Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 16, 2021; 9(11): 2524-2532
Published online Apr 16, 2021. doi: 10.12998/wjcc.v9.i11.2524
Three-dimensional-printed custom-made patellar endoprosthesis for recurrent giant cell tumor of the patella: A case report and review of the literature
Jie Wang, Yong Zhou, Yi-Tian Wang, Li Min, Yu-Qi Zhang, Min-Xun Lu, Fan Tang, Yi Luo, Ya-Han Zhang, Xian-Liang Zhang, Chong-Qi Tu
Jie Wang, Yong Zhou, Yi-Tian Wang, Li Min, Yu-Qi Zhang, Min-Xun Lu, Fan Tang, Yi Luo, Chong-Qi Tu, Department of Orthopedics, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Ya-Han Zhang, Xian-Liang Zhang, Department of Pathology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Wang J, Zhou Y, Wang YT, and Tu CQ were involved in the concept and design of this manuscript; Wang J, Min L, Zhang YQ, and Tang F were involved in the acquisition of data; Luo Y, Wang J, Lu MX, Zhou Y, and Tu CQ were involved in the preoperative 3-dimensional design; Wang J, Min L, and Tu CQ were involved in the postsurgical evaluation of the patient; Zhang XL and Zhang YH were involved in pathology evaluation; all authors contributed toward data analysis and drafting and critically revising the paper, gave final approval of the version to be published, and agreed to be accountable for all aspects of the work.
Supported by National Key Research and Development Program of China, No. 2016YFC1102003; Science and Technology Research Program of Sichuan Province, No. 2020YFS0036; Chengdu Science and Technology Program Projects, No. 2017-CY02-00032-GX; National Natural Science Foundation of China, No. 81801852; and National Key Research and Development Program of China, No. 2017YFB0702604.
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 report no competing interest in this work.
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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chong-Qi Tu, MD, Chief Doctor, Professor, Surgeon, Surgical Oncologist, Teacher, Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu 610041, Sichuan Province, China. tuchongqibone@hotmail.com
Received: September 4, 2020
Peer-review started: September 4, 2020
First decision: December 21, 2020
Revised: January 4, 2021
Accepted: February 10, 2021
Article in press: February 10, 2021
Published online: April 16, 2021
Abstract
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.

Keywords: Giant cell tumor of bone, Patellectomy, Three-dimensional-printed, Endoprosthesis, Biological reconstruction, Extensor mechanism, Case report

Core Tip: The history of allogenic patellectomy has been a predominant option for recurrent giant cell tumor of the patella for decades. Although many reconstructive methods were reported following patellectomy, much needs to be researched for better knee function and fewer complications. Our study is a pioneering case using three-dimensional-printed custom-made patella, which could be able to minimize complications and improve knee function. What’s more, a review of the previous relevant research and the potential future avenues of research related to the novel introduction of reconstructive methods following patellectomy cases was performed.