Three-dimensional-printed custom-made patellar endoprosthesis for recurrent giant cell tumor of the patella:A case report and review of the literature

BACKGROUND Giant cell tumor(GCT)is a benign lesion and rarely involves the patella.This disease is characterized by a relatively high recurrence rate after primary treatment.En bloc resection has been a predominant option for recurrent GCT.However,total patellectomy can lead to disruption of the knee.Therefore,exploration of functional reconstruction of the extensor mechanism is worthwhile.CASE SUMMARY A 54-year-old woman presented with right knee pain and swelling,and was diagnosed as having a GCT in the patella following curettage and autograft.Medical imaging revealed a lytic and expanded lesion involving the whole patella with focal cortical breaches and pathological fracture.Based on the combination of histological,radiological,and clinical features,a diagnosis of recurrent GCT in the patella was made(Campanacci grade III).After a multidisciplinary team discussion,three-dimensional(3D)-printed custom-made patellar endoprosthesis was performed following en bloc resection for reconstructing the extensor mechanism.The patient was followed for 35 mo postoperatively.No evidence of local recurrence,pulmonary metastasis,or osteoarthritis of the right knee was observed.The active flexion arc was 0°-120°,and no extension lag was detected.A favorable patellar tracking and height(Insall-Salvati ratio 0.93)were detected by radiography.CONCLUSION We depict a case of a GCT at the right patella,which was successfully treated by patellectomy and 3D-printed custom-made endoprosthetic replacement.The patella normal reconstruction,the precise-fit articular design,and gastrocnemius flap augmentation could lead to satisfactory knee function and a low rate of complications in the short-term follow-up.

Patellar reconstruction in primary total knee arthroplasty using bone chips from routine cuts:A case report and review of literature

BACKGROUND Total patellectomy is currently reserved for exceptional cases,such as recalcitrant patellofemoral instability and comminuted fractures,due to its demonstrated negative impact on knee biomechanics.Therefore,managing patellectomy is crucial to mitigate its inherent deleterious effects.Various techniques have been described,including autologous or allogeneic bone grafts for reconstruction and soft tissue realignment to enhance the extensor mechanism.CASE SUMMARY A 73-year-old male underwent a patellectomy due to a comminuted fracture,subsequently developing osteoarthritis and experiencing a decline in functional status.Concurrent with total knee replacement,we conducted a patellar reconstruction,incorporating routine bone cuts and utilizing bone chips to fashion a new patella.This intervention resulted in the restoration of full extension and improvement of knee function.CONCLUSION Patellar reconstruction demonstrates benefits on knee mechanics and stabilization,contributing to enhanced outcomes and satisfaction following knee replacement.We present an affordable technique for managing patellectomized patients undergoing total knee replacement.