Cartiva or Fusion for Hallux Rigidus? A Systematic Review and Meta-analysis.

Abstract

First metatarsophalangeal arthrodesis is the standard for advanced hallux rigidus; the Cartiva synthetic cartilage implantation (polyvinyl alcohol hydrogel hemiarthroplasty) preserves motion, but its role is uncertain. We searched MEDLINE, Embase, Cochrane CENTRAL, Web of Science, and Scopus to 6 June 2025 for adult comparisons of synthetic cartilage hemiarthroplasty using a polyvinyl alcohol hydrogel implant (Cartiva®; Stryker, Kalamazoo, MI, USA) versus arthrodesis (≥12-month follow-up). Outcomes were pain, function, range of motion, satisfaction, complications, and reoperations. Random-effects meta-analysis pooled standardized mean differences and risk ratios. Six studies (one randomized, five cohorts; ∼600 patients: 348 synthetic cartilage implantation, 252 arthrodesis) met criteria. At 12-24 months, both procedures improved pain and function; functional differences were not consistent (low-certainty evidence). Cartiva preserved ∼6° dorsiflexion, whereas arthrodesis showed greater pain relief (SMD 0.44, 95% CI 0.25-0.64; I²=0%). For reoperations, counting all subsequent surgeries showed no difference (RR 0.90, 95% CI 0.45-1.78; I²=35%); restricting to true revisions suggested a nonsignificant increase with Cartiva (RR 1.79, 95% CI 0.69-4.65; I²=0%). Complications were otherwise similar. Cartiva may preserve motion with similar short-term function, whereas pain relief likely favors arthrodesis. Evidence for reoperations and complications is very uncertain; sensitivity analysis suggested a possible increase in true revisions after Cartiva. Given the small, heterogeneous, short-term evidence base, findings should be interpreted cautiously and confirmed in longer-term studies.