High tibial osteotomy for acutely exacerbated knee osteoarthritis owing to medial meniscal extrusion in well-controlled rheumatoid arthritis: A case report

Abstract

Background

Rheumatoid arthritis (RA) has previously been considered a contraindication for high tibial osteotomy (HTO) because the difficulties in controlling RA make the realignment effects of HTO uncertain. However, as new biological agents for RA ensure optimal outcomes, HTO may be a surgical option for knee osteoarthritis (KOA) superimposed on RA.

Case presentation

A 66-year-old man with elderly-onset RA who achieved clinical remission using prednisolone/methotrexate/salazosulfapyridine developed recurrent bilateral medial knee pain with hydrarthrosis. The recurrence was diagnosed as KOA exacerbation because he had normal CRP and MMP-3 concentrations, clear synovial fluid, bilateral cartilage defects on the medial femoral condyles with medial meniscal extrusions, and severely varus-aligned knees. As conservative therapies were not effective, bilateral simultaneous closed wedge HTO was performed. The symptoms completely disappeared 3 months after HTO, and the remission has been maintained for 3 years.

Conclusions

HTO can obtain biomechanical remission for KOA exacerbation in patients with RA.