Two Cases of High Tibial Osteotomy in Patients with Rheumatoid Arthritis Treated with Biologic Disease-modifying Anti-rheumatic Drugs

High tibial osteotomy (HTO) procedure is generally contraindicated in rheumatoid arthritis (RA) patients because synovial inflammation may exacerbate joint damage post-surgery. The natural course of joint destruction in RA changed dramatically with new treatment strategies and the introduction of biologic disease-modifying anti-rheumatic drugs (bDMARDs). We report the cases of two RA patients who underwent HTO and whose disease activities were well controlled by bDMARDs. Despite their short follow-up periods, they showed acceptable objective and subjective clinical results. We believe that the combination of bDMARDs and HTO can be indicated for selected RA patients before total knee arthroplasty

Time to Bone Union after Hybrid Closed-Wedge High Tibial Osteotomy

Medial open- and lateral closed-wedge high tibial osteotomy (hybrid CWHTO) can overcome the limitations of conventional CWHTO and open-wedge HTO (OWHTO) for medial compartmental osteoarthritis (OA) of the knee. Hybrid CWHTO increases stability by using a rigid locking plate and allows early full weight-bearing. However, the literature contains no information about time to bone union after this new procedure. The aim of this study is to evaluate the time to bone union after hybrid CWHTO. We reviewed 44 knees treated with hybrid CWHTO. Patients were able to stand on both legs on the day after surgery and walked with full weight-bearing within 4 weeks of the procedure. The time to achievement of bone union at the osteotomy site was defined as the number of months until bone union was confirmed on radiographic imaging. The mean time to radiographic confirmation of bone union was 4.5±1.5 months after surgery. Eleven knees (25.0%) required 6 months or more. Radiographic analysis and JOA score improved significantly between before and 1 year after surgery (p<0.01). Hybrid CWHTO is a very useful method for treating medial OA, but radiographic bone union requires 4.5 months on average. We must be aware of bone union after hybrid CWHTO