In Search of The Holy Grail

In Search of The Holy Grail


For as long as humans have inhabited the earth, they have suffered from osteoarthritis. 

What, exactly, is osteoarthritis? 

When two bones form a joint, Mother Nature intersperses cartilage. 

Cartilage is an absolutely fabulous substance that enables the bones to move with very little friction. 

Even better, the cartilage is constantly broken down, hauled away, and replaced with brand new cartilage.

Except, sometimes it isn’t. 

Inadequate cartilage, sometimes coupled with inflammation, leads to osteoarthritis.



There are several causes of osteoarthritis, but I am going to break them into two main categories:

1. Trauma: The word trauma can encompass many factors.  Being tackled or falls during sports is an obvious one.  Some are less obvious.  Increased weight places more force upon lower extremity joints. 

How much hand osteoarthritis is likely in a group of concert pianists versus a group of people who operate a jackhammer?  Sadly, as we age, the ratio of cartilage produced to cartilage destroyed alters. (Alas, not for the better.)

2. Genetics: This is a bit harder to identify because there aren’t ironclad tests to detect genetic factors that more readily lead to osteoarthritis. 

If one develops osteoarthritis of the knee, is it because of being overweight, because of a fall several years ago, or because of that person’s diet?  However, if both of your parents had osteoarthritis for no obvious reason, the odds of being arthritis free are less favorable.



Wouldn’t it be great if we could replace missing or damaged cartilage with our own brand new cartilage? 

We can’t…yet. 

It is not for lack of trying. 

Scientists have been researching this problem for decades. 

I do believe we are closer. 

Perhaps soon, although I can assure you we have been saying soon for many years.



One solution for badly damaged and painful joints has been artificial joints. 

Artificial joints are usually made of metal and/or a polymer (a very large repeating molecule). 

They have been around for a long time (1938 or even earlier, depending upon your definition). 

I have not been a big fan of artificial joints, at least not in the foot, because of the large repetitive forces. 

Two problems with artificial joints in the foot:

1. The artificial joint would often wear out.

2. The artificial joint would sometimes erode the surrounding bone.

Fortunately, scientists have continued to make improvements.



I had three patients in the office with one thing in common: 

I had replaced each of their great toe joints with an artificial joint due to very advanced and painful osteoarthritis. 

More importantly, they all were doing well.  I realized I had changed my attitude toward artificial joints, at least for the great toe joint. 

So, what was different?



Developed in the U.S. and tested in the U.K. and Canada for the past several years, an amazing thing occurred:  The patients lived.  Actually, they did quite well.  Thus, the product was approved by the FDA.

However, approval by the FDA does not always mean a medical device is perfect. 

Indeed, nothing is better than Mother Nature.  But Mother Nature is not always an option; remember, these are damaged and painful great toe joints.

Fortunately, this new implant has several desirable properties:

  • It held up very well after 5,000,000 cycles.
  • It is quite non reactive.
  • It provides a bit of shock absorption.
  • It is extremely slippery (very low friction).



Cartilage is amazing.  Nothing is better. 

No one should have a joint replacement if it is not needed. 

Fortunately, when dealing with advanced osteoarthritis of the great toe joint, we now have another option.




Click Here to watch a video simulation of the surgical procedure.


Dr. Goldstein is a podiatrist who is Board certified by the American College of Foot and Ankle Surgeons, the American Board of Podiatric Medicine, and a Fellow of the American Society of Podiatric Surgeons.  He is a member of the American Podiatric Medical Association and the American Society of Podiatric Sports Medicine.  He has run about 34 marathons; if his brain had not bounced up and down so much he could probably remember exactly how many.  Fortunately, he does not have osteoarthritis of his great toe joint.


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