-arthritis joint mobility, he said.
Although the implant material is only approved in the U.S. for the big toe, it has been successfully used to treat arthritic thumbs and knees in Canada and Europe and offers hope for the millions of arthritis sufferers who wish to remain active and avoid joint replacements that steal their mobility and require extensive surgeries once the devices wear out.
An estimated 2.7 million middle-aged people in the U.S. have big-toe arthritis.
Brewster’s patients’ health insurance agreed to cover the Cartiva implant and procedure costs, which are said to be slightly higher than a standard bone fusion.
“When he approached me with this, it sounded too good to be true — it’s not,” said Karen Schumann, 51 of Chesterfield Township, Mich., Brewster’s most recent patient.
In recent interview, Schumann said her left toe had been in increasing pain for nearly 10 years and that she could no longer bend it. Now more than three weeks after the operation, her pain level is “zero,” and she once again can go on long walks for exercise and go up and down stairs.
She hopes to have the same procedure done later this year on her right foot.
“You never realize how much you use the big toe until it hurts,” Schumann said.
Headquartered outside Atlanta, Cartiva developed its Synthetic Cartilage Implant through research that originated out of Georgia Tech. The device is made of polyvinyl alcohol hydrogel, the same material as contact lenses, but is much thicker and the result of a patented process that makes the material tough yet with a water content comparable to healthy cartilage. Each implant is expected to last many years, although the material is still too new to make precise estimates.
Cartilage is a smooth, connective tissue that has a limited ability to repair itself if damaged. Researchers have been trying for decades to find a way to replace it. Degenerative arthritis occurs when cartilage gets worn away and bones then rub against each other.