Foot & Ankle International - September 2020 - 1039

Chrea et al
use of the PVA implant with concurrent cheilectomy and
Moberg osteotomy is not consistent with the technique
described by the manufacturer.23 We also acknowledge that
our use of the CM technique prior to the introduction of the
PVA implant and subsequent shift to the PVACM technique
introduces a potential bias based on technical familiarity
with the CM procedure. The nature of this multisurgeon
study also introduces the potential for variations in surgical
technique, though the fact that 8 orthopedic surgeons are
represented may allow for more generalizable conclusions
to be drawn with regard to outcomes for hallux rigidus
patients undergoing PVACM or CM.
Since this review of our outcomes, a number of attending surgeons in our group no longer have any indications
for PVA implantation and utilize cheilectomy with Moberg
osteotomy alone when a patient is indicated to avoid
arthrodesis, otherwise electing to perform an arthrodesis if
the condition is advanced. These members of our group
have shifted away from utilizing the PVA implant in light
of patients whose postoperative imaging showed bone
marrow edema such that the implant appears unable to
transmit loads to the bone appropriately in some cases.
However, some surgeons are still using the implant in a
limited capacity when the disease is not as advanced and
the patient has maintained motion.

Conclusion
PVA hydrogel implantation in combination with cheilectomy and Moberg osteotomy presents a viable option in the
operative management of moderate to advanced hallux rigidus. However, our data demonstrate that patients in both the
CM and PVACM groups achieved improvements in pain
relief and physical function postoperatively, with greater
improvement for patients who did not undergo the addition
of the PVA implant. A longer follow-up is needed to evaluate long-term functional and clinical outcomes, including
survivorship of the implant and need for revision.
Declaration of Conflicting Interests
The author(s) declared the following potential conflicts of interest
with respect to the research, authorship, and/or publication of this
article: Scott J. Ellis, MD, reports other from Wright Medical, outside the submitted work.

Funding
The author(s) received no financial support for the research,
authorship, and/or publication of this article.

ORCID iDs
Stephanie K. Eble, BA,
https://orcid.org/0000-0002-6425-5112
Jonathan Day, MS,
https://orcid.org/0000-0003-1106-3042
Scott J. Ellis, MD,
https://orcid.org/0000-0002-4304-7445

1039
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https://www.orcid.org/0000-0002-6425-5112 https://www.orcid.org/0000-0003-1106-3042 https://www.orcid.org/0000-0002-4304-7445

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