Hallux rigidus is a term to describe osteoarthritis of the great toejoint. This can occur due to wear-and-tear of the joint cartilage throughrepetitive stress and can also occur from trauma. Severe arthritis of thegreat toe joint can be treated with surgical options if conservativetreatment has failed. Traditionally the surgical options have includedjoint fusion (arthrodesis) which eliminates pain but patients will losemotion. Another viable option has been either a hemi or total jointreplacement which will improve motion but the lifespan of these joints havenot been clinically established. One of the newest implants that hasbecome available to surgeons is a polyvinyl synthetic implant known asCartiva (by Stryker/Wright Medical Group). It is made of a material similarto that found in contact lenses. The advantage of this implant has beenbased on the ease of application and relative fast return to walking andphysical activity.In the clinical setting, however, foot and ankle surgeons like myself havebegun to see a concerning trend in patients who have continued or worseningpain to the foot following surgical treatment with the Cartiva implant. Itappears the clinical indication for use of the Cartiva implant has beenquite broad from mild early osteoarthritis (stage 1 hallux rigidus) tosevere end-stage osteoarthritis (stage 3 hallux rigidus). Some of thesepatients have required revision type surgery to address the Cartiva implantfailure including implant removal. In my experience, I have had to convertpatients with the failed Cartiva implant into either a different hemi ortotal joint replacement as well as revision fusion (arthrodesis) using bonegraft. Orthopedic device companies have now even developed revisionsystems dedicated specifically to address this growing need for treatingCartiva implant failure.For my patients whom I have treated with a failed Cartiva implant and whowish to retain motion to the great toe joint my revision procedure ofchoice is a joint arthroplasty system offered by Arthrosurface. It isdesigned specifically to revise a failed Cartiva Implant and deal with thetechnical challenge of a large bone void left after removal of the Cartivaimplant of the first metatarsal head. The Arthrosurface joint implant alsoprovides the option of a hemi or total joint implant system in cases inwhich both sides of the great toe joint need to be replaced.Overall, revision surgery to address a failed Cartiva implant can bechallenging but so far in my clinical experience patients have been contentwith the outcomes provided by removing the Cartiva implant and treating thehallux rigidus with a dedicated revision joint implant.