The big toe on Pattie Bostick-Winn's right foot was excruciatingly painful, likely the result of her 10 years as a professional dancer in Broadway-style shows. Often, she had to wear heels on the stage, and by age 48, the cartilage had worn away between the bones connecting her big toe to the ball of her foot.
One option was to have a surgeon fuse the bones together with metal plates, but she worried that would limit her flexibility when she taught at her family's dance studio. Instead, she opted to have a new type of implant inserted between the bones, cushioning the aching joint.
The size and shape of a miniature marshmallow, the implant is made from saline solution and polyvinyl alcohol _ the same material as in soft contact lenses. The material compresses slightly under pressure, much like real cartilage.
The type of cartilage on the ends of bones enables them to move with low friction, but when the smooth, whitish tissue wears away, the result is arthritis. For years, biomedical engineers have been exploring ways to regenerate that lost cartilage, with limited success, so device makers began to pursue synthetic alternatives. The one Bostick-Winn was considering, called Cartiva, is the first of its kind, approved in the United States in 2016 and used in Europe for years before that. So far, the material has held up well in the big toes of thousands of patients, and now is being tested in the thumb and knee. Other synthetic implants are on the horizon, including one in development by Kevin Mansmann, of Premier Orthopaedics in Paoli, Pa.
Bostick-Winn sought multiple opinions before deciding to move forward with the Cartiva implant, getting a thumbs-up from three out of four physicians she consulted.
On Dec. 3, she walked into an operating room at Pennsylvania Hospital, and a team led by orthopedic surgeon Keith Wapner went to work.
