Case Report
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Methodol. Jun 20, 2024; 14(2): 89809
Published online Jun 20, 2024. doi: 10.5662/wjm.v14.i2.89809
Patellar reconstruction in primary total knee arthroplasty using bone chips from routine cuts: A case report and review of literature
Juan Ignacio Perez-Abdala, Franco L De Cicco, Tomas Nicolino, Juan Astoul
Juan Ignacio Perez-Abdala, Franco L De Cicco, Tomas Nicolino, Juan Astoul, Institute of Orthopaedics “Carlos E. Ottolenghi”, Italian Hospital of Buenos Aires, Capital Federal 1198, Argentina
Author contributions: Perez Abdala JI contributed to the conception and design of the study, acquisition of data, and drafting the article; De Cicco FL contributed to creating illustrations and critically analyzing the data; Astoul J and Nicolino T contributed to the conception and design of the study; all authors have read and approved the reviewed manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Juan Ignacio Perez-Abdala, MD, Surgeon, Orthopaedic Department, Italiano Hospital of Buenos Aires, Peron 4190, Capital Federal 1199, Argentina. ignacio.perez@hospitalitaliano.org.ar
Received: November 13, 2023
Peer-review started: November 13, 2023
First decision: January 25, 2024
Revised: January 31, 2024
Accepted: March 19, 2024
Article in press: March 19, 2024
Published online: June 20, 2024
Processing time: 213 Days and 16.9 Hours
Abstract
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.

Keywords: Patellectomy; Patella; Reconstruction; Knee arthroplasty; Autologous bone; Knee osteoarthritis; Case report

Core Tip: Patients who have undergone patellectomy tend to experience worse outcomes following total knee arthroplasty than those with an intact patella. We present a 73-year-old male who, after a left patellectomy due to a comminuted fracture, developed osteoarthritis leading to detriment knee function. We reconstructed the patella using bone chips from routine bone cuts during the total knee arthroplasty. Post-surgery, the patient reported improved knee function and satisfaction. The key takeaway is that patellar reconstruction enhances knee function mainly due to its mechanical advantages, leading to better outcomes. The technique performed is safe and feasible.