**4.2 Cement filling**

The use of cement seems to be applicable in knee arthroplasty, either alone or in combination with screws, but only in cases of relatively small defects (Figure 3). Some authors (Lotke et al., 1991; Ritter et al., 1993) have observed good medium or long term results, while others (Brooks et al., 1984; Freeman et al., 1982; Insall & Ealsey, 2001) had obtained poor ones. Moreover these studies showed that weak biomechanical characters of cement do not improve in resistance of the implant with use of support screws.

So that we currently suggest cement only for peripheral small defects with defect extension of less than 50% of bone surface and less than 5mm of depth. In larger lesions, alone or in combination with support screws, it is not recommended.

Management of Bone Loss in Primary and Revision Knee Replacement Surgery 393

Recently, grafting constitutes a frequent option used for the treatment of bone defect in knee arthroplasty. The rationale in using bone grafts consisted in the possibility of a new formation of vital bone, through a process of osteoinduction and/or osteoconduction. Autoplastic bone grafts are likely to be used for limited defects, while structural allograft

Bone grafts, both homoplastic and autoplastic, are to be preferred in younger patients because they allow for bone regeneration that represents an essential condition in case of

In primary TKA, the resected femoral condyles or tibial plateau sometimes can be used as a source of autograft for tibial defects; morcelized bone obtained from the tibia and femoral

Its use have been advocated by various authors (Dorr et al., 1986; Scuderi et al., 1989), constituting a viable option due to excellent osteoinductive, osteoconductive and osteogenic

Fig. 4. An oblique planar cancellous surface is created on the recipient side, and coaptation of proximal tibia autograft surface is ensured to this recipient bed by screw or wire fixation.

Nevertheless Laskin in a series of 26 patients with severe tibial bone loss treated by TKA using autogenic bone graft into the defect, observed 4 cases of grafts fragmentation with

**4.3 Bone grafting** 

reintervention.

properties (Fig. 4).

could be necessary in cases of larger lesions.

resections can be used as autograft in contained defects.

**4.3.1 Autologous bone grafting** 

(courtesy of Dr. E.A. Martucci)

Fig. 2. Translating tibial component could be a viable option for very small defect; this technique should not be used in angular deformity due to abnormal concentration of load forces.

Fig. 3. Cement filling could be used with or without screws (modified from Brooks et al.,1984).
