Primary total knee arthroplasty in a patient with a chronic total patellectomy using femoral condyle autograft for patellar reconstruction and resurfacing: New technique: A case report.

Abstract

Introduction: Undertaking a primary total knee arthroplasty for chronic complete patellectomy knees is an infrequent and complex scenario. The technical demands are high, often leading to suboptimal outcomes. However, our innovative approach, which involves a patellar autograft from an intraoperatively cut femoral condyle placed into the extensor mechanism following cement resurfacing, has shown promising results.

Case presentation: A 74-year-old man had been living with the consequences of a road accident that occurred 40 years ago. This incident led to an open knee injury in his right knee and a thorough patellectomy. He arrived at Ratchaburi Hospital in 2017 with pain in both knees and had been using crutches for 40 years.

Management and outcomes: His left knee had primary total knee arthroplasty in December 2017, and his right knee was scheduled for 2019; but, because of the COVID-19 pandemic, his procedure was postponed and performed as of February 2022. Our patient's knee function significantly improved after using an unconstrained posterior stabilized prosthesis on both knees and the right knee using the patient's patellar autograft from an intraoperatively cut femoral condyle. At 12 weeks postoperatively, the Oxford Knee Society Scores increased from 12 to 45, while the Feller Patellar Scores increased from 8 to 26.

Conclusion: These successful outcomes at 12 weeks postoperatively and even more so after two years demonstrate the significant potential of this new technique, instilling hope for improved outcomes in similar cases.