Cartiva - Has anyone had it?

can you look at the cartiva webpage. they may be able to steer you in the right direction. My doctor had only done 40 of them.  I went to one doctor who had only done 1 of them. I didnt pick that one to do my surgery. I wanted someone with alittle bit of experience at least.

Lana,

I submitted an inquiry from the "Patients" tab on and asked for a list of Michigan physicians trained in the procedure.  I researched education/training of those on the list Cartiva sent, then contacted quite a few to determine how many Cartiva implants that had actually been performed.  I eventually chose a physician in Metro Detroit area which was 2 1/2 hours away.  I will have to admit I have grown weary of traveling for the follow-ups, but I know that it was the best decision to choose someone who was Cartiva experienced.

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My friend had it done almost 3 mos ago on both feet at the same time. He is returning to play basketball at his 3 month post op date. He went to Europe at two months post op which requires lots and lots of walking and he was fine. I am walking three miles a day now outside and I am just five weeks post op. He told me he has much better movement in his left foot then his right so both toes don't necessarily heal at the same rate. 

I'm glad to hear he's had a good recovery? How old is he? What was his level of activity before the surgery?

I'm 48. I can still do a lot of activity, but for much shorter duration (do to the hallux rigidus) and i have to tape around the joint. Stationary bike and elliptical machine doesn't cause a problem, but still want to get outside and hike and run more.

He is 61. Jogger, basketball player with the guys. Had it bad in both big toes just like me. I never did inside machines pre op. I just suffered thru the pain outside jogging and walking, I am 62. 

Sometimes I suffer through the pain too, especially if I do push ups or hard running. I'm worried that if I push the activity too much, the hallux rigidus will progress to stage III or IV and then it will be too late for cartiva. I've got to wait until next June to get the surgery in Canada because I'm working in Asia and I don't know any doctor's here that have done this surgery.  I don't want to make it worse in the meantime.

Looks like I'm stuck with elliptical machine or stationary bike for exercise.  I can still walk okay when I apply enough tape, so I guess it could be worse.

 

Just had my five week check up. Foot very swollen,  he told me to buy sockwell compression peds, online and wear the toe pulling thingy when I sleep. He said it takes a full five months for all the swelling to go down. I don't need to take pain pills anymore, but there is some pain after I do my 2 mile walk outside. Due to shoe rubbing on surgical site while walking. Still not much movement in my toe but definitely less pain then pre op 

I take it from your recent post that the sockwell compression peds and the toe pulling thing must be helping?

How do you tape in order to do activities without pain or aggravating your MTP more? I am holding off on Cartiva surgery while appealing my insurance company and if I can tape my toe so that I can be more active, I would do that!

I couldnt find that brand of compression stocking. I bought a pair of compression peds on the for your legs website and it seems to be doing the trick. I dont wear the sleeve around my foot or the toe holding thingy, that seems useless to me.  I try to push my toe up 10x and hold for 5. Then down 10 x and hold for 5 quite often. Still quite stiff but not painful. 

my doctor told me this pain is part of the healing. I walk bare foot all over the house to keep using my toe a lot. Try a compression sock it has really helped me. I only use the ped size. Sleep with it too. So the swelling goes down while you sleep. 

Yesterday i was on my feet all day at work and went to a party all night with lots of standing and i hAve to say I didnt have much pain at all. I had to wear boxier shoes, no heels,but I didnt have pain. Five and a half weeks post op.

That's a nice report to hear Nancy! Am I correct that you just had the Cartiva, no cheilectomy? I have such a large bone spur from the big toe arthritis  that I have to get that shaved in order to regain ROM for my big toe and be able to walk normally again. My doc wants to do both at the same time and I really only want to have surgery once.   I am holding off for now, fighting my insurance over the Cartiva implant. They would cover the cheilectomy if that is only  what I would have do.

I don't have  a lot of bone on bone pain right now, but my doctor said if I just did the cheilectomy, I wouldn't be happy in the long run because my arthritis is so bad that I would be back. I also want my surgery to be successful. He suggest either cheilectomy with Cartiva or cheilectomy with fusion.  I am definitely not interested in the fusion option. 

Jan,

I can tell you as I already had cheilectomy and big toe shortened, if you have severe arthritis and just do the cheilectomy, you are going to end up with return of spurs and progression of arthritic pain. I don't know how soon, but it will happen. I would do the cheilectomy with cartiva if you are in hopes of maintaining some motion in the big toe. Ceilectomy with fusion is more of the gold standard for making you pain free, some people would rather have that.

Thanks for the info. It is helpful.

I just had my surgery last Monday 8/21.  I had cartiva, chielectomy and my big toe bone shortened (osteotomy). I can't tell from this blog how many people have had all three and what the success rate of the cartiva is when combined.  I'll keep you posted. I am in total elevation mode for two weeks. My surgeon believes osteotomy helps lessen the pain afterwards.  I believe he is routinely doing this now.  

Only cartiva no bone cleaning or shortening. My guy said he needed all bone intact for implant to take. My friend did both feet at the same time he was running and playing basketball at four months. I started cutting the lawn again at four weeks. 

I'll be watching your recovery closely as 8/21 was when I was suppose to have my surgery  (Cartiva and cheilectomy)  It's since been rescheduled to November to give me time to appeal my insurance companies denial. I wish you a full and speedy recovery!!

May I ask, did insurance cover your surgery and if so, what insurance company?  I am trying to gather up what plans cover the procedure and what ones don't.

Hi Jan

I have unicare insurance and it's covered except for copay and deductible.  Deemed medically necessary.  So they way it is written is bunionectomy w/cartiva implant and osteotomy metatarsal.  The recovery is definitely more involved than just having the implant.  However, I can't imagine not having the bone spur removed as mine was quite large and prevented shoes from fitting. Also painful.  As for the osteotomy, I don't see a lot of people taking about that piece here or elsewhere.  I had some pins put in to realign my big toe apparently. I am staying completely off the foot except for bathroom breaks.  Which isn't hard bc the minute I put it down it throbs. I took oxycodone for the first 4 days then switched to hydrocodone.  Hoping to ween off that soon.  I have a splint like cast.  

Good luck with your case.  Ask a lot of questions.  I'll keep you posted. 

interesting.... I looked up Unicare's Medical policy on cartiva trying to get argument for my case and here is what I found. You are fortunate to have it covered without going through an appeal. I will let folks here know how my appeal goes:Medical Policy

Subject:   Synthetic Cartilage Implant for Metatarsophalangeal Joint Disorders

Policy #:   SURG.00147 Current Effective Date:   06/28/2017

Status: Reviewed Last Review Date:   05/04/2017

Description/Scope

This document addresses the use of a metatarsophalangeal synthetic cartilage implant. These implants may be used as a treatment for hallux limitus or hallux rigidus in the first metatarsophalangeal joint with or without the presence of mild hallux valgus, or for other metatarsophalangeal joint disorders.

Position Statement

Investigational and Not Medically Necessary:

Use of a metatarsophalangeal synthetic cartilage implant (consisting of biocompatible, molded cylindrical hydrogel) is considered investigational and not medically necessary as a treatment for metatarsophalangeal joint disorders including but not limited to hallux limitus or hallux rigidus.

 

here  is my cpt code  28291

Hi, I’m set to have the same done except to straighten big toe also,bone spur is so big has antlers,my concern is as a letter carrier if I can return. Glad for the input as I feel will be a process but hopefully better then now.

george,

I am not far enough out yet to comment, but from everything I have read and people that I have talked to if your job is physically demanding, you will need to be off for at least 6 weeks. I don't think you can be carrying mail or driving the car for that time period but everyone is different. Maybe you could be moved to desk duty for a while until you recuperate.

Abbe had bone spur removed, cartiva and two pins to straighten her bone. She was wearing a boot for seven weeks and not having an easy time at recovery. She still is not driving and still using crutches. She is 7 weeks.  I was able to drive starting week 3 and walk in regular shoe but I only had the implant done. 

Nancy, 

I think for those that had more than implant, it will definitely be a longer recovery.  At what point post op did you attempt to start moving the toe? You may have already mentioned this. I have a call into my doctor asking that question. I am just day 6, have been elevated other than shower, bathroom, tried to ice as much as I can. I am concerned about scar tissue forming as I know it can happen quickly. I don't see dr for 2 weeks, and am to leave dressing alone until I see him.  Not in any pain so thats good. I know its a long recovery, just don't want to do anything to mess it up.

 

KAREN you might want to join the Facebook group.  I elevated and did nothing with bandage on and heel bearing shoe for two weeks, icing too. On the first day of week 3 he took the compression bandage off, gave me a flat surgical Sandel and told me to start pressing the toe back and forward, I even drove my car after that but it hurt to press the pedals. Little by little it got better. It still is not 100% pain free at 3 mos post op but it is definitely better than it felt pre op. 

thanks Nancy. My doctors office just called and said ice and elevation until they see me at 2 week follow up. They told me getting around in the post op sandal for bathroom, and shower fine, but stay off of it as much as possible as it will swell and delay healing. They said toe bruising normal. You sound like you have done so well. I just want my surgery to be successful. After having failed chielectomy in 2015, was really hard to face a second foot surgery but staying optimistic. I know it will take time, persistence and a lot of patience.  Are you talking about cartiva fb group?

Yes it is cartiva FB group. it's a closed group but they will let you in. I only had the implant, my doctor said not to do chielectomy years ago as most of those are unsuccessful. So I just managed for 10 years with cortisone injections, I still have the bone spur and the arthritic bone but I am doing ok, I didn't baby myself when that compression bandage came off, I walked a mile the first day, And did that for a few days. Then moved up to two miles. I didn't sit on the couch after two weeks were over. I moved thru the pain. It hurt to exercise the toe but I forced myself to do it. Now I can jog, walk everything. I had to wear wide width shoes at the beginning too. Sketchers go walks in wide width size, it hurts when anything rubs on the scar area. Now I am wearing scar away bandages so the shoe doesn't bother the scar anymore.

Who was your physician 

Yes u might check the Facebook Group.  Everyone on there told their doctors names for references. I live in Chicago so my doc is here,